Prognostic Evaluation of Early Indicators in Fulminant Hepatic Failure by Multivariate Analysis

Abstract

Viral hepatitis is the commonest cause offulminant hepatic failure (FHF) in developing countries.We evaluated the early indicators of prognosis in thesepatients by multivariate analysis. The records of 204 consecutive patients with acute liverfailure admitted with hepatic encephalopathy over fiveyears were studied. The etiology of these patientsincluded virus related in 186 (91.1%), drug induced in 15 (7.4%), Wilson's disease in one (0.5%),acute Budd-Chiari syndrome in one (0.5%), and malignantinfiltration in one (0.5%). Patients with FHFcomplicating viral hepatitis were analyzed by univariate and multivariate analysis. These patients werefurther subclassified depending upon the intervalbetween the onset of jaundice and the onset ofencephalopathy into hyperacute (HALF; interval 0-7days), acute (ALF; interval 8-28 days) and subacuteliver failure (SALF; interval 4-12 weeks). Sixty (32.3%)patients with viral hepatitis survived. Univariateanalysis showed that the interval between onset of encephalopathy and onset of jaundice, grade ofencephalopathy, raised intracranial pressure,prothrombin time, and serum bilirubin levels onadmission were related to outcome in these patients.Multivariate logistic regression analysis showed that thepresence of raised intracranial pressure at the time ofadmission, prothrombin time >100 sec on admission,age (>50 yr), and onset of encephalopathy seven days after onset of jaundice were associated withpoor prognosis. Forty seven (37.0%) of 129 patients withHALF survived compared with 9 (22.5%) of 40 with ALF and4 (21.1%) of 19 with SALF (P = NS). Raised intracranial pressure was more frequent in patients withHALF (48.8%) than in patients with ALF (32.5%) and SALF(15.8%; P = 0.01), while clinically detectable asciteswas more frequent in patients with SALF (78.9%) compared with HALF (19.7%) and ALF (37.5%; P< 0.0001). The factors adversely affecting theoutcome in our patients with FHF complicating viralhepatitis include presence of overt clinical features of raised ICP at the time of hospitalization,prothrombin time (>100 sec) on admission, age (>50yr), and onset of encephalopathy seven days after onsetof jaundice.