- 期刊
Fulminant Hepatitis in Japan-Etiology and Prognostic Prediction
並列摘要
A collaborative national study on fulminant hepatitis was carried out in 1983-88, and 411 authentic cases with complete viral serology were analyzed: 22 due to A, 171 B, 150 NANB, 49 drug and 19 halothane. Comparison was made among the three viral types. Survival was bertter in A, and poorest in NANB, which had the highest average age of patients. Duration of illness and jaundice before encephalopathy was longer in NANB. Relative prevalence of these viruses showed a temporal change; B was most common in 1983 and began declining in 1986 while NANB has been increasing. Among posttransfusion hepatitis, B accounted for 82-89% before 1987 and 67% in 1988. Among sporadic cases of fulminant hepatitis, prevalence of B steadily declined from 64% (1983) to 20% (1988) and that of NANB increased to 72%. 55% of patients developed encephalopahty within 10 days from onset of symptoms (acute form), B consituting 67%, NANB 24% and A 9% among them. In the group developing encephalopathy after 11 days (subacute form), NANB accounted for 67%, B 30% and A 3%. The survival was significantly worse in the subacute form. A similar trend was noted with jaundice. However, NANB had a better survival rate in the acute form than in the subacute. It is not clear whether this is due dto different NANB viruses or masked B placed in NANB because of negative IgM anti-HBc antibody. The prognostic factors were determined by uni-and multivariate analyses. The significant factors included age, total bilirubin, ratio of total to direct bilirubin, prothrombin, WBC and duration of illness before encephalopathy. Logistic regression analysis was performed using these factors. Positive predictive value was 0.84, negative predictive value 0.66, predictive accuravy 0.81, sensitivity 0.94 and specificity 0.39. A risk score for dying was calculated from the regression equation. Using this scoring system, a prospective validation study was made on 104 new cases. Prediction of prognosis by this scoring sytem may prove useful in selecting transplantation candidates. The epidemiology of fulminant hepatic failure varies with the country and perhaps with the ethnic group as well; hepatitis B and E infections, both the major causes of acute fatal hepatitis, are endemic in certain areas of the world and acetaminophen induced hepatic failure which is very common in London is rare in the Far East. it is, therefore, important to ascertain the epidemiological features of fulminant hepatic failure in each country from the etiological point of view. The therapeutic approach should vary with the etiology. The current study is based on a national collaborative survey carried out in the period of 1983-1988 (chairman: Y. Takahashi) on fulminant hepatic failure (FH) in Japan, with particular emphasis on viral etiology and outcome. In addition, the prognostic factors were evaluated based on the data accumulated in this study, using the uni-and multivariate analyses in order to see whether or not early prediction of prognosis is possible from the best fitted regression model. Whether the patient should dbe considered for liver transplantation or otherwise is an urgent decision required in clinical practice.