Analysis Of The Prognostic Factors In 126 Patients With Fulminant Hepatitis

ObjectsFulminant hepatitis is one of the severest diseases and has deadly high mortality rate. It's important to estimate the prognostic factors exactly. However there was not enough clinical research about this. In this article, analysis and e-valuation was done on those about the prognostic factors with fulminant hepatitis, which might guide forecast and treatment.MethodsFulminant hepatitis inpatients taken in our department during Oct. 2001 and Feb. 2005 were retrospectively analysised. Death group and survival group were divided based on their prognosis. Difference of age, gender, clinical types, pathogeny, biochemistry target and syndrome were compared in two groups respectively.ResultsThere was no obvious influence to prognosis of fulminant hepatitis patients in gender, pathogeny and clinical types (p >0.05). However, to the patients whose age was ≤45 or >45 years, difference of mortality was highly markedly (p <0.01). Death group and survival group greatly differed in many biochemistry target such as ALT/AST, TBIL, DBII/TBIL, ALB,PTA, CHOL, CHE, AFP and Na~+. And syndromes were occurred in death group more than survival group (p<0.01).DiscussionFulminant hepatitis was a serious disease and mortality rate was high. Prognosis of fulminant hepatitis was influenced by many factors. In this article, based on observation of 126 patients, I found mortality rate raised with age increasing. 45 group was greatly different from >45 group. ALT and AST were targets that could reflect damnification of liver, but there was no obvious difference between death group and survival group. However, ALT/AST differed deadly between the two groups. The lower ALT/AST was, the higher mortality rate was. Bilirubin is a sensitive target estimating prognosis of fulminant hepatitis , and bilirubin in serum heighten when liver cells is damnified. Death group and survival group greatly differed in DBIL/TBIL in this reach, and the lower DBIL/TBIL was, the higher mortality rate was. Thrombin, cholesterol, albumin and cholinesterase are all synthesized in liver. liver cells of fulminant hepatitis necrotize heavily, and synthetic function of liver is so damaged that the level of thrombin, cholesterol, albumin and cholinesterase falls down. So cholesterol, albumin, cholinesterase and prothrombin time activity are correlative with prognosis of fulminant hepatitis. AFP could reflect regenesis of liver cells. AFP levels of two groups increased, and survival group exceeded death group, which suggested regenesis of liver cells and better prognosis. Electrolytical turbulence often occurs in fulminant hepatitis patients, and hyponatremia and hypokalemia are the most familiar. In the article, concentration of natrium in death group was lower than in survival group. All kinds of syndrome could appear in fulminant hepatitis because of hypohepatia and immunodeficiency. Syndrome means high death rate, and two or more two syndromes mean higher death rate. Bacteroidal peritonitis occurs the highest frequency, and 50% fulminant hepatitis might occur. Death rate of hepatic renal syndrome is the highest, 96.4% , and hepatic encephalopathy and alimentary haemorrhage is the second. With hepatic en-cephalopathy aggravating, death rate increased.