Prognosis Of Fulminant Hepatitis Research Articles

Etiology and prognosis of fulminant hepatitis and late‐onset hepatic failure in Japan: Summary of the annual nationwide survey between 2004 and 2009

To summarize the annual nationwide survey on fulminant hepatitis (FH) and late-onset hepatic failure (LOHF) between 2004 and 2009 in Japan. The annual survey was performed in a two-step questionnaire process to detail the clinical profile and prognosis of patients in special hospitals. Four hundred and sixty (n = 227 acute type; n = 233 subacute type) patients had FH and 28 patients had LOHF. The mean age of patients with FH and LOHF were 51.1 ± 17.0 and 58.0 ± 14.4 years, respectively. The causes of FH were hepatitis A virus in 3.0%, hepatitis B virus (HBV) in 40.2%, other viruses in 2.0%, autoimmune hepatitis in 8.3%, drug allergy-induced in 14.6% and indeterminate etiology in 29.6% of patients. HBV reactivation due to immunosuppressive therapy was observed in 6.8% of FH patients. The short-term survival rates of patients without liver transplantation (LT) were 48.7% and 24.2% for the acute and subacute type, respectively, and 13.0% for LOHF. The prognosis was poor in patients with HBV reactivation. The implementation rate for LT in FH patients was equivalent to that in the previous survey. The short-term survival rates of total patients, including LT patients, were 54.2% and 40.8% for the acute and subacute type, respectively, and 28.6% for LOHF. The demographic features and etiology of FH patients has gradually changed. HBV reactivation due to immunosuppressive therapy is problematic. Despite advances in therapeutic approaches, the prognosis of patients without LT has not improved.

Severe Alcoholic Hepatitis in Japan: Prognosis and Therapy

Recently, the incidence of alcoholic liver disease (ALD) has been increasing in Japan; this associated with an increase in alcoholic beverage consumption. Multiple organ failures are frequently observed in patients with severe alcoholic hepatitis (AH), most of whom have a poor prognosis similar to fulminant hepatitis; as well numbers of severe AH patients appear to be increasing. Although prognosis of fulminant hepatitis in Japan has been recently improved by intensive treatments such as plasma exchange (PE) that of severe AH has not changed. The objective of this study was to determine whether there was any factor that could determine the prognosis of severe AH. We carried out nation-wide survey by asking hospitals certified by the Japanese Society of Gastroenterology and hospitals related to ours hospital for the current status of patients seen with severe alcoholic hepatitis since 1998. We investigated correlations between various factors including blood laboratory data, presence of other organ failure, and prognosis. Mortality of patients with severe AH was high (66.4%). The ratio of female patients with severe AH (26%) was higher than that for other ALD (approximately 10%). Mean age was older (Alive: 44 +/- 11; Dead: 50 +/- 11 years old), white blood cell (WBC) counts were higher (11600 +/- 5200; 21800 +/- 13400/microl), red blood cell counts were lower (320 +/- 95; 265 +/- 72 x 10/microl) and prothrombin time (PT) was prolonged (36.2 +/- 10.4; 29.1 +/- 9.4%, respectively) in patients who had died than in patients who had survived. However, as all differences diminished after carrying out PE, we analyzed data in patients without PE. The results were similar to those in all patients. Prevalence of infection, gastrointestinal (GI) bleeding and disseminated intravascular coagulation (DIC) was higher in patients who had died. Although intensive treatments such as PE, hemodialysis, and anticoagulation therapy did not change the prognosis of severe AH, PE improved the prognosis of patients without either GI bleeding or DIC. WBC counts were also slightly higher in patients who had died after carrying out PE. Two cases had been cured by granulocytapheresis (GCAP) CONCLUSIONS: PE can compensate for and reduce the risk due to prolonged PT in patients with severe AH. These results suggest that the patients with markedly elevated WBC counts, prolonged PT, or anemia should, if possible, be treated at an earlier stage with an intensive treatment such as PE, hemodialysis, or anticoagulation therapy before infection, GI bleeding or DIC occurs. Further, GCAP might be useful for severe AH patients with higher WBC counts.

Clinical features of fulminant hepatitis in Nagasaki Prefecture, Japan.

