Yonsei Med J.  2014 Jul;55(4):953-959. 10.3349/ymj.2014.55.4.953.

Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

• Shin HS
• Kim SP
• Han SH
• Kim DY
• Ahn SH
• Han KH
• Chon CY
• Park JY

• KMID: 2130819
• DOI: http://doi.org/10.3349/ymj.2014.55.4.953

Abstract

PURPOSE
Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA.
MATERIALS AND METHODS
A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation.
RESULTS
The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELD > or =23.5 was significantly more predictive than a SIRS score > or =3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD score > or =23.5, King's College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis.
CONCLUSION
MELD and SIRS scores > or =23.5 and > or =3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores > or =3 were valuable in predicting mortality of patients with a MELD > or =23.5.

Keyword

Acute liver failure; hepatitis A; mortality; prognostic indicator

MeSH Terms

Adult
Female
Hepatitis A/*complications
Humans
Liver Failure, Acute/*etiology/*mortality/pathology
Male
Multivariate Analysis
Prognosis
Prospective Studies
ROC Curve
Systemic Inflammatory Response Syndrome/complications

Figure

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  Fig. 1 Patient enrollment and clinical outcomes. ALF, acute liver failure.

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