Accurate prediction of fulminant hepatic failure in severe acute viral hepatitis: multicenter study.
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.
Yoshiba
Makoto
M
Division of Gastroenterology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan.
Sekiyama
Kazuhiko
K
Inoue
Kazuaki
K
Yamada
Masaya
M
Kako
Makoto
M
Nagai
Kozo
K
Takatori
Masao
M
Iwabuchi
Shogo
S
Sumino
Yasukiyo
Y
Tanaka
Katsuaki
K
Hakozaki
Yukiya
Y
Hasegawa
Kiyoshi
K
Shibuya
Akitaka
A
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