Fulminant hepatitis is a rare but fatal disease. In the present study, we examined the changes in etiology and prognosis of fulminant hepatitis in Nagasaki Prefecture, Japan between 1980 to 1999. Eighty-one patients with fulminant hepatitis admitted to our hospitals from 1980 to 1999 were examined with respect to the etiology and prognosis. Fulminant hepatitis was due to hepatitis A virus in 2 (12%) cases, hepatitis B virus in 18 (22%) cases, unknown etiology in 50 (62%) cases, and drug-induced in 11(14%) cases. The number of cases in the first half of the study (1980-1989) was 47 and that of the latter half (1990-1999) was 34 cases. The incidence of fulminant hepatitis type B also decreased from 14 cases (30%) to 4 cases (12%) during these periods. The overall survival rate of fulminant hepatitis was 32%; it was equal in fulminant hepatitis type B, fulminant hepatitis of unknown etiology and fulminant drug-induced hepatitis. The survival rate of fulminant hepatitis type A was 100%, though only two cases were identified. Retrospectively, the survival rate in patients with a pre-encephalopathy period of < or = 10 days and aged < or = 39 years was significantly higher than in patients > or = 40 years of age (p<0.01). There was no difference between the two age groups when pre-encephalopathy period was > or = 11 days. The incidence of fulminant hepatitis especially that of fulminant hepatitis type B in Nagasaki Prefecture has decreased in recent years. The survival rate is significantly higher in younger patients with a short pre-encephalopathy period.

Significance of soluble TNF receptor-I in acute-type fulminant hepatitis

OBJECTIVE: Fulminant hepatitis is associated with apoptosis of hepatocytes, which is mediated via Fas and tumor necrosis factor (TNF) receptors. The clinical significance of apoptotic factors and these receptors was investigated in fulminant hepatitis. METHODS: Serum levels of TNF-α, soluble TNF receptor-I and -II, soluble Fas antigen, and Fas ligand were measured. Then, the relationships between these parameters and the severity or prognosis of fulminant hepatitis were studied. RESULTS: Serum levels of TNF-α, soluble TNF receptor-I, and soluble TNF receptor-II were increased in acute-type fulminant hepatitis. In particular, soluble TNF receptor-I was significantly higher than in patients with subacute-type fulminant hepatitis, severe acute hepatitis, acute hepatitis, or healthy controls. The soluble TNF receptor-I level continued to increase or remained high in patients who died of acute-type fulminant hepatitis, and eight of nine patients had a level >10 ng/ml. In contrast, the soluble TNF receptor-I level remained <10 ng/ml in survivors. Soluble Fas and soluble Fas ligand levels tended to increase in all types of acute liver disease and were not specific to fulminant hepatitis. CONCLUSION: Our findings suggested that monitoring the soluble TNF receptor-I level may help to assess the prognosis of acute-type fulminant hepatitis and that TNF might be associated with massive hepatic necrosis.

Significance of soluble TNF receptor-I in acute-type fulminant hepatitis.

Fulminant hepatitis is associated with apoptosis of hepatocytes, which is mediated via Fas and tumor necrosis factor (TNF) receptors. The clinical significance of apoptotic factors and these receptors was investigated in fulminant hepatitis. Serum levels of TNF-alpha, soluble TNF receptor-I and -II, soluble Fas antigen, and Fas ligand were measured. Then, the relationships between these parameters and the severity or prognosis of fulminant hepatitis were studied. Serum levels of TNF-alpha, soluble TNF receptor-I, and soluble TNF receptor-II were increased in acute-type fulminant hepatitis. In particular, soluble TNF receptor-I was significantly higher than in patients with subacute-type fulminant hepatitis, severe acute hepatitis, acute hepatitis, or healthy controls. The soluble TNF receptor-I level continued to increase or remained high in patients who died of acute-type fulminant hepatitis, and eight of nine patients had a level >10 ng/ml. In contrast, the soluble TNF receptor-I level remained <10 ng/ml in survivors. Soluble Fas and soluble Fas ligand levels tended to increase in all types of acute liver disease and were not specific to fulminant hepatitis. Our findings suggested that monitoring the soluble TNF receptor-I level may help to assess the prognosis of acute-type fulminant hepatitis and that TNF might be associated with massive hepatic necrosis.

Risk factors and prognosis of fulminant hepatitis A

Risk factors and prognosis of fulminant hepatitis A