Early prognostic biochemical indicators of fulminant hepatic failure

We investigated whether prognostic factors could be used for selecting appropriate therapy in patients with fulminant hepatic failure, for which orthotopic liver transplantation is often considered necessary. As, however, some patients survive without transplantation, a method is required to enable early distinction between patients requiring immediate transplantation and those who would survive without transplantation. As a number of prognostic indicators proposed for the identification of patient types are not completely satisfactory, in this retrospective study we investigated whether laboratory tests to evaluate severity of illness are best performed on the day of the appearance of the transaminase peak or the day of admission. The study included 44 patients with acute non-acetaminophen-induced liver failure. All patients received the same supportive can. Fourteen (group A) survived without transplantation and 20 (group B) died during hospitalization. Ten patients were excluded either because they underwent liver transplantation or data were incomplete. We studied prothrombin times and alpha-fetoprotein levels; values increased in the group of survivors throughout the period of illness, whereas they were low in patients who died. Both parameters allowed differentiation between patients of the two groups as from the Ist day after peak (P<0.05). The method proposed allows us to improve the predictive capacity of these laboratory tests in fulminant hepatic failure at an early stage of disease and to make an early selection of candidates for liver transplantation.