Early indicators of prognosis in fulminant hepatic failure

Gastroenterology. 1989 Aug;97(2):439-45. doi: 10.1016/0016-5085(89)90081-4.


The successful use of orthotopic liver transplantation in fulminant hepatic failure has created a need for early prognostic indicators to select the patients most likely to benefit at a time when liver transplantation is still feasible. Univariate and multivariate analysis was performed on 588 patients with acute liver failure managed medically during 1973-1985, to identify the factors most likely to indicate a poor prognosis. In acetaminophen-induced fulminant hepatic failure, survival correlated with arterial blood pH, peak prothrombin time, and serum creatinine--a pH less than 7.30, prothrombin time greater than 100 s, and creatinine greater than 300 mumol/L indicating a poor prognosis. In patients with viral hepatitis and drug reactions three static variables [etiology (non A, non B hepatitis or drug reactions), age less than 11 and greater than 40 yr, duration of jaundice before the onset of encephalopathy greater than 7 days] and two dynamic variables (serum bilirubin greater than 300 mumol/L and prothrombin time greater than 50 s) indicated a poor prognosis. The value of these indicators in determining outcome was tested retrospectively in a further 175 patients admitted during 1986-1987, leading to the construction of models for the selection of patients for liver transplantation.

Publication types

  • Comparative Study

MeSH terms

  • Acetaminophen / poisoning
  • Adult
  • Chemical and Drug Induced Liver Injury / complications
  • Child
  • Drug Hypersensitivity / complications
  • Halothane / adverse effects
  • Hepatitis, Viral, Human / complications
  • Humans
  • Liver Diseases / etiology
  • Liver Diseases / mortality*
  • Liver Transplantation
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Statistics as Topic


  • Acetaminophen
  • Halothane