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. 2002 Jul;87(1):54–56. doi: 10.1136/adc.87.1.54

Natural history and risk factors in fulminant hepatic failure

U Poddar 1, B Thapa 1, A Prasad 1, A Sharma 1, K Singh 1
PMCID: PMC1751142  PMID: 12089125

Abstract

Background: The natural history of fulminant hepatic failure (FHF) without liver transplantation is not well known.

Aims: To study the natural history and prognostic factors, especially the presence of ascites and spontaneous bacterial peritonitis (SBP), in children with FHF.

Methods: FHF was defined by the onset of encephalopathy within 12 weeks of onset of jaundice. From August 1997 to December 2000, 67 children (≤12 years) were diagnosed with FHF. Their clinical features, investigations and outcome were noted. Viral markers A to E (IgM, anti-HAV; IgM, anti-HEV, HBsAg, and anti-HCV) were determined by ELISA. SBP was defined by the presence of ≥250 neutrophils with or without a positive culture in ascitic fluid.

Results: Mean age of the children was 5.8 years with an almost equal sex distribution. Viral markers were positive in 63 (94%) cases: hepatitis A in 34 (54%), E in 17 (27%), A+E in seven (11%), and B in five (8%). Thirty one children presented with grade I or II encephalopathy and all recovered, whereas 17 of 36 children who had grade III or IV encephalopathy died. Ascites was detected (both clinically and ultrasonically) in 34 (51%) cases, nine (26%) of which had SBP. Overall mortality was 25%. Mortality was higher in those who had ascites than in those who did not (32% v 18%); among those with ascites it was maximum in those who had SBP (78% v 16%). Total serum bilirubin and grade of encephalopathy were significantly higher, serum albumin was significantly lower, and prothrombin time was significantly prolonged in those who died than in those who recovered.

Conclusion: The natural history of FHF in Indian children depends on age, grade of encephalopathy, ascites, and SBP. SBP depicts worse outcome. In all cases of FHF with ascites, the presence of SBP should be investigated.

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Selected References

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  1. Arora N. K., Nanda S. K., Gulati S., Ansari I. H., Chawla M. K., Gupta S. D., Panda S. K. Acute viral hepatitis types E, A, and B singly and in combination in acute liver failure in children in north India. J Med Virol. 1996 Mar;48(3):215–221. doi: 10.1002/(SICI)1096-9071(199603)48:3<215::AID-JMV1>3.0.CO;2-B. [DOI] [PubMed] [Google Scholar]
  2. Bendre S. V., Bavdekar A. R., Bhave S. A., Pandit A. N., Chitambar S. D., Arankalle V. A. Fulminant hepatic failure: etiology, viral markers and outcome. Indian Pediatr. 1999 Nov;36(11):1107–1112. [PubMed] [Google Scholar]
  3. Chu C. M., Chiu K. W., Liaw Y. F. The prevalence and prognostic significance of spontaneous bacterial peritonitis in severe acute hepatitis with ascites. Hepatology. 1992 May;15(5):799–803. doi: 10.1002/hep.1840150509. [DOI] [PubMed] [Google Scholar]
  4. Dhiman R. K., Makharia G. K., Jain S., Chawla Y. Ascites and spontaneous bacterial peritonitis in fulminant hepatic failure. Am J Gastroenterol. 2000 Jan;95(1):233–238. doi: 10.1111/j.1572-0241.2000.01691.x. [DOI] [PubMed] [Google Scholar]
  5. Guarner C., Runyon B. A. Spontaneous bacterial peritonitis: pathogenesis, diagnosis, and management. Gastroenterologist. 1995 Dec;3(4):311–328. [PubMed] [Google Scholar]
  6. Navasa M., Garcia-Pagán J. C., Bosch J., Riera J. R., Bañares R., Mas A., Bruguera M., Rodés J. Portal hypertension in acute liver failure. Gut. 1992 Jul;33(7):965–968. doi: 10.1136/gut.33.7.965. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. O'Grady J. G., Schalm S. W., Williams R. Acute liver failure: redefining the syndromes. Lancet. 1993 Jul 31;342(8866):273–275. doi: 10.1016/0140-6736(93)91818-7. [DOI] [PubMed] [Google Scholar]
  8. Pinzello G., Simonetti R. G., Craxì A., Di Piazza S., Spanò C., Pagliaro L. Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic cirrhotic patients. Hepatology. 1983 Jul-Aug;3(4):545–549. doi: 10.1002/hep.1840030411. [DOI] [PubMed] [Google Scholar]
  9. Poddar U., Chawla Y., Dhiman R. K., Vaiphei K., Vasishta R. K., Dilawari J. B. Spontaneous bacterial peritonitis in fulminant hepatic failure. J Gastroenterol Hepatol. 1998 Jan;13(1):109–111. doi: 10.1111/j.1440-1746.1998.tb00554.x. [DOI] [PubMed] [Google Scholar]
  10. Psacharopoulos H. T., Mowat A. P., Davies M., Portmann B., Silk D. B., Williams R. Fulminant hepatic failure in childhood: an analysis of 31 cases. Arch Dis Child. 1980 Apr;55(4):252–258. doi: 10.1136/adc.55.4.252. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Runyon B. A., Hoefs J. C. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology. 1984 Nov-Dec;4(6):1209–1211. doi: 10.1002/hep.1840040619. [DOI] [PubMed] [Google Scholar]
  12. Runyon B. A. Spontaneous bacterial peritonitis: an explosion of information. Hepatology. 1988 Jan-Feb;8(1):171–175. doi: 10.1002/hep.1840080131. [DOI] [PubMed] [Google Scholar]
  13. Srivastava K. L., Mittal A., Kumar A., Gupta S., Natu S. M., Kumar R., Govil Y. C. Predictors of outcome in fulminant hepatic failure in children. Indian J Gastroenterol. 1998 Apr;17(2):43–45. [PubMed] [Google Scholar]
  14. Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]
  15. Thomas F. B., Fromkes J. J. Spontaneous bacterial peritonitis associated with acute viral hepatitis. J Clin Gastroenterol. 1982 Jun;4(3):259–262. doi: 10.1097/00004836-198206000-00012. [DOI] [PubMed] [Google Scholar]
  16. Valla D., Flejou J. F., Lebrec D., Bernuau J., Rueff B., Salzmann J. L., Benhamou J. P. Portal hypertension and ascites in acute hepatitis: clinical, hemodynamic and histological correlations. Hepatology. 1989 Oct;10(4):482–487. doi: 10.1002/hep.1840100414. [DOI] [PubMed] [Google Scholar]
  17. el-Zimaity D. M., Hyams K. C., Imam I. Z., Watts D. M., Bassily S., Naffea E. K., Sultan Y., Emara K., Burans J., Purdy M. A. Acute sporadic hepatitis E in an Egyptian pediatric population. Am J Trop Med Hyg. 1993 Mar;48(3):372–376. doi: 10.4269/ajtmh.1993.48.372. [DOI] [PubMed] [Google Scholar]

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