Fulminant hepatitis: an experience based on 137 cases. II. Course and prognosis
Nusinovici, V.; Crubille, C.; Opolon, P.; Touboul, J.P.; Darnis, F.; Caroli, J.
Gastroenterologie Clinique et Biologique 1(11): 875-886
1977
ISSN/ISBN: 0399-8320 PMID: 598657 Document Number: 120810
The course of fulminant hepatitis in 137 patients was analyzed. The following parameters were of statistical value in predicting the prognosis: age, depth of coma, convulsions, gastrointestinal bleeding, creatininemia, urinary urea, hypocapnia, galactose clearance, prothrombin time, factor V, fibrinogen, ethanol test, von Kaulla's test, hepatocyte volume fraction measured during coma. Alpha fetoprotein measured by electroimmunodiffusion in 51 patients and by radioimmunoassay in 10 was of no prognostic value. The main causes of death were decerebration (50%), bleeding (18%), cardiovascular collapse (11%) and sepsis (6%). Seventeen patients showed evidence of hepatic regeneration at the time of death. Survival rate (17.5% overall) was independent of treatment. Transient recovery of consciousness was more frequent in patients treated by hemodialysis with a polyacrylonitrile membrane than in the patients not treated by this method (6/13 vs. 5/96, P < 0.001). Mean duration of coma until death or decerebration was longer in the former than in the latter (7.6 days .+-. 6 vs. 3.9 days .+-. 2.6, P < 0.02). Chronic active hepatitis developed in 1 of the 24 survivors.