Acute hepatic failure in India: A perspective from the East

Acute hepatic failure (AHF) in India almost always presents with encephalop athy within 4 weeks of the onset of acute hepatitis. Further subclassificat ion of AHF into hyperacute, acute and subacute forms may not be necessary i n this geographical area, where the rapidity of onset of encephalopathy doe s not seem to influence survival. Viral hepatitis is the cause in approxima tely 95-100% of patients, who therefore constitute a more homogeneous popul ation than AHF patients in the West. In India, hepatitis E (HEV) and hepati tis B (HBV) viruses are the most important causes of AHF; approximately 60% of cases are caused by to these viruses. Hepatitis B virus core mutants ar e very important agents in cases where hepatitis B results in AHF in this c ountry. Half of the patients with AHF admitted to our centre are female, on e-quarter of whom are pregnant. Therefore, pregnant females who contract vi ral hepatitis constitute a high-risk group for the development of AHF. Howe ver, the outcome of AHF in this group is similar to that in non-pregnant wo men and men. No association with any particular virus has been identified a mong sporadic cases of AHF. In our centre, approximately one-third of AHF patients survive with aggress ive conservative therapy, whereas two-thirds of deaths occur within 72 h of hospitalization. Cerebral oedema and sepsis are the major fatal complicati ons. Both fungal and Gram-negative bacteria are major causes of sepsis. Amo ng patients with AHF, despite the presence of sepsis, its overt clinical fe atures (i.e. fever, leucocytosis) may be absent and objective documentation of the presence of sepsis in such patients is achieved by repeated culture of various body fluids. It should be possible to develop simple, clinical prognostic markers for AHF in this geographical region, in order to identif y patients suitable for liver transplantation. (C) 2000 Blackwell Science A sia Pty Ltd.