Clinical Features and Prognostic Factors of Fulminant Hepatic Failure in Koreans.
- Author:
Sung Jae SHIN
1
;
Sang Hoon AHN
;
Hee Man KIM
;
Ja Kyung KIM
;
Byung Chang KIM
;
Jae Hyun LEE
;
Yong Han PAIK
;
Kwan Sik LEE
;
Kwang Hyub HAN
;
Chae Yoon CHON
;
Young Myoung MOON
Author Information
1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ahnsh@yumc.yonsei.ac.kr
- Publication Type:Original Article ; English Abstract
- Keywords:
Fulminant hepatic failure;
Hepatic encephalopathy;
Prognostic factors;
Hepatitis B virus;
Drug
- MeSH:
Adult;
English Abstract;
Female;
Humans;
Liver Failure, Acute/*diagnosis/etiology/surgery;
Liver Transplantation;
Male;
Middle Aged;
Prognosis
- From:The Korean Journal of Hepatology
2004;10(4):298-307
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: There have been scant reports on the prognostic factors of fulminant hepatic failure for selecting the patients who need liver transplantation. We investigated the clinical features and prognostic factors throughout the clinical course of the disease in Korean patients with fulminant hepatic failure. METHODS: Between 1992 and 2003, a total of 60 patients with fulminant hepatic failure were divided into the survival group and the non-survival group, and these groups were compared according to gender, age, etiology, values of the laboratory tests, grade of the encephalopathy that was obtained at the time of admission and the worst clinical status (hepatic encephalopathy). RESULTS: The mean age of the total patients was 40.9 years (M:F=31:29) and the survival rate was 28.3% (n=17). Drugs (n=25, 12 herbal medicines) and viral infection (n=24, 18 HBV infection) were most common causes. On univariate analysis, the WBC, AST, ALT, total bilirubin and HE IV stage at the time of admission were the significant factors for a poor prognosis. Total bilirubin, albumin and HE IV stage also remained as significant factors at the time of the worst clinical status. On multivariate analysis, total bilirubin (P=0.033) and ALT (P=0.042) at admission were the prognostic factors, and the progression to HE IV stage (P=0.019) or hypoalbuminemia (P=0.028) during hospitalization represented the significant factors for a poor prognosis. CONCLUSIONS: In contrast to Western countries, HBV infection and herbal medicines were major causes of fulminant hepatic failure in Korea. The total serum bilirubin level and progressive hyperbilirubinemia with HE (stage IV) during hospitalization seemed to be the most important prognostic factors, and liver transplantation should be considered before the patient reaches this status.
