| Clinical Characteristics and Prognosis of Fulminant Hepatic Failure in Infants and Children. |
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Keum Cheon Kim, Ki Sup Chung |
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Department of Pediatrics, Yonsei University, College of Medicine, Seoul, Korea |
| 소아의 전격성 간부전증의 임상적 특성 및 예후 |
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김금전, 정기섭 |
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연세대학교 의과대학 소아과학교실 |
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Received: 24 May 1990 • Accepted: 18 July 1990 |
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| Abstract |
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29 patients admitted into Department of Pediatrics, Severance Hospital, Yonsei University, college
of medicine during 16 years period from 1974 to 1989 with the diagnosis of fulminant hepatic failure
were divided into 2 groups, live and expired groups. These patients were compared with sex, age
distribution and etiology and in order to find the factors responsible for death platelet counts,
prothrombin time, SGOT, SGPT, SGOT/SGPT ratio, albumin, ammonia, BUN and serum creatinine
were compared and analyzed during the worst clinical state and following results were obtained.
1) Among the 29 patients with fulminant hepatic failure, 6 patients were in the live group and 23
were in the expired group with a death rate of 79.3%. 10 cases (34.5%) among the 29 cases were less
than 1 year of age and the death rate was highest also for patients under the age of 1 being 90%.
2) Distribution of etiology was as follows: 21 cases (79.4%) were unknown origin, viral infection in
7 cases (24.2%) and hypoxia in 1 cases. 4 cases (13.7%) were due to hepatitis B virus and hepatitis A
virus, Epstein-Barr virus, herpes virus was 1 case (3.4%) each.
3) Clinical symptoms at times of admission were jaundice in 25 cases (86.2%), fever in 18 cases (62.
1%), vomiting in 16 cases (55.2%) and hepatomegaly was found in 25 cases (86.2%) which
splenomegaly was noted only 2 cases (6.9%).
4) The laboratory findings during the patients* worst clinical state between the live groups and
expired groups were significantly difference for platelet counts (p<0.05), but there were no difference
between 2 groups for WBC, platelet, SGOT, SGPT, albumin, ammonia, BUN and serum creatinine.
5) In the presence of complications, bleeding occur in 24 cases (82.8%), ascitis in 15 cases (51.7%),
renal failure in 12 cases (41.3%), electrolyte imbalnce such as hyponatremia and hypernatremia in 8
cases (34.8%), seizure in 7 cases (24.1%), sepsis and pulmonary hemorrhage in 6 cases each (20.6%),
hypoglycemia and disseminated intravascular coagulation (DIC) 4 cases each (13.8%). All patients
died when renal failure or electrolyte imbalance such as hyponatremia and hypernatremia, seizure,
pulmonary hemorrhage, hypoglycemia, DIC were present.
6) When the death rate was divided according to the stage of encephalopathy at time of admission,
stage I encephalopathy showed a death rate of 68.4% but all died beyond stage II. The death rate of
patients with hepatic encephalopathy after admission was 66.6% in stage II, 75.0% in stage III and
100% in stage IV. The average duration from appearance of jaundice to death was 11.5 days (1—30
days) and from appearance of encephalopathy to death was 5.7 days (1~39 days).
7) The death rate according to platelet counts was as follows:
The death rate for platelet counts above 150,000/mm3 was 33.3% but 88.9% for less than 150,000/
mm3, significantly increasing death rate for decreased platelet counts (p<0.05, Yates’ correction).
8) The average serum creatinine level was not significantly different between two groups (p>0.05),
but all 12 patients with serum creatinine greater than 1.5 mg/dl died and with significant increase in
the death rate (p<0.05, Yates’ correction).
In conclusion, the death rate in fulminant hepatic failure was significantly increased when throm-
bocytopenia was present or serum creatinine level was increased more than 1.5 mg/dl (p<0.05, Yates’
correction). All patients died when hepatic encephalopathy greater than stage II at the time of
admission or progress to stage IV, renal failure, electrolyte imbalance such as hyponatremia and
hypernatremia, seizure, pulmonary hemorrhage, hypoglycemia, DIC were present. |
| Key Words:
Fulminant hepatic failure |
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