A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation
✍ Scribed by Yoshiyata Takahashi; Hiromitsu Kumada; Masaru Shimizu; Kyuichi Tanikawa; Ryukichi Kumashiro; Masao Omata; Toshiki Ehata; Takao Tsuji; Minoru Ukida; Mitsuru Yasunaga; Kiwamu Okita; Shunichi Sato; Toshihiko Takeuchi; Katsuhiko Tsukada; Hiroshi Obata; Etsuko Hashimoto; Yasuyuki Ohta; Kouji Tada; Yoshitane Kosaka; Koujiro Takase; Makoto Yoshiba; Kazuhiko Sekiyama; Takashi Kano; Yasuhiro Mizoguchi
- Publisher
- John Wiley and Sons
- Year
- 1994
- Tongue
- English
- Weight
- 758 KB
- Volume
- 19
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
MITSURU YASUNAGA,' KrwAMu OKITA,' SHUNICHI S A T O , ~ TOSHIHIKO TAKEUCHI,~ KATSUHIKO TSUKADA,~ To determine the risk of death at an early stage of fulminant viral hepatitis, we created severity indexes drawn from clinical data on the day of development of encephalopathy in 128 patients with fulminant hepatitis B and 103 with fulminant hepatitis non-A, non-B.
In fulminant hepatitis B, the risk score was 2.75 x BL + 2.75 x BR + 2.7 x AG + 2.3 x WB + 1.67 x CD + 1.56 x AL -0.098 x PR -0.88, where BL is 1 if total bilirubin is higher than 20 mg/dl, BR is 1 if the ratio of total to direct bilirubin exceeds 2.2, AG is 1 if age is above 40 yr, WB is 1 if white blood cell count is less than 4,000 cells/mm3 or more than 18,000 cells/mm3, CD is 1 if a hazardous disease coexists and AL is 1 if ALT is less than 100 times the upper limit of normal (otherwise all are O), and PR is prothrombin time (percentage of normal value). Using a cutoff score of 0, we found the positive predictive value, negative predictive value and predictive accuracy to be 0.90, 0.86 and 0.89, respectively. Sensitivity and specificity were 0.94 and 0.77, respectively. In fulminant non-A, non-B hepatitis, the risk score was 2.66 x BR + 2.25 x BL + 2.24 x DI + 2.05 x AL f 1.38 x AG + 0.00021 x WB -6.33. BR is 1 if the ratio of total to direct bilirubin is more than 1.5, BL is 1 if total bilirubin is higher than 15 mg/dl, DZ is 1 if the duration of illness before encephalopathy is less than 4 days or more than 12 days, AL is 1 if the ALT level exceeds 40 times the upper limit of normal and AG is 1 if age exceeds 50; otherwise all variables are 0. WB is WBC count per cubic millimeter. Positive predictive value, negative predictive value and predictive accuracy were 0.92, 0.80 and 0.89, respectively. Sensitivity and