Decreasing serum alpha-fetoprotein levels in predicting poor prognosis of acute hepatic failure in patients with chronic hepatitis B
Journal
Journal of Gastroenterology
Journal Volume
37
Journal Issue
8
Pages
626-632
Date Issued
2002
Author(s)
Abstract
Background. We carried out a study to predict the prognosis of acute hepatic failure in patients with chronic hepatitis B. Methods. We studied 25 consecutive patients with severe acute hepatitis. Severe acute hepatitis was defined as the development of acute hepatitis with a total serum bilirubin level of more than 15 mg/dl, prolonged prothrombin time (PT) of more than 5s, and hepatic encephalopathy (HE). All patients were assessed for King's criteria. Positivity for King's criteria was defined as PT more than 100s, or any three of the following: (age < 10 years or >40 years; cryptogenic or drug-induced hepatitis; jaundice for more than 7 days before the onset of HE; PT > 50 s; and serum bilirubin > 17.5 mg/dl). All but 1 patient had serial serum alpha-fetoprotein (AFP) levels measured every 1-2 weeks. Results. Eleven of 17 patients who died during the study met the King's criteria, whereas none of the surviving patients met the criteria. The sensitivity was 64.7% and the specificity, 100% for King's criteria in predicting a poor prognosis. In 16 of the 17 deceased patients, the AFP levels were reduced while their jaundice increased (sensitivity, 94.1%; specificity, 87.5%). All 17 deceased patients met the King's criteria and/or had reduced AFP levels while their jaundice increased (sensitivity, 100 %; specificity, 87.5%). Conclusions. Our observations suggest that the combined use of follow-up AFP levels and King's criteria is helpful in predicting the poor prognosis of severe acute hepatitis superimposed on chronic hepatitis B.
Subjects
Acute hepatic failure; Alpha-fetoprotein; Hepatic encephalopathy
Other Subjects
alpha fetoprotein; bilirubin; alpha fetoprotein; bilirubin; hepatitis B(e) antigen; acute hepatitis; adult; age; aged; article; bilirubin blood level; clinical article; controlled study; death; disease severity; female; hepatic encephalopathy; hepatitis B; human; jaundice; liver failure; male; prediction; priority journal; prognosis; prothrombin time; sensitivity and specificity; survival; toxic hepatitis; acute disease; blood; hepatitis B; liver failure; middle aged; mortality; prediction and forecasting; Acute Disease; Adult; alpha-Fetoproteins; Bilirubin; Female; Hepatic Encephalopathy; Hepatitis B e Antigens; Hepatitis B, Chronic; Humans; Liver Failure; Male; Middle Aged; Predictive Value of Tests; Prognosis
Type
journal article