All issues > Volume 33(10); 1990

Original Article

J Korean Pediatr Soc. 1990;33(10):1362-1373. Published online October 31, 1990.

Clinical Characteristics and Prognosis of Fulminant Hepatic Failure in Infants and Children.

Keum Cheon Kim¹, Ki Sup Chung¹

¹Department of Pediatrics, Yonsei University, College of Medicine, Seoul, Korea

Received: May 24, 1990;  Accepted: July 18, 1990.

Abstract

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.

Keywords :Fulminant hepatic failure