Abstract
Serial hepatic volumetry calculated from the liver area on abdominal computed tomography was performed in 19 patients with fulminant hepatic failure to determine a relationship between liver volume and prognosis. All patients received intensified artificial liver support comprised of plasma exchange and hemodiafiltration using high-performance membranes, and 10 patients survived. Liver volume was significantly larger in survivors than in nonsurvivors, both in an initial volumetry performed at the onset of coma and in subsequent volumetry performed 10–20 days after the onset of coma. The difference became more significant in the subsequent volumetry because of the recovery of liver size in some of the survivors and progressive liver shrinkage in all nonsurvivors. All patients with a liver volume greater than 656 ml at 10–20 days after the onset of coma survived, whereas all but one patient with a liver volume less than that died. Multivariate analysis revealed only liver volume in subsequent volumetry had discriminatory power upon prognosis among six prognostic factors. These observations imply that in order to obtain an accurate prediction of fulminant hepatic failure by hepatic volumetry, serial studies at least until 10–20 days after the onset of coma are necessary.
Similar content being viewed by others
References
Honda H, Onitsuka H, Masuda K, Nishitani H, Nakata H, Watanabe K: Chronic liver disease: value of volumetry of liver and spleen with computed tomography. Radiat Med 8:222–226, 1990
Fisher MR, Gore RM: Computed tomography in the evaluation of cirrhosis and portal hypertension. J Clin Gastroenterol 7:173–181, 1985
Kamei T, Asou M, Taki K, Seto H, Futatsuya R, Ishizaki Y, Furumoto N, Soya T, Kakishita M: Evaluation of the degree of severity in liver cirrhosis by computed tomography. Radiat Med 3:197–203, 1985
Kumahara T, Muto Y, Moriwaki H, Yoshida T, Tomita T: Determination of the integrated CT number of the whole liver in patients with severe hepatitis: As an indicator of the functional reserve of the liver. Gastroenterol Jpn 24:290–297, 1989
Trey C, Davidson, CS: The management of fulminant hepatic failure.In Progress in Liver Disease, Vol 3. H Popper, F Schaffner, (eds). New York, Grune & Stratton, 1970, pp 282–290
Okamoto H, Okada S, Sugiyama Y, Tanaka T, Sugai Y, Akahane Y, Machida A, Mishiro S, Yoshizawa H, Miyakawa Y, Mayumi M: Detection of hepatitis C virus RNA by a two-stage polymerase chain reaction with two pairs of primers deduced from the 5′-noncoding region. J Exp Med 60:215–222, 1990
Okamoto H, Munekata E, Tsuda F, Takahashi K, Yotsumoto S, Tanaka T, Tachibana K, Akahane Y, Sugai Y, Miyakawa Y, Mayumi M: Enzyme-linked immunosorbent assay for antibodies against the capsid protein of hepatitis C virus with a synthetic oligopeptide. J Exp Med 60:223–233, 1990
Henderson JM, Heymsfield SB, Horowitz J, Kunter MH: Measurement of liver and spleen volume by computed tomography. Radiology 141:525–527, 1981
Opolon P: Significance of middle molecules in the pathogenesis of hepatic encephalopathy.In Advance in Hepatic Encephalopathy and Urea Cycle Diseases. G Kleinberger, P Ferenci, P Riederer, H Thuler (eds). Basel, Karger, 1984, pp 310–314
Yoshiba M, Yamada H, Yoshikawa Y, Fujiwara K, Toda G, Oka H, Sanjo T, Yamazaki Z, Idezuki Y, Inoue N, Sakai Y, Kunitomo T: Hemodiafiltration treatment of deep hepatic coma by protein passing membrane: Case report. Artif Organs 10:417–419, 1986
Inaba S, Kishikawa T, Zaitsu A, Ishibashi H, Kudo J, Ogawa R, Yoshiba M: Continuous haemoperfusion for fulminant hepatic failure. Lancet 338:1342–1343, 1991
Yoshiba M, Sekiyama K, Iwamura Y, Sugata F: Development of a reliable intensive liver support (ALS)-plasma exchange in combination with hemodiafiltration using high performance membranes. Dig Dis Sci 38:469–477, 1993
Redeker AG, Yamahiro HS: Controlled trial of exchange transfusion therapy in fulminant hepatitis. Lancet 1:3–6, 1973
O'Grady JG, Gimson AES, O'Brien CJ, Pucknell A, Hughes RD, Williams R: Controlled trial of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure. Gastroenterology 94:1186–1192, 1988
Denis J, Opolon P, Nusinovici V, Granger A, Darnis F: Treatment of encephalopathy during fulminant hepatic failure by haemodialysis with high permeability membrane. Gut 19:787–793, 1978
Peleman RR, Gavaler JS, Van Thiel DH, Esquivel C, Gordon R, Iwatsuki S, Starzl TE: Orthotopic liver transplantation for acute and subacute hepatic failure in adults. Hepatology 7:484–489, 1987
Bismuth H, Samuel D, Gugenheim J, Casting D, Bernuau J, Rueff B, Benhamou JP: Emergency liver transplantation for fulminant hepatitis. Ann Intern Med 107:337–341, 1987
Brems JJ, Hiatt JR, Ramming KP, Baldrich WJQ, Busuttil RW: Fulminant hepatic failure: The role of liver transplantation as primary therapy. Am J Surg 154:137–141, 1987
Chapman RW, Forman D, Peto R, Smallwood R: Liver transplantation for acute hepatic failure? Lancet 335:32–35, 1990
O'Grady JG, Alexander GJM, Hayllar KM, Williams R: Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97:439–445, 1989
Christensen E, Bremmelgaard A, Bahnsen M, Andreasen PB, Tygstrup N: Prediction of fatality in fulminant hepatic failure. Scand J Gastroenterol 19:90–96, 1984
Bernuau J, Goudeau A, Poynard T, Dubois F, Lesage G, Yvonnet B, Degott C, Bezeaud A, Rueff B, Benhamou JP: Multivariate analysis of prognostic factors in fulminant hepatitis B. Hepatology 4:648–651, 1986
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sekiyama, K., Yoshiba, M., Inoue, K. et al. Prognostic value of hepatic volumetry in fulminant hepatic failure. Digest Dis Sci 39, 240–244 (1994). https://doi.org/10.1007/BF02090192
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02090192