Clinical characteristics and prognostic indicators of drug-induced fulminant hepatic failure.
OBJECTIVE
In most cases of drug-induced liver injury, it is difficult to diagnose whether these cases would progress to fulminant hepatic failure. We investigated the characteristics of non-viral and suspiciously drug-induced fulminant hepatic failure by comparing clinical data between cases that progressed and those that did not progress to fulminant hepatic failure.


METHODS
Ninety-five cases of suspicious drug-induced liver injury including 22 cases that had been treated at our hospital, and subsequently progressed to fulminant hepatic failure were involved in this study. We investigated the characteristics of drug-induced fulminant hepatic failure by a comparison of non-fulminant and fulminant cases, and simultaneously of survivors and fatal cases in the group of fulminant cases.


RESULTS
Many of the clinical variables were significantly deteriorated in fulminant cases. The latent period, which means the duration of drug administration, correlated with the severity of drug-induced liver injury including fulminant hepatic failure. Suspicious cases of drug-induced liver injury where the bilirubin level at the time of definite diagnosis stayed over 13 mg/dL for more than one month were likely to progress to fulminant hepatic failure.


CONCLUSIONS
Our results suggest that the latent period and the peak level of total bilirubin would be prognostic factors for the severity of drug-induced fulminant hepatic failure. Early preparation of liver transplantation should be recommended by referring these characteristics.
First Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Shigeru
S
Ohmori
Katsuya
K
Shiraki
Hidekazu
H
Inoue
Hiroshi
H
Okano
Takenari
T
Yamanaka
Masatoshi
M
Deguchi
Takahisa
T
Sakai
Koujiro
K
Takase
Takeshi
T
Nakano
Yukihiko
Y
Tameda
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000032:analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000139:chemically induced / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D001663:Bilirubin