Skip to main content

Advertisement

SpringerLink
Log in

Systemic inflammatory response syndrome strongly affects the prognosis of patients with fulminant hepatitis B

  • Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Hepatitis B virus infection is the most frequent cause of fulminant hepatic failure. Recently, systemic inflammatory response syndrome has been reported to be important in patients with fulminant hepatic failure. However, prognostic factors for fulminant hepatitis B have not been fully examined. In this study, we analyzed prognostic factors for fulminant hepatitis B in order to accurately identify patients with fatal outcomes.

Methods

Of 110 consecutive patients with fulminant hepatic failure, 36 (33%) were diagnosed with fulminant hepatitis B. Five of the 36 patients received liver transplants, and we analyzed prognostic factors associated with fatal outcomes in the other 31 patients, who consisted of 15 men and 16 women with a median age of 45 (range, 20–74) years.

Results

Eleven patients (35%) survived without liver transplantation, and the remaining 20 (65%) died. Nonsurvivors were older and had a higher prevalence ratio of systemic inflammatory response syndrome than survivors. Treatments were similar between survivors and nonsurvivors. Using a multivariate Cox proportional hazard model, age (>45 years), systemic inflammatory response syndrome, and ratio of total to direct bilirubin (>2.0) were associated with fatal outcomes. In particular, 1-week and overall survival rates of patients with systemic inflammatory response syndrome at the time of diagnosis were 39% and 8%, respectively, while those of patients without systemic inflammatory response syndrome were 94% and 56%, respectively.

Conclusions

Systemic inflammatory response syndrome strongly affects the short-term prognosis of patients with fulminant hepatitis B, and patients with systemic inflammatory response syndrome might need urgent liver transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. WM Lee (1993) ArticleTitleAcute liver failure N Engl J Med 329 1862–72 Occurrence Handle8305063 Occurrence Handle10.1056/NEJM199312163292508 Occurrence Handle1:STN:280:DyaK2c%2FmslaitA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  2. JG O'Grady GJ Alexander KM Hayllar R Williams (1989) ArticleTitleEarly indicators of prognosis in fulminant hepatic failure Gastroenterology 97 439–45 Occurrence Handle2490426

    PubMed  Google Scholar 

  3. G Ostapowicz RJ Fontana FV Schiodt A Larson TJ Davern SH Han InstitutionalAuthorNameU.S. Acute Liver Failure Study Group et al. (2002) ArticleTitleResults of a prospective study of acute liver failure at 17 tertiary care centers in the United States Ann Intern Med 137 947–54 Occurrence Handle12484709

    PubMed  Google Scholar 

  4. N Rolando J Wade M Davalos J Wendon J Philpott-Howard R Williams (2000) ArticleTitleThe systemic inflammatory response syndrome in acute liver failure Hepatology 32 734–9 Occurrence Handle11003617 Occurrence Handle10.1053/jhep.2000.17687 Occurrence Handle1:STN:280:DC%2BD3cvpsFKnuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. J Vaquero J Polson C Chung I Helenowski FV Schiodt J Reisch et al. (2003) ArticleTitleInfection and the progression of hepatic encephalopathy in acute liver failure Gastroenterology 125 755–64 Occurrence Handle12949721 Occurrence Handle10.1016/S0016-5085(03)01051-5

    Article  PubMed  Google Scholar 

  6. Y Miyake K Sakaguchi Y Iwasaki H Ikeda Y Makino H Kobashi et al. (2005) ArticleTitleNew prognostic scoring model for liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure Transplantation 80 930–6 Occurrence Handle16249741 Occurrence Handle10.1097/01.tp.0000173651.39645.35

    Article  PubMed  Google Scholar 

  7. Y Takahashi H Kumada M Shimizu K Tanikawa R Kumashiro M Omata et al. (1994) ArticleTitleA multicenter study on the prognosis of fulminant viral hepatitis: early prediction for liver transplantation Hepatology 19 1065–71 Occurrence Handle8175127 Occurrence Handle1:STN:280:DyaK2c3ivFOgtQ%3D%3D

    PubMed  CAS  Google Scholar 

  8. H Bismuth D Samuel D Castaing R Williams SP Pereira (1996) ArticleTitleLiver transplantation in Europe for patients with acute liver failure Semin Liver Dis 16 415–25 Occurrence Handle9027954 Occurrence Handle1:STN:280:DyaK2s7nvFOiug%3D%3D

    PubMed  CAS  Google Scholar 

  9. SM Riordan R Williams (2003) ArticleTitleMechanisms of hepatocyte injury, multiorgan failure, and prognostic criteria in acute liver failure Semin Liver Dis 23 203–15 Occurrence Handle14523674 Occurrence Handle10.1055/s-2003-42639 Occurrence Handle1:CAS:528:DC%2BD2cXhs1Grtr8%3D

    Article  PubMed  CAS  Google Scholar 

  10. M Omata T Ehata O Yokosuka K Hosoda M Ohto (1991) ArticleTitleMutations in the precore region of hepatitis B virus DNA in patients with fulminant and severe hepatitis N Engl J Med 324 1699–704 Occurrence Handle2034246 Occurrence Handle1:STN:280:DyaK3M3jvV2isg%3D%3D Occurrence Handle10.1056/NEJM199106133242404

