Recent Advances in Acute and Fulminant Hepatitis in Japan.

Mochida, Satoshi; Fujiwara, Kenji

doi:10.2169/internalmedicine.40.175

Cited by 25 publications

(1 citation statement)

References 19 publications

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“…ALF in Japan has been typically regarded as fulminant hepatitis, for which the diagnostic criteria were established by the Inuyama Symposium held in 1981 [2]. Among patients with ALF, those showing histological findings of hepatitis (characterized by inflammatory lymphocyte infiltration), as well as 40% or less of the standardized prothrombin timeand grade II or more severe hepatic encephalopathy, are diagnosed as having “fulminant hepatitis”, which is classified as acute and subacute types in the same manner as ALF [2, 3]. Thus, fulminant hepatitis is almost synonymous with ALF in the United States and Europe as well as in Japan, except that patients without histological evidence of hepatitis are excluded from both disease conditions in Japan.…”

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confidence: 99%

Algorithm to determine the outcome of patients with acute liver failure: a data-mining analysis using decision trees

et al. 2012

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BackgroundWe established algorithms to predict the prognosis of acute liver failure (ALF) patients through a data-mining analysis, in order to improve the indication criteria for liver transplantation.MethodsThe subjects were 1,022 ALF patients seen between 1998 and 2007 and enrolled in a nationwide survey. Patients older than 65 years, and those who had undergone liver transplantation and received blood products before the onset of hepatic encephalopathy were excluded. Two data sets were used: patients seen between 1998 and 2003 (n=698), whose data were used for the formation of the algorithm, and those seen between 2004 and 2007 (n=324), whose data were used for the validation of the algorithm. Data on a total of 73 items, at the onset of encephalopathy and 5 days later, were collected from 371 of the 698 patients seen between 1998 and 2003, and their outcome was analyzed to establish decision trees. The obtained algorithm was validated using the data of 160 of the 324 patients seen between 2004 and 2007.ResultsThe outcome of the patients at the onset of encephalopathy was predicted through 5 items, and the patients were classified into 6 categories with mortality rates between 23% and89%. When the prognosis of the patients in the categories with mortality rates greater than 50% was predicted as “death”, the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the algorithm were 79, 78, 81, 83, and 75%, respectively. Similar high values were obtained when the algorithm was employed in the patients for validation. The outcome of the patients 5 days after the onset of encephalopathy was predicted through 7 items, and a similar high accuracy was found for both sets of patients.Conclusions Novel algorithms for predicting the outcome of ALF patients may be useful to determine the indication for liver transplantation.

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confidence: 99%

Algorithm to determine the outcome of patients with acute liver failure: a data-mining analysis using decision trees

et al. 2012

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Hepatic Microcirculation in Massive Liver Necrosis and Liver Regeneration

Mochida

Fujiwara

2001

Trends in Gastroenterology and Hepatology

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Indications and criteria for liver transplantation for fulminant hepatic failure

Fujiwara

Mochida

2002

J Gastroenterol

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Liver transplantation is the only effective treatment for potentially fatal cases of fulminant hepatic failure. However, it is very difficult to predict which cases will be fatal. The mortality may depend on alternative medical therapies. According to a nationwide survey of patients with fulminant hepatic failure presenting with encephalopathy of a coma grade greater than II within 8 weeks from the first symptoms of illness with a prothrombin time less than 40% of normal value, there were 93 patients in 311 hospitals between January and December 1998 in Japan. During this period, there were 11 patients with late-onset hepatic failure. The etiology was HAV infection in 4%, HBV infection in 44%, and nonA-nonB in 41%. Specific therapies were intensively used in all patients. The mean survival rate was 41%, with differences depending on the etiology. Six patients underwent liver transplantation, and 5 survived. In animal experiments, sinusoidal fibrin deposition caused massive liver necrosis. Activation of Kupffer cells and hepatic macrophages was a major contributing factor of this development. There were different mechanisms of such fibrin deposition. Tumor necrosis factor-alpha and superoxide anions released from hepatic macrophages after endotoxin administration destroyed endothelial cells, and then coagulopathy occurred in the sinusoids in rats given Propionibacteriom acnes, while a tissue factor from Kupffer cells played that role in rats undergoing partial hepatectomy. The prognosis of fulminant hepatic failure may depend on the etiology. The indication for liver transplantation for this disease must be carefully decided by analyzing the etiology, pathological conditions, and response to therapies in each case.

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Recent Advances in Acute and Fulminant Hepatitis in Japan.

Cited by 25 publications

References 19 publications

Algorithm to determine the outcome of patients with acute liver failure: a data-mining analysis using decision trees

Algorithm to determine the outcome of patients with acute liver failure: a data-mining analysis using decision trees

Hepatic Microcirculation in Massive Liver Necrosis and Liver Regeneration

Indications and criteria for liver transplantation for fulminant hepatic failure

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