Aetiology and prognostic factors in acute liver failure in India

Authors

  • M. S. Khuroo,

    1. Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar Kashmir, India; Present addresses:
    2. Department of Medicine, King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia; and
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  • S. Kamili

    1. Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar Kashmir, India; Present addresses:
    2. Experimental Pathology Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention Atlanta, GA, USA
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Prof. Mohammad Sultan Khuroo, Department of Medicine (MBC 46), King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia. E-mail: khuroo@yahoo.com

Abstract

Summary.  The early prognostic indicators for acute liver failure in endemic zones for hepatitis E virus have not been determined. All consecutive patients with acute liver failure from a geographically defined region endemic for hepatitis E virus were studied over the period April 1989–April 1996. Demographic, clinical and biochemical parameters were recorded at presentation and serum samples were analysed for known viral hepatitis (A–E) markers. Multiple parameters were compared in survivors and non-survivors in a univariate analysis. All significant factors on univariate analysis were entered into a stepwise logistic regression analysis to identify independent variables of prognosis. The sensitivity and specificity of significant prognostic factors was then assessed.

A total of 180 [69 males and 111 females: age (mean ± SD) 31.1 ± 14.7 years] with acute liver failure were studied. Of these, 131 (72.8%) patients died. Hepatitis E virus was the aetiological cause in 79 (43.9%) patients, while hepatitis A virus, hepatitis B virus, hepatitis C virus and non-A, non-E agent/'s could be incriminated in four (2.1%), 25 (13.9%), 13 (7.2%) and 56 (31.1%) patients respectively. Of 83 women in childbearing age, 49 (59.0%) were pregnant, 33 (67.3%) of these were in the third trimester. Forty-seven (95.8%) pregnant women had HEV infection. Nine variables differed significantly between survivors and non-survivors on univariate analysis. Of these, four variables which predicted the adverse outcome on multivariate analysis were non-hepatitis-E aetiology, prothrombin time >30 s, grade of coma >2 and age >40 years in that order of significance. Pregnancy per se or duration of gestation did not adversely affect the prognosis. In endemic areas, hepatitis E virus is the commonest cause of acute liver failure. Acute liver failure occurs in a high proportion of pregnant women, mostly in third trimester. Early predictors of a poor outcome are non-E aetiology, prothrombin time >30 s, grade of coma >2 and age >40 years.

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