Fulminant hepatic failure in multan: five years experience

ABSTRACT

Four hundred sixteen patients of fulminant hepatic failure [FHF] with a prevalence of 31.39% out of AVH patients were studied, who were admitted in Medical Unit II, Nishtar Hospital, Multan during January, 1987 to December, 1991. There were 323 male [77.64%] and 93 [22.36%] female patients. A progressive rise in number of FHF patients were noted during this period. Mean age was 40.31 +/- 16.84 years, male pts. Higher than female patients [42.33 +/- 17.18 and 35.35 +/- 15.51 years respectively]. In FHF patients hospital stay was shorter [6.18 +/- 6.06 V 7.95 +/- 1.65 days], disease was more acute [16.71 +/- 13.05 V 23.45 +/- 14.54 days], temperature higher [99.02 +/- 1.52 V 98.63 +/- 1.15 F], vomiting less frequent [12.73% V 17.82%], HbsAg positive rate higher [76.36% V 69.31%], serum bilirubin higher [9.67 +/- 5.87 V 5.7 +/- 4.83mg/dl], SALT higher [439.16 +/- 377.91 V 192.55 +/- 172.66 u/l], prothrombin time more prolonged [26.2 +/- 11.43 V 21.03 +/- 7.34sec.] and serum potassium lower [3.73 +/- 0.75 V 4.05 +/- 0.57 mmol/l] than in Non-FHF patients. Complications like ascites, hepatorenal syndrome and hypoprothrombinemia were more common in FHF [P<0.001]. Extremes of age [female<30years, P<0.001; male>60 years, P<0.01], short hospital stay [P<0.001] acute illness [P<0.001], higher temperature [P<0.001], serum bilirubin >10mg/dl [P<0.001], SALT>400u/l [P<0.01 in male, P<0.001 in female], were associated more frequently with FHF patients than Non-FHF patients. Overall mortality rate in FHF patients was very high [in total 61.3 V 4.5%, in male 53.5% V 6.9%, in female 88.2% V zero] as compared to Non-FHF patients. In male patients older age, short hospital stay, acute illness [all with P<0.001], high serum alkaline phosphatase, hypoglycemia, hypokalemia, prolonged prothrombin time and coma grade V [all with P<0.01] were associated with higher mortality and can be considered as poor prognostic factors. While coma grade I in both sexes [P<0.001] was associated with better survival. Such prognostic factors were of no value in female patients