title: [Clinical outcomes and predictive factors of spontaneous survival in patients with fulminant hepatitis A].
abstract: OBJECTIVE
  The occurrence of acute hepatitis A is increasing and its progression to fulminant hepatic failure (FHF) is frequent. We investigated the frequency and clinical outcomes of fulminant hepatitis A and also analyzed the predictive factors of spontaneous survival.
  
  
  METHODS
  A total of 568 patients presented with acute hepatitis A from January 2003 to June 2008, of which the 35 (6.2%) patients with FHF were divided into two groups: spontaneous survival and transplant/death. These two groups were compared according to various clinical features including the MELD score and King's College Hospital (KCH) criteria.
  
  
  RESULTS
  The rate of FHF development increased over time among patients with acute hepatitis A: 0% in 2003, 3.4% in 2004, 3.2% in 2005, 6.0% in 2006, 7.7% in 2007, and 13.0% in 2008. Twenty patients (57.1%) showed spontaneous survival, 13 (37.1%) received liver transplantation, and 5 (14.3%) died during hospitalization. The two groups of spontaneous survival (N=20) and transplant/death (N=15) showed significant differences in prothrombin time at admission and at its worst value, albumin at its worst value, and hepatic encephalopathy grade at admission and at its worst value. The MELD score was lower in the spontaneous-survival group than in the transplant/death group (27.0+/-7.8 vs. 37.0+/-7.1, mean+/-SD; P=0.001). However, KCH criteria did not differ significantly between the two groups. On multivariate analysis, HEP grade was the only significant predictive factor, being negatively correlated with spontaneous survival (OR=0.068, P=0.025).
  
  
  CONCLUSIONS
  FHF due to hepatitis A has increased in recent years, and in our cohort the HEP grade was closely associated with spontaneous survival.
authors.affiliation: Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
authors.forename: Jwa Min
authors.initials: JM
authors.lastname: Kim
authors.forename: Yoon Seon
authors.initials: YS
authors.lastname: Lee
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lim
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006506:Hepatitis A / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome