Prognostic factor analysis of fulminant and subfulminant hepatic failure in an area endemic for hepatitis B

In order to determine the criteria in selecting candidates for orthotopic liver transplantation (OLT), we assessed the aetiology and prognostic indicators in 61 patients with fulminant or subfulminant hepatitis during the past 13 years. Several previously reported models of high risk predictors were not suitable for a large portion of our patients with different aetiological and ethnic backgrounds. In the present study, serological markers of various hepatitis viruses were tested and clinical parameters were compared between survivors and non-survivors. Multiple virus infection and multifactorial causes were important in the pathogenesis (48%) of acute liver failure. Among the 13 clinical parameters, six were considered significant on univariate analysis: prothrombin time prolongation (P<0.001), total bilirubin, creatinine and alpha-fetoprotein (P<0.01), age and cholesterol (P<0.05). With stepwise logistic regression using most discriminatory cut-off values, an age of >43 years (P=0.0001), total bilirubin levels of >23mg/dL (P<0.005) and prothrombin time prolongation >19 s (P<0.0001) were independent predictors of non-survival. When applied to determine the index of poor prognosis, the sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were 100, 67, 95, 100 and 95%, respectively, in the presence of any one of these prognostic factors. We conclude that these indicators may be useful for selecting patients with acute liver failure indicated for OLT.