An institutional review of fulminant hepatic failure in an urban Canadian centre

Abstract

This study describes the demographic, etiologic, biochemical, and outcome features of 20 adult patients admitted to an urban intensive care unit with fulminant hepatic failure (FHF) from January 1989 to November 1994. The mean age of the group was 46±16 years (range: 18–70) with the majority (12/20, 60%) female. Fifteen (75%) of the 20 patients were encephalopathic prior to admission to the ICU while the remaining five (25%) developed encephalopathy during their ICU stay. The mean ICU stay was 5±4.6 days (range: 1–17 days). Acetaminophen toxicity was the most common cause of FHF (9/20, 45%) followed by hepatic ischemia (5/20, 25%), viral hepatitis (2/20, 10%), and miscellaneous or undiagnosed causes (4/20, 20%). The mortality rate was 95%. These findings indicate that in this Canadian centre the most common cause of FHF admissions to the intensive care unit is acetaminophen toxicity rather than viral hepatitis (British rather than American pattern) and is associated with an unexpectedly high mortality rate.