New Prognostic Scoring Model for Liver Transplantation in Patients with Non-Acetaminophen-Related Fulminant Hepatic Failure
| Autor: | Yasuhiro Miyake, Kohsaku Sakaguchi, Keiji Kita, Hiroshi Ikeda, Yasuyuki Araki, Haruhiko Kobashi, Yasushi Shiratori, Yasuhiro Makino, Yoshiaki Iwasaki, Masaharu Ando |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Fulminant Liver transplantation Severity of Illness Index Gastroenterology Fulminant hepatic failure Positive predicative value Internal medicine medicine Humans Prospective Studies Survival rate Acetaminophen Aged Retrospective Studies Transplantation business.industry Liver Failure Acute Middle Aged Prognosis medicine.disease Liver Transplantation Surgery Systemic inflammatory response syndrome Treatment Outcome Female business medicine.drug |
| Zdroj: | Transplantation. 80:930-936 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/01.tp.0000173651.39645.35 |
| Popis: | BACKGROUND Many patients with fulminant hepatic failure die before receiving liver transplantation because of the difficulty of pinpointing the suitable timing for liver transplantation. The revised King's College criteria are useful for patients with acetaminophen-related fulminant hepatic failure; however, in those with non-acetaminophen-related fulminant hepatic failure, a new prognostic system that can accurately identify the suitable timing for liver transplantation is required. METHODS Using the first sample consisted of eighty patients with fulminant hepatic failure, we examined 2-week poor prognostic parameters at the time of diagnosis of fulminant hepatic failure (day 1) and on days 4, 8, and 15, respectively, and a 2-week prognostic scoring model was constructed. To confirm the accuracy of this model, validation was performed in the second sample consisting of 26 patients. RESULTS Cause of fulminant hepatic failure (hepatitis B virus or indeterminate), hepatic coma grade (III or IV), systemic inflammatory response syndrome (yes) and ratio of total to direct bilirubin (> 2.0) were associated with 2-week outcomes during days 1-15. Each of these four parameters was valued at +1. The 2-week survival rate in patients scoring or = 80% in contrast to less than 30% in patients scoring > or = 3. When this scoring model was applied to the second sample, the sensitivity, specificity, and positive and negative predictive values were 87.5%, 90.0%, 93.3%, and 81.8%, respectively. CONCLUSIONS This scoring model may be useful for predicting 2-week outcomes and determining the suitable timing for liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure. |
| Databáze: | OpenAIRE |
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