Clinical features of fulminant hepatitis in Nagasaki Prefecture, Japan

Objective Fulminant hepatitis is a rare but fatal disease. In the present s tudy, we examined the changes in etiology and prognosis of fulminant hepati tis in Nagasaki Prefecture, Japan between 1980 to 1999. Methods Eighty-one patients with fulminant hepatitis admitted to our hospit als from 1980 to 1999 were examined with respect to the etiology and progno sis. Results Fulminant hepatitis was due to hepatitis A virus in 2 (12%) cases, hepatitis B virus in 18 (22%) cases, unknown etiology in 50 (62%) cases, an d drug-induced in 11(14%) cases. The number of cases in the first half of t he study (1980-1989) was 47 and that of the latter half (1990-1999) was 34 cases, The incidence of fulminant hepatitis type B also decreased from 14 c ases (30%) to 4 cases (12%) during these periods, The overall survival rate of fulminant hepatitis was 32%; it was equal in fulminant hepatitis type B , fulminant hepatitis of unknown etiology and fulminant drug-induced hepati tis. The survival rate of fulminant hepatitis type A was 100%, though only two cases were identified. Retrospectively, the survival rate in patients w ith a pre-encephalopathy period of less than or equal to 10 days and aged l ess than or equal to 39 years was significantly higher than in patients gre ater than or equal to 40 years of age (p<0.01). There was no difference bet ween the two age groups when pre-encephalopathy period was <greater than or equal to>11 days. Conclusions The incidence of fulminant hepatitis especially that of fulmina nt hepatitis type B in Nagasaki Prefecture has decreased in recent years. T he survival rate is significantly higher in younger patients with a short p re-encephalopathy period.