Factors affecting the mortality of pediatric fulminant hepatic failure in relation to hepatitis B virus infection.
OBJECTIVE
To investigate the factors affecting the outcome of fulminant hepatic failure (FHF) in children in relation to hepatitis B virus (HBV) infection.


METHODS
Retrospective review of a total of 94 cases (61 males and 33 females, aged from 1 month to 15 years) recruited from nine tertiary referral centers in Taiwan from 1985 to 1999.


RESULTS
The overall mortality rate was 75%. Patients in the mortality group were of an older age, had higher peak total bilirubin levels, a longer prothrombin time, and a lower percentage of HBV positivity (P < 0.001, P = 0.003, P = 0.0027 and P = 0.042, respectively). Mortality was 65% in the HBV positive (n = 42) and 83% in the HBV negative (n = 52) group (P = 0.05). In the HBV positive group, the prothrombin time was noted to be the single factor affecting outcome (P = 0.036). In the HBV negative group, older age and higher peak value of total serum bilirubin were suggestive of poor survival rate (P < 0.001 and P = 0.006, respectively). Multivariate analysis revealed that total bilirubin was the single factor affecting outcome in the HBV-negative group. The mortality rate of HBV positive children in three consecutive time periods without liver transplantation (1985-1989, 1990-1994, 1995-1999) decreased gradually (91, 67 and 38%, respectively, with P = 0.027). This change was not observed in HBV-negative cases.


CONCLUSIONS
Hepatitis B virus positive FHF had a lower mortality rate than HBV negative FHF, with each group having different factors affecting mortality.
Chan
Pei-Chun
PC
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Chen
Huey-Ling
HL
Kong
Man-Shan
MS
Huang
Fu-Chen
FC
Lee
Hung-Chang
HC
Lin
Chieh-Chung
CC
Liu
Ching-Chuan
CC
Lee
I-Hsien
IH
Wu
Tzee-Chung
TC
Wu
Shu-Fen
SF
Ni
Yen-Hsuan
YH
Hsu
Hong-Yuan
HY
Chang
Mei-Hwei
MH
D000208:Acute Disease; D000293:Adolescent; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000150:complications* / Q000821:virology*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000097:blood / Q000150:complications* / Q000821:virology*; D008297:Male; D011379:Prognosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood
D000637:Transaminases; D001663:Bilirubin