Discriminative and Prognostic Signs in Acute Hepatic Coma, Treated by Exchange Transfusions

Abstract

Discriminative and prognostic signs in 14 patients with acute hepatic coma, treated by exchange transfusion and permanent intensive care are described. Five patientssurvived and in none of them was there evolution towards cirrhosis. Nine patients diedduring the therapy, without any temporary clinical improvement. The clinical encephalopathy was initially very similar in both groups. Other parameters were, however, different and might have a prognostic value. The arterial blood ammonia and prothrombinvalue were initially more disturbed and improved only very partially with treatment in thegroup with lethal outcome. The EEG abnormalities were also more pronounced in the latter group; none of the patients with an EEG pattern 4b survived. The histological examination of liver specimens revealed more extensive necrosis with interlobular confluence inthe patients who died.

Galactose elimination capacity as a prognostic index in patients with fulminant liver failure.

“…Neither the prothrombin value nor blood ammonia differed between those who survived and those who died. This is in accordance with works by Reynolds (1969), and by Saunders et al (1972), but not with that of Demedts et al (1974), who found blood ammonia to be significantly higher in nine patients who died, compared with five patients who survived. Furthermore, the initial prothrombin values were not significantly different but before a third exchange transfusion was performed the prothrombin value (percentage of normal) was significantly higher in the survivors.…”

The role of transjugular liver biopsy in fulminant liver failure: Relation to other prognostic indicators

“…These results indicate that transjugular liver Fulminant liver failure (FLF) is a syndrome associated with a high mortality rate of 65% to 85% (1,2); however, survivors generally recover without sequelae. Various forms of medical treatment have been tried, but none has been shown to alter mortality of FLF (3,4).…”