    Article  PubMed  CAS  Google Scholar 

  11. TJ Liang K Hasegawa N Rimon JR Wands E Ben-Porath (1991) ArticleTitleA hepatitis B virus mutant associated with an epidemic of fulminant hepatitis N Engl J Med 324 1705–9 Occurrence Handle2034247 Occurrence Handle1:STN:280:DyaK3M3jvV2isw%3D%3D Occurrence Handle10.1056/NEJM199106133242405

    Article  PubMed  CAS  Google Scholar 

  12. S Sato K Suzuki Y Akahane K Akamatsu K Akiyama K Yunomura et al. (1995) ArticleTitleHepatitis B virus strains with mutations in the core promoter in patients with fulminant hepatitis Ann Intern Med 122 241–8 Occurrence Handle7825758 Occurrence Handle1:CAS:528:DyaK2MXksFejtbc%3D

    PubMed  CAS  Google Scholar 

  13. T Imamura O Yokosuka T Kurihara T Kanda K Fukai F Imazeki et al. (2003) ArticleTitleDistribution of hepatitis B viral genotypes and mutations in the core promoter and precore regions in acute forms of liver disease in patients from Chiba, Japan Gut 52 1630–7 Occurrence Handle14570734 Occurrence Handle10.1136/gut.52.11.1630 Occurrence Handle1:CAS:528:DC%2BD3sXpsFyks7w%3D

    Article  PubMed  CAS  Google Scholar 

  14. K Fujiwara S Mochida (2002) ArticleTitleIndications and criteria for liver transplantation for fulminant hepatic failure J Gastroenterol 37 S74–7 Occurrence Handle10.1007/BF02990104

    Article  Google Scholar 

  15. F Alvarez PA Berg FB Bianchi L Bianchi AK Burroughs EL Cancado et al. (1999) ArticleTitleInternational Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis J Hepatol 31 929–38 Occurrence Handle10580593 Occurrence Handle10.1016/S0168-8278(99)80297-9 Occurrence Handle1:STN:280:DC%2BD3c%2Fks1Ggug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–74

    Google Scholar 

  17. MS Rangel-Frausto D Pittet M Costigan T Hwang CS Davis RP Wenzel (1995) ArticleTitleThe natural history of the systemic inflammatory response syndrome (SIRS). A prospective study JAMA 273 117–23 Occurrence Handle7799491 Occurrence Handle10.1001/jama.273.2.117 Occurrence Handle1:STN:280:DyaK2M%2FpslCntA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  18. Miyake Y, Iwasaki Y, Makino Y, Kobashi H, Takaguchi K, Ando M, et al. Prognostic factors for fatal outcomes prior to receiving liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure. J Gastroenterol Hepatol (in press)

  19. AL Singer KM Olthoff H Kim E Rand G Zamir A Shaked (2001) ArticleTitleRole of plasmapheresis in the management of acute hepatic failure in children Ann Surg 234 418–24 Occurrence Handle11524594 Occurrence Handle10.1097/00000658-200109000-00015 Occurrence Handle1:STN:280:DC%2BD3MvotVyltA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  20. G De Silvestro P Marson R Brandolese G Pittoni G Ongaro (2000) ArticleTitleA single institution's experience (1982–1999) with plasma-exchange therapy in patients with fulminant hepatic failure Int J Artif Organs 23 454–61 Occurrence Handle10941639 Occurrence Handle1:STN:280:DC%2BD3M%2FmslKnsg%3D%3D

    PubMed  CAS  Google Scholar 

  21. NH He YJ Wang ZW Wang J Liu JJ Li GD Liu et al. (2004) ArticleTitleEffects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: a comparative study World J Gastroenterol 10 1218–21 Occurrence Handle15069730

    PubMed  Google Scholar 

  22. HL Tillmann J Hadem L Leifeld K Zachou A Canbay C Eisenbach et al. (2006) ArticleTitleSafety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experience J Viral Hepat 13 256–63 Occurrence Handle16611192 Occurrence Handle10.1111/j.1365-2893.2005.00695.x Occurrence Handle1:STN:280:DC%2BD283gsFOqsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Yasuhiro Miyake, Yoshiaki Iwasaki, Ryo Terada, Kohsaku Sakaguchi & Yasushi Shiratori

  2. Department of Internal Medicine, Kagawa Prefectural Central Hospital, Takamatsu, Japan

    Kouichi Takaguchi

Authors
  1. Yasuhiro Miyake
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiaki Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryo Terada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kouichi Takaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kohsaku Sakaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasushi Shiratori
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miyake, Y., Iwasaki, Y., Terada, R. et al. Systemic inflammatory response syndrome strongly affects the prognosis of patients with fulminant hepatitis B. J Gastroenterol 42, 485–492 (2007). https://doi.org/10.1007/s00535-007-2029-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-007-2029-9

Key words

Search

Navigation