Decreasing serum alpha-fetoprotein levels in predicting poor prognosis of acute hepatic failure in patients with chronic hepatitis B.
BACKGROUND
We carried out a study to predict the prognosis of acute hepatic failure in patients with chronic hepatitis B.


METHODS
We studied 25 consecutive patients with severe acute hepatitis. Severe acute hepatitis was defined as the development of acute hepatitis with a total serum bilirubin level of more than 15 mg/dl, prolonged prothrombin time (PT) of more than 5 s, and hepatic encephalopathy (HE). All patients were assessed for King's criteria. Positivity for King's criteria was defined as PT more than 100 s, or any three of the following: (age < 10 years or >40 years; cryptogenic or drug-induced hepatitis; jaundice for more than 7 days before the onset of HE; PT > 50 s; and serum bilirubin > 17.5 mg/dl). All but 1 patient had serial serum alpha-fetoprotein (AFP) levels measured every 1-2 weeks.


RESULTS
Eleven of 17 patients who died during the study met the King's criteria, whereas none of the surviving patients met the criteria. The sensitivity was 64.7% and the specificity, 100% for King's criteria in predicting a poor prognosis. In 16 of the 17 deceased patients, the AFP levels were reduced while their jaundice increased (sensitivity, 94.1%; specificity, 87.5%). All 17 deceased patients met the King's criteria and/or had reduced AFP levels while their jaundice increased (sensitivity, 100%; specificity, 87.5%).


CONCLUSIONS
Our observations suggest that the combined use of follow-up AFP levels and King's criteria is helpful in predicting the poor prognosis of severe acute hepatitis superimposed on chronic hepatitis B.
Liver Unit, Cathay General Hospital, Taipei, Taiwan.
Sien-Sing
SS
Yang
Ken-Sheng
KS
Cheng
Yung-Chih
YC
Lai
Chi-Hwa
CH
Wu
Tzen-Kwan
TK
Chen
Chia-Long
CL
Lee
Ding-Shinn
DS
Chen
D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood; D006513:Hepatitis B e Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality*; D006801:Humans; D017093:Liver Failure / Q000097:blood* / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D000509:alpha-Fetoproteins / Q000032:analysis*
D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins; D001663:Bilirubin