rum bilirubin, and prothrombin time prolongation over The profiles of patients with fulminant hepatic failure controls at admission were related to survival (P Γ΅ .01). (FHF) from developing countries have not been reported The rapidity of onset of encephalopathy and cause of earlier. The current study was conducted prospectively, FHF did not influence the outcome. Cox's proportional at a single tertiary care center in India, to document the hazard regression showed age Β’40 years, presence of demographic and clinical characteristics, natural cerebral edema, serum bilirubin Β’15 mg/dL, and procourse, and causative profile of patients with FHF as thrombin time prolongation of 25 seconds or more over well as to define simple prognostic markers in these pacontrols were independent predictors of outcome. tients. Four hundred twenty-three consecutive patients Ninety-three percent of the patients with three or more with FHF admitted from January 1987 to June 1993 were of the above prognostic markers died. The sensitivity, included in the study. Each patient's serum was tested specificity, positive predictive value, and the negative for various hepatotropic viruses. Univariate Cox's repredictive value of the presence of three or more of these gression for 28 variables, multivariate Cox's proporprognostic factors for mortality was 93%, 80%, 86%, and tional hazard regression, stepwise logistic regression, 89.5%, respectively, with a diagnostic accuracy of 87.3%. and Kaplan-Meier survival analysis were done to iden-We conclude that most of our patients with FHF might tify independent predictors of outcome at admission. All have been caused by hepatotropic viral infection, and patients presented with encephalopathy within 4 weeks non-A, non-B virus(es) seems to be the dominant hepatoof onset of symptoms. Hepatotropic viruses were the tropic viral infection among these patients. They prelikely cause in most of these patients. Hepatitis A (HAV), sented with encephalopathy within 4 weeks of the onset hepatitis B (HBV), hepatitis D (HDV) viruses, and antituof symptoms. Pregnancy, cause, and rapidity of onset of bercular drugs could be implicated as the cause of FHF encephalopathy did not influence survival. The progin 1.7% (n Γ
7), 28% (n Γ
117), 3.8% (n Γ
16), and 4.5% (n nostic model developed in the current study is simple Γ
19) patients, respectively. In the remaining 62% (n and can be performed at admission. (HEPATOLOGY Γ
264) of patients the serological evidence of HAV, HBV, 1996;23:1448-1455.
) or HDV infection was lacking, and none of them had ingested hepatotoxins. FHF was presumed to be caused by non-A, non-B virus(es) infection. Sera of 50 patients
Most reports on fulminant hepatic failure (FHF) from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be have been predominantly from the West, 1-9 and particuimplicated as the causative agent, and isolated HCV larly from three countries: the United Kingdom, 1,2 Ja-RNA could be detected in 7 (19%). Two hundred eightypan, 3,4 and France. 5 Based on these geographically limeight (66%) patients died. Approximately 75% of those ited observations, a new classification of this disease who died did so within 72 hours of hospitalisation. One entity into hyperacute, acute, and subacute liver failquarter of the female patients with FHF were pregnant. ure has been suggested. 2 These authors also suggested Mortality among pregnant females, nonpregnant fethe adoption of this classification universally for a unimales, and male patients with FHF was similar (P ΓΊ .1). form terminology. The latter study has not been able Univariate analysis showed that age, size of the liver to consider the disease characteristics in the tropical assessed by percussion, grade of coma, presence of clinipopulation, presumably because of the lack of pubcal features of cerebral edema, presence of infection, selished data from the tropics. The cause and rapidity of the onset of hepatic enceph-Abbreviations: FHF, fulminant hepatic failure; Ig, immunoglobulin; HAV, alopathy in patients with FHF have been reported as hepatitis A virus; HDV, hepatitis D virus; HBV, hepatitis B virus; HEV, hepati-important prognostic predictors. 1-3 However, the cause tis E virus; HCV, hepatitis C virus.
of FHF may have regional differences, and the rapidity From the Departments of 1 Gastroenterology, 2 Biostatistics, and 3 Pathology, of onset of encephalopathy after the occurrence of acute