title: Prognostic factors for fatal outcomes prior to receiving liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure.
abstract: OBJECTIVE
  Many patients continue to die due to the rapid development of cerebral edema and/or multiple organ failure prior to receiving a liver transplantation.
  
  
  METHODS
  We investigated the prognostic factors associated with 1-week fatal outcomes after the diagnosis of fulminant hepatic failure, which were associated with fatal outcomes prior to receiving liver transplantation, in 104 patients with non-acetaminophen-related fulminant hepatic failure.
  
  
  RESULTS
  With a multivariate logistic regression analysis, age (>40 years), systemic inflammatory response syndrome (SIRS) and plasma prothrombin activities (<or=10%) were significantly associated with fatal outcomes at 1 week after diagnosis in 104 patients. At the time of diagnosis, 50 patients (48%) were in a state of SIRS. Significant differences were observed between patients with and without SIRS regarding the period from the initial symptoms to the diagnosis of fulminant hepatic failure, hepatic coma grade, serum alanine aminotransferase level, serum creatinine level and plasma prothrombin activity. With a multivariate logistic regression analysis, age (>40 years), cause of fulminant hepatic failure (viral hepatitis), plasma prothrombin activity (<or=10%) and no administration of protease inhibitor were significantly associated with the 1-week fatal outcomes of 50 patients with SIRS.
  
  
  CONCLUSIONS
  Patients with SIRS exhibited hepatic failure of increased severity and SIRS may reduce the probability of receiving a liver transplantation. In order to estimate the efficacy of protease inhibitor for patients with SIRS, a prospective randomized trial is required.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. miyakeyasuhiro@hotmail.com
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Makino
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kobashi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Takaguchi
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ando
authors.forename: Kohsaku
authors.initials: K
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
mesh_terms: D000367:Age Factors; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000401:mortality*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011516:Prothrombin / Q000032:analysis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications
chemical_list: D011516:Prothrombin