rum bilirubin, and prothrombin time prolongation over The profiles of patients with fulminant hepatic failure controls at admission were related to survival (P õ .
01). (FHF) from developing countries have not been reportedThe rapidity of onset of encephalopathy and cause of earlier. The current study was conducted prospectively, FHF did not influence the outcome. Cox's proportional at a single tertiary care center in India, to document the hazard regression showed age ¢40 years, presence of demographic and clinical characteristics, natural cerebral edema, serum bilirubin ¢15 mg/dL, and procourse, and causative profile of patients with FHF as thrombin time prolongation of 25 seconds or more over well as to define simple prognostic markers in these pacontrols were independent predictors of outcome. tients. Four hundred twenty-three consecutive patients Ninety-three percent of the patients with three or more with FHF admitted from January 1987 to June 1993 were of the above prognostic markers died. The sensitivity, included in the study. Each patient's serum was tested specificity, positive predictive value, and the negative for various hepatotropic viruses. Univariate Cox's repredictive value of the presence of three or more of these gression for 28 variables, multivariate Cox's proporprognostic factors for mortality was 93%, 80%, 86%, and tional hazard regression, stepwise logistic regression, 89.5%, respectively, with a diagnostic accuracy of 87.3%. and Kaplan-Meier survival analysis were done to idenWe conclude that most of our patients with FHF might tify independent predictors of outcome at admission.
Most reports on fulminant hepatic failure (FHF)from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be have been predominantly from the West, 1-9 and particuimplicated as the causative agent, and isolated HCV larly from three countries: the United Kingdom, 1,2 Ja-RNA could be detected in 7 (19%). Two hundred eighty-pan, 3,4 and France. 5 Based on these geographically limeight (66%) patients died. Approximately 75% of those ited observations, a new classification of this disease who died did so within 72 hours of hospitalisation. One entity into hyperacute, acute, and subacute liver failquarter of the female patients with FHF were pregnant. ure has been suggested.2 These authors also suggested Mortality among pregnant females, nonpregnant fe-the adoption of this classification universally for a unimales, and male patients with FHF was similar (P ú .1). form terminology. The latter study has not been able The cause and rapidity of the onset of hepatic enceph-
