What is the prognosis of non-acetaminophen-induced fulminant hepatic failure (FHF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Answer

Non-acetaminophen-induced fulminant hepatic failure

In non-acetaminophen-induced fulminant hepatic failure, a PT of greater than 100 seconds and any three of the following five criteria are independent predictors [35] of a poor prognosis:

  • Age younger than 10 years or older than 40 years

  • Fulminant hepatic failure due to non-A, non-B, non-C hepatitis; halothane hepatitis; or idiosyncratic drug reactions

  • Jaundice present longer than 1 week before the onset of encephalopathy

  • PT longer than 50 seconds

  • Serum bilirubin level greater than 300 mmol/L (17.5 mg/dL)

In patients who meet three or more of these criteria, preparations for OLT should be arranged.

The above criteria were developed at King's College Hospital in London [35] and have been validated in other centers. However, significant variability occurs in terms of the patient populations encountered at any center, and this heterogeneity may preclude widespread applicability.

Many other prognosticating tests have been proposed. The combination of reduced levels of group-specific component (Gc)-globulin (a molecule that binds actin) is reported in fulminant hepatic failure, [36, 37] and a persistently increasing PT portends death. These and other parameters have not been widely validated yet.


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