Differential diagnosis of fulminant hepatic failure in India by Amarapurkar DN and Patel ND
This study reports on the analysis of a 56 patients with Fulminant Hepatic Failure (FHF) due to either viral infection (28) or infectious diseases (28) to understand the difference in the clinical picture and outcome. The study was prospectively conducted in 24 months and consisted in a careful case-control design. Of notice was the etiology of FHF which was accounted by almost 30% in the infective form while acute hepatitis E was the cause in more that 60% of the viral form. The severity of liver failure was significantly greater in the viral moiety where encephalopathy was 7 times more frequent and an increment of ALT activity more that 10 times above the normal value was found in all patients with viral hepatitis but only in one (3%) with infective hepatitis. More important was the observation that viral-related FHF was associated with a 50% mortality, a value 2 times higher that the infective-related liver failure. Although it remains to be established the curative role of the underlying infective disease in improving the outcome of FHF, the difference is clinically relevant. Accordingly, in the presence of a FHF, particularly in a patient originating from or traveling to endemic countries, a quick diagnosis of underlying infectious disease may help in changing the clinical course and the outcome of the life threatening condition.
