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A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation
Author(s) -
Takahashi Yoshiyata,
Kumada Hiromitsu,
Shimizu Masaru,
Tanikawa Kyuichi,
Kumashiro Ryukichi,
Omata Masao,
Ehata Toshiki,
Tsuji Takao,
Ukida Minoru,
Yasunaga Mitsuru,
Okita Kiwamu,
Sato Shunichi,
Takeuchi Toshihiko,
Tsukada Katsuhiko,
Obata Hiroshi,
Hashimoto Etsuko,
Ohta Yasuyuki,
Tada Kouji,
Kosaka Yoshitane,
Takase Koujiro,
Yoshiba Makoto,
Sekiyama Kazuhiko,
Kano Takashi,
Mizoguchi Yasuhiro
Publication year - 1994
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840190502
Subject(s) - liver transplantation , medicine , fulminant hepatitis , fulminant , viral hepatitis , virology , transplantation , gastroenterology , hepatitis
To determine the risk of death at an early stage of fulminant viral hepatitis, we created severity indexes drawn from clinical data on the day of development of encephalopathy in 128 patients with fulminant hepatitis B and 103 with fulminant hepatitis non‐A, non‐B. In fulminant hepatitis B, the risk score was 2.75×BL+2.75×BR+2.7×AG+2.3×WB+1.67×CD+1.56×AL−0.098×PR−0.88, where BL is 1 if total bilirubin is higher than 20 mg/dl, BR is 1 if the ratio of total to direct bilirubin exceeds 2.2, AG is 1 if age is above 40 yr, WB is 1 if white blood cell count is less than 4,000 cells/mm 3 or more than 18,000 cells/mm 3 , CD is 1 if a hazardous disease coexists and AL is 1 if ALT is less than 100 times the upper limit of normal (otherwise all are 0), and PR is prothrombin time (percentage of normal value). Using a cutoff score of 0, we found the positive predictive value, negative predictive value and predictive accuracy to be 0.90, 0.86 and 0.89, respectively. Sensitivity and specificity were 0.94 and 0.77, respectively. In fulminant non‐A, non‐B hepatitis, the risk score was 2.66×BR+2.25×BL+2.24×DI+2.05×AL ± 1.38×AG+0.00021×WB−6.33. BR is 1 if the ratio of total to direct bilirubin is more than 1.5, BL is 1 if total bilirubin is higher than 15 mg/dl, DI is 1 if the duration of illness before encephalopathy is less than 4 days or more than 12 days, AL is 1 if the ALT level exceeds 40 times the upper limit of normal and AG is 1 if age exceeds 50; otherwise all variables are 0. WB is WBC count per cubic millimeter. Positive predictive value, negative predictive value and predictive accuracy were 0.92, 0.80 and 0.89, respectively. Sensitivity and specificity were 0.95 and 0.70, respectively. These prediction equations were validated prospectively on a population of testing samples comprising 52 patients with fulminant hepatitis B and 47 with fulminant non‐A, non‐B hepatitis. Positive predictive values were 0.92 and 0.92, negative predictive values were 0.71 and 0.78 and predictive accuracies were 0.87 and 0.89 for patients with fulminant hepatitis B and fulminant non‐A, non‐B hepatitis, respectively. They may be used for selecting candidates for liver transplantation and for evaluating efficacy of a new therapy. (H EPATOLOGY 1994;19:1065–1071.)