title: Accurate prediction of fulminant hepatic failure in severe acute viral hepatitis: multicenter study.
abstract: BACKGROUND
  We have attempted to predict the development of fulminant hepatic failure at the stage of severe acute hepatitis before the onset of coma. This prediction is valuable because it may be used to block the development of fulminant hepatic failure with appropriate medical treatment.
  
  
  METHODS
  To establish a discrimination formula, we retrospectively compared 13 clinical and laboratory variables in 36 patients with acute viral hepatitis and prothrombin levels of 40% or less of the control value who later developed fulminant hepatic failure with these variables in 12 patients who recovered spontaneously. A prospective study of 58 patients who developed fulminant hepatic failure and 18 who spontaneously recovered confirmed the validity of this formula.
  
  
  RESULTS
  In the retrospective study,we established the following discrimination equation: Z = -0.89 + 1.74 x (causal viruses, 1 point for type A or type B in acute hepatitis B virus [HBV] infection, 2 points for others) + 0.056 x (total bilirubin, mg/dl)-0.014 x (cholinesterase, U/ml). A positive Z value indicates that fulminant hepatic failure will develop. In the prospective study, the specificity, sensitivity, predictive accuracy, and positive and negative predictive values were 0.833, 0.983, 0.947, 0.950, and 0.938, respectively.
  
  
  CONCLUSIONS
  The present study indicated that fulminant hepatic failure can be predicted, by a simple discrimination equation, at the stage of severe acute hepatitis.
authors.affiliation: Division of Gastroenterology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshiba
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sekiyama
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Inoue
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamada
authors.forename: Makoto
authors.initials: M
authors.lastname: Kako
authors.forename: Kozo
authors.initials: K
authors.lastname: Nagai
authors.forename: Masao
authors.initials: M
authors.lastname: Takatori
authors.forename: Shogo
authors.initials: S
authors.lastname: Iwabuchi
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Sumino
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yukiya
authors.initials: Y
authors.lastname: Hakozaki
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D006525:Hepatitis, Viral, Human / Q000097:blood / Q000150:complications*; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011517:Prothrombin Time; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index