PROGNOSTIC EVALUATION OF EARLY INDICATORS IN FULMINANT HEPATIC-FAILURE BY MULTIVARIATE-ANALYSIS

Viral hepatitis is the commonest cause of fulminant hepatic failure (F HF) in developing countries. We evaluated the early indicators of prog nosis in these patients by multivariate analysis. The records of 204 c onsecutive patients with acute liver failure admitted with hepatic enc ephalopathy over five years were studied. The etiology of these patien ts included virus related in 186 (91.1%), drug induced in 15 (7.4%), W ilson's disease in one (0.5%), acute Budd-Chiari syndrome in one (0.5% ), and malignant infiltration in one (0.5%). Patients with FHF complic ating viral hepatitis were analyzed by univariate and multivariate ana lysis. These patients were further subclassified depending upon the in terval between the onset of jaundice and the onset of encephalopathy i nto hyperacute (HALF; interval 0-7 days), acute (ALF; interval 8-28 da ys) and subacute liver failure (SALF; interval 4-12 weeks). Sixty (32. 3%) patients with viral hepatitis survived. Univariate analysis showed that the interval between onset of encephalopathy and onset of jaundi ce, grade of encephalopathy, raised intracranial pressure, prothrombin time, and serum bilirubin levels on admission were related to outcome in these patients. Multivariate logistic regression analysis showed t hat the presence of raised intracranial pressure at the time of admiss ion, prothrombin time >100 sec on admission, age (>50 yr), and onset o f encephalopathy seven days after onset of jaundice were associated wi th poor prognosis. Forty seven (37.0%) of 129 patients with HALF survi ved compared with 9 (22.5%) of 40 with ALF and 4 (21.1%) of 19 with SA LF (P = NS). Raised intracranial pressure was more frequent in patient s with HALF (48.8%) than in patients with ALF (32.5%) and SALF (15.8%; P = 0.01), while clinically detectable ascites was more frequent in p atients with SALF (78.9%) compared with HALF (19.7%) and ALF (37.5%; P < 0.0001). The factors adversely affecting the outcome in our patient s with FHF complicating viral hepatitis include presence of overt clin ical features of raised TCP at the time of hospitalization, prothrombi n time (>100 sec) on admission, age (>50 yr), and onset of encephalopa thy seven days after onset of jaundice.