Fulminant Hepatitis in A Tropical Population: Clinical Course, Cause, and Early Predictors of Outcome

作者：Subrat Kumar Acharya, Srinivasan Dasarathy, T L Kumer, S Sushma, K. S. Prasanna, Anurag Tandon, Vishnubhatla Sreenivas, Sandeep Nijhawan, Subrat Kumar Panda, Santosh Kumar Nanda, Mohammad A. Irshad, Yogesh Kumar Joshi, Sandeep Duttagupta, R. K. Tandon, B N Tandon · 发表于：Hepatology · 年份：1996 · DOI：10.1002/hep.510230622 · 被引用次数：258 · 研究领域：Liver Disease and Transplantation、Hepatitis Viruses Studies and Epidemiology、Liver Disease Diagnosis and Treatment

The profiles of patients with fulminant hepatic failure (FHF) from developing countries have not been reported earlier. The current study was conducted prospectively, at a single tertiary care center in India, to document the demographic and clinical characteristics, natural course, and causative profile of patients with FHF as well as to define simple prognostic markers in these patients. Four hundred twenty-three consecutive patients with FHF admitted from January 1987 to June 1993 were included in the study. Each patient's serum was tested for various hepatotropic viruses. Univariate Cox's regression for 28 variables, multivariate Cox's proportional hazard regression, stepwise logistic regression, and Kaplan-Meier survival analysis were done to identify independent predictors of outcome at admission. All patients presented with encephalopathy within 4 weeks of onset of symptoms. Hepatotropic viruses were the likely cause in most of these patients. Hepatitis A (HAV), hepatitis B (HBV), hepatitis D (HDV) viruses, and antitubercular drugs could be implicated as the cause of FHF in 1.7% (n= 7), 28% (n= 117), 3.8% (n= 16), and 4.5% (n= 19) patients, respectively. In the remaining 62% (n= 264) of patients the serological evidence of HAV, HBV, or HDV infection was lacking, and none of them had ingested hepatotoxins. FHF was presumed to be caused by non-A, non-B virus(es) infection. Sera of 50 patients from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. ...