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Category: Volume 07 Issue 06 June 2019
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Title: Outcome and Prognostic Factors in Fulminant Hepatic Failure

Authors: Dr Tauseef Nabi, Dr Sajad Ahmad Dar, Dr Nadeema Rafiq

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.12

Abstract

Background: Acute liver failure (ALF) is a rare critical illness with high mortality whose successful management requires early recognition and effective initial management. ALF of less than 8 weeks is called Fulminant Hepatic Failure (FHF). Clinical and etiological profile varies with geographical area and over time. Prognostic criteria are applied to identify patients for emergency liver transplantation, and candidates for surgery are prioritized on wait listing schemes.

Objective: The objective of this prospective study was to determine the prognostic factors and outcome of FHF.

Methods: A total of 84 consecutive patients with a diagnosis of FHF were included in the study. The variables evaluated were etiological profile, outcome and prognostic criteria. 

Results: Viral hepatitis 32 (38.1%) was the most common cause of FHF but large number of the patients 30 (35.7%) had indeterminate etiology. Among viral causes, acute hepatitis E (19.1%) was most common followed by hepatitis B (9.5%) and A (9.5%). Drug or toxic induced liver failure (17.8%) also contributed a significant proportion. Overall mortality was 44 (52.4%) in FHF patients. Six variables which predicted the adverse outcome on multivariate analysis were age >60 years, bilirubin >20mg/dl, III–IV grade of encephalopathy, lactate >3.5 mmol/L, MELD score >30 and Non HEV induced FHF.

Conclusion: Like the rest of India, viral hepatitis was the common cause of FHF but a large number of patients 30 (35.7%) had indeterminate etiology. Overall mortality was 52.4%. Age >60 years, bilirubin >20mg/dl, III–IV grade of encephalopathy, lactate >3.5 mmol/L, MELD score >30 and Non HEV induced FHF were the independent prognostic factors determining mortality.

Keywords: Acute Liver failure (ALF); Fulminant Hepatic Failure (FHF); Viral hepatitis; Survival; Prognostic factors.

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Corresponding Author

Dr Nadeema Rafiq

Department of Physiology, Govt. Medical College, Baramulla, J&K, India