Síndrome de falla orgánica múltiple en el curso de la insuficiencia hepática fulminante / Multiple systems organ failures in fulminant hepatic failure

RESUMO

Background: in fulminant hepatic failure, different organs systems become involved and a multiple systems organic failure may ensue. Aim: to perform a retrospective analysis of patients with fulminant hepatic failure admitted to UC Hospital Intensive Care Unit. Patients and methods: the charts of 14 patients (8 male) were analyzed. Multiple systems organic failure was defined as the presence of 2 or more organic dysfunctions. The evolution and mortality of these patients was analyzed. Results: patients` ages ranged from 30 to 74 years. The etiology of hepatic failure was B hepatitis in 4, non A non B hepatitis in 5, acute fatty liver of pregnancy in 3 and use of halothane and HIN in 2. ICU stay ranged from 1 to 44 days and 2 patients survived (one with drug induced liver failure and 1 with acute fatty liver of pregnancy). Mean prothrombin time was 19 ñ 9.5 per cent , total bilirrubin as 24 ñ 8.9 mg/dl and 12 patients reached grade IV encephalopathy. Mean admission APACHE II score was 21.5 ñ 6. Twelve patients developed multiple systems organic failure, that appeared 1.5 days or was already present at ICU admission; it lasted a mean of 2.5 days and all these 12 patients died. Neurologic involvement occured in 13 patients, renal in 10, cardiovascular in 9, respiratory in 5 and hematological involvement in 1. Conclusions: multiple systems organic failure is frequent in fulminant hepatic failure and is associated with a high mortality