P0091 PP OUTCOME OF FULMINANT HEPATIC FAILURE IN CHILDREN IN RELATION TO HBV INFECTION AFTER UNIVERSAL VACCINATION PROGRAM

Abstract

Introduction: Fulminant hepatic failure (FHF) is a rare disorder with high mortality. The correlation of HBV infection and outcome is not clear.This study aimed to investigate the factors affecting the outcome of fulminant hepatic failure in children within 15 years of universal hepatitis B vaccination program. Methods: Retrospective review of a total of 94 cases (62 males and 33 females, ages 0 month to 15 years) recruited from nine tertiary referral centers in Taiwan during 1985~ 1999 respectively. Results: The overall mortality rate was 75%. Patients in the mortality group had older age, higher peak total bilirubin levels, longer prothrombin time, and lower percentage of HBV positivity (p<0.001, p=0.003, p=0.0027, and 0.042 respectively). Multivariate logistic regression showed that age greater than 2-year-old, PT > 50 seconds, bilirubin > 25 mg/dL were significantly correlated with mortality. Mortality was 65% in the HBV positive and 83% in the HBV negative group (p=0.05). In the HBV positive group, prothrombin time is noted to be the main factor affecting the outcome (p = 0.036). In HBV negative group, older age and higher peak value of total serum bilirubin suggested poor survival rate (p = 0.000, p = 0.006). The mortality rate of the HBV positive children in the consecutive three time periods without liver transplantation (1985~89, 1990~94, 1995~99) decreased (91%, 67%, 38%, p = 0.027). This change was not observed in the HBV-negative cases. Conclusion: HBV positive FHF had a lower mortality rate than HBV negative FHF. The two groups differed in risk factors affecting mortality.