Treatment of fulminant hepatic failure with intravenous prostaglandin E-1

Fulminant hepatic failure (FHF) is a severe, life-threatening disorder. Pre vious studies have suggested that intravenous prostaglandin treatment may i mprove survival in FHF, The present study was performed to further investig ate the possible benefit of intravenous prostaglandin E-1 (PGE(1)) for pati ents with FHF. A total of 18 patients, all excluded as candidates for hepat ic transplantation, were studied. Thirteen of 18 participated in a randomiz ed, double-blind, placebo-controlled trial, PGE1 was administered by contin uous infusion at a dose of 10 to 40 mu g/h as tolerated. After 48 hours of blinded treatment, 3 of 7 patients randomized to placebo were converted to open-label PGE(1) for lack of biochemical and/or clinical improvement. Mean values for alanine transaminase, aspartate transaminase, total bilirubin, prothrombin time, factor V percent, factor VII percent, hepatic encephalopa thy score, days from onset of symptoms to initiation of treatment, and caus e of FHF were similar between treatment groups. Ten of 18 patients (55%) en rolled in this trial survived, However, survival was not different between PGE(1)-(60%) and placebo (50%) treated patients, The greatest predictor of survival was the number of days from onset of symptoms to hospitalization, which was significantly (P = .002) shorter for survivors (3.3 v 12.4 days), regardless of PGE(1) treatment. Six of 8 patients (75%) who began PGE(1) t herapy and 4 of 5 placebo-treated patients (80%) hospitalized within 10 day s of onset of symptoms survived. By contrast, all 5 patients who were hospi talized and subsequently began PGE(1) treatment 10 days or longer after the onset of symptoms died. We conclude that early recognition and hospitaliza tion is the most important factor in reduction of mortality from FHF. It is unclear whether PGE(1) treatment is beneficial when administered during th is period. However, it is apparent that PGE(1) was not effective for treatm ent of FHF if treatment started more than 10 days after onset of this clini cal syndrome. Copyright (C) 1998 by the American Association for the Study of Liver Diseases.