We assessed prognostic factors in 115 patients with serologically defined fulminant hepatitis B. The diagnosis in each case WM based on the finding of IgM antibody to the hepatitis B core antigen in serum. Multivariate analysis showed that factor V level (p < 0.001), patient's age (p = 0.001), absence of detectable HBsAg by radioimmunoassay (p = 0.06) and serum a-fetoprotein concentration (p = 0.07) were independent predictors of survival. The survival rate in the 21 patients in whom HBsAg was not detected was 47%, which was significantly higher than the survival rate of 17% observed in the 94 HBsAg-positive patients (p = 0.006).
In patients with fulminant hepatitis B, the absence of HBsAg in serum as detected by radioimmunoassay has an independent, favorable prognostic value.
Hepatitis B virus (HBV) is the major cause of fulminant viral hepatitis. An evaluation of prognostic factors of fulminant hepatitis B appears warranted for several reasons. First, in previous studies (1-6), prognosis was assessed in patients with fulminant hepatitis of various causes and not specifically in patients with fulminant hepatitis cacsed by HBV. Second, in previous studies (1-6), univariate analysis was employed, whereas multivariate analysis is a more appropriate statistical method for evaluating multiple factors. Third, other studies have not used IgM antibody to hepatitis B core antigen (IgM anti-HBc), a recognized marker of current or recent infection with HBV (7), to diagnose acute hepatitis B in cases in which HBsAg is no longer detectable (8, 9). We report the evaluation of prognostic factors based on univariate and multivariate analyses in a large series of patients with IgM anti-HBc-positive fulminant hepatitis.
PATIENTS AND METHODS
From January, 1972 to December, 1981, 115 patients over the age of 15 years were admitted for fulminant hepatitis B to the Liver Unit at H6pital Beaujon. Diagnosis of fulminant hepatitis B was based on the following criteria: (a) histologically