title: Prognostic indicators for acute liver failure development and mortality in patients with hepatitis A: consecutive case analysis.
abstract: OBJECTIVE
  Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA.
  
  
  METHODS
  A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation.
  
  
  RESULTS
  The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELD≥23.5 was significantly more predictive than a SIRS score≥3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD score≥23.5, King's College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis.
  
  
  CONCLUSIONS
  MELD and SIRS scores≥23.5 and ≥3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores≥3 were valuable in predicting mortality of patients with a MELD≥23.5.
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Hye Sun
authors: HS
authors: Shin
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Sae Pyul
authors: SP
authors: Kim
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Sang Hoon
authors: SH
authors: Han
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ; Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Do Young
authors: DY
authors: Kim
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ; Liver Cirrhosis Clinical Research Center, Seoul, Korea. ; Brain Korea 21 Project of Medical Science, Seoul, Korea.
authors: Sang Hoon
authors: SH
authors: Ahn
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ; Liver Cirrhosis Clinical Research Center, Seoul, Korea. ; Brain Korea 21 Project of Medical Science, Seoul, Korea.
authors: Kwang-Hyub
authors: KH
authors: Han
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ; Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Chae Yoon
authors: CY
authors: Chon
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. DRPJY@yuhs.ac; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ; Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Jun Yong
authors: JY
authors: Park
mesh_terms: D000328:Adult; D005260:Female; D006506:Hepatitis A / Q000150:complications*; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications
keywords: Acute liver failure; hepatitis A; mortality; prognostic indicator