Journal of Gastroenterology

, Volume 42, Issue 6, pp 485–492

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

  • Yasuhiro Miyake
  • Yoshiaki Iwasaki
  • Ryo Terada
  • Kouichi Takaguchi
  • Kohsaku Sakaguchi
  • Yasushi Shiratori
Liver, Pancreas, and Biliary Tract



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.


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.


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.


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.

Key words

fulminant hepatitis B systemic inflammatory response syndrome ratio of total to direct bilirubin 


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  1. 1.
    Lee, WM 1993Acute liver failureN Engl J Med329186272PubMedCrossRefGoogle Scholar
  2. 2.
    O'Grady, JG, Alexander, GJ, Hayllar, KM, Williams, R 1989Early indicators of prognosis in fulminant hepatic failureGastroenterology9743945PubMedGoogle Scholar
  3. 3.
    Ostapowicz, G Fontana, RJ Schiodt, FV Larson, A Davern, TJ Han, SH U.S. Acute Liver Failure Study Group et al. 2002Results of a prospective study of acute liver failure at 17 tertiary care centers in the United StatesAnn Intern Med13794754PubMedGoogle Scholar
  4. 4.
    Rolando, N, Wade, J, Davalos, M, Wendon, J, Philpott-Howard, J, Williams, R 2000The systemic inflammatory response syndrome in acute liver failureHepatology327349PubMedCrossRefGoogle Scholar
  5. 5.
    Vaquero, J, Polson, J, Chung, C, Helenowski, I, Schiodt, FV, Reisch, J,  et al. 2003Infection and the progression of hepatic encephalopathy in acute liver failureGastroenterology12575564PubMedCrossRefGoogle Scholar
  6. 6.
    Miyake, Y, Sakaguchi, K, Iwasaki, Y, Ikeda, H, Makino, Y, Kobashi, H,  et al. 2005New prognostic scoring model for liver transplantation in patients with non-acetaminophen-related fulminant hepatic failureTransplantation809306PubMedCrossRefGoogle Scholar
  7. 7.
    Takahashi, Y, Kumada, H, Shimizu, M, Tanikawa, K, Kumashiro, R, Omata, M,  et al. 1994A multicenter study on the prognosis of fulminant viral hepatitis: early prediction for liver transplantationHepatology19106571PubMedGoogle Scholar
  8. 8.
    Bismuth, H, Samuel, D, Castaing, D, Williams, R, Pereira, SP 1996Liver transplantation in Europe for patients with acute liver failureSemin Liver Dis1641525PubMedGoogle Scholar
  9. 9.
    Riordan, SM, Williams, R 2003Mechanisms of hepatocyte injury, multiorgan failure, and prognostic criteria in acute liver failureSemin Liver Dis2320315PubMedCrossRefGoogle Scholar
  10. 10.
    Omata, M, Ehata, T, Yokosuka, O, Hosoda, K, Ohto, M 1991Mutations in the precore region of hepatitis B virus DNA in patients with fulminant and severe hepatitisN Engl J Med3241699704PubMedCrossRefGoogle Scholar
  11. 11.
    Liang, TJ, Hasegawa, K, Rimon, N, Wands, JR, Ben-Porath, E 1991A hepatitis B virus mutant associated with an epidemic of fulminant hepatitisN Engl J Med32417059PubMedCrossRefGoogle Scholar
  12. 12.
    Sato, S, Suzuki, K, Akahane, Y, Akamatsu, K, Akiyama, K, Yunomura, K,  et al. 1995Hepatitis B virus strains with mutations in the core promoter in patients with fulminant hepatitisAnn Intern Med1222418PubMedGoogle Scholar
  13. 13.
    Imamura, T, Yokosuka, O, Kurihara, T, Kanda, T, Fukai, K, Imazeki, F,  et al. 2003Distribution of hepatitis B viral genotypes and mutations in the core promoter and precore regions in acute forms of liver disease in patients from Chiba, JapanGut5216307PubMedCrossRefGoogle Scholar
  14. 14.
    Fujiwara, K, Mochida, S 2002Indications and criteria for liver transplantation for fulminant hepatic failureJ Gastroenterol37S747CrossRefGoogle Scholar
  15. 15.
    Alvarez, F, Berg, PA, Bianchi, FB, Bianchi, L, Burroughs, AK, Cancado, EL,  et al. 1999International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitisJ Hepatol3192938PubMedCrossRefGoogle Scholar
  16. 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;20:864–74Google Scholar
  17. 17.
    Rangel-Frausto, MS, Pittet, D, Costigan, M, Hwang, T, Davis, CS, Wenzel, RP 1995The natural history of the systemic inflammatory response syndrome (SIRS). A prospective studyJAMA27311723PubMedCrossRefGoogle Scholar
  18. 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)Google Scholar
  19. 19.
    Singer, AL, Olthoff, KM, Kim, H, Rand, E, Zamir, G, Shaked, A 2001Role of plasmapheresis in the management of acute hepatic failure in childrenAnn Surg23441824PubMedCrossRefGoogle Scholar
  20. 20.
    De Silvestro, G, Marson, P, Brandolese, R, Pittoni, G, Ongaro, G 2000A single institution's experience (1982–1999) with plasma-exchange therapy in patients with fulminant hepatic failureInt J Artif Organs2345461PubMedGoogle Scholar
  21. 21.
    He, NH, Wang, YJ, Wang, ZW, Liu, J, Li, JJ, Liu, GD,  et al. 2004Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: a comparative studyWorld J Gastroenterol10121821PubMedGoogle Scholar
  22. 22.
    Tillmann, HL, Hadem, J, Leifeld, L, Zachou, K, Canbay, A, Eisenbach, C,  et al. 2006Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experienceJ Viral Hepat1325663PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Yasuhiro Miyake
    • 1
  • Yoshiaki Iwasaki
    • 1
  • Ryo Terada
    • 1
  • Kouichi Takaguchi
    • 2
  • Kohsaku Sakaguchi
    • 1
  • Yasushi Shiratori
    • 1
  1. 1.Department of Gastroenterology & HepatologyOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
  2. 2.Department of Internal MedicineKagawa Prefectural Central HospitalTakamatsuJapan

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