FULMINANT HEPATIC FAILURE - 09/09/11
Résumé |
Fulminant hepatic failure (FHF) is an acute, catastrophic, rapidly fatal illness that results in severe hepatocyte damage or massive necrosis.46 Acute liver damage is sufficient to cause the rapid onset of encephalopathy and coagulopathy followed by multi-organ failure. Unlike progressive liver failure from underlying cirrhosis, FHF occurs in previously healthy individuals and carries an 80% mortality rate without liver transplantation. Approximately 2000 cases of FHF are reported annually in the United States, with no identifiable cause found in up to 50% of these cases.18 The clinical manifestations of this disorder are varied, and treatment is primarily supportive.
Fulminant hepatic failure usually is defined as either acute liver disease occurring in the absence of preexisting liver disease leading to encephalopathy within 8 weeks of the onset of symptoms77 or liver disease leading to encephalopathy within 2 weeks of the onset of jaundice.7 A new classification of fulminant hepatic failure has been proposed based on the interval from the onset of jaundice to the development of encephalopathy.59 This new classification provides a better determination of etiology and estimate of prognosis than did previous definitions. Three subgroups of fulminant hepatic failure have been defined as: (1) hyperacute, (2) acute, and (3) subacute.59 Hyperacute liver failure is encephalopathy that develops within 8 days of the onset of jaundice. The most common etiology is acetaminophen overdose. Occasionally, hepatitis A or B may present in this fashion. Acute liver failure is defined as the onset of encephalopathy 8 to 28 days after the development of jaundice. Viral hepatitis and idiosyncratic drug reactions make up the majority of cases that present in this fashion. Subacute liver failure is defined as the development of encephalopathy 4 to 26 weeks after the onset of jaundice.27 Patients with non-A non-B non-C hepatitis represent most of these cases. Patients with hyperacute liver failure have a reported survival rate of 36% without liver transplantation; the survival rate of patients with acute and subacute liver failure is reported at 7% and 14%, respectively.55, 59
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| Address reprint requests to David Bernstein, MD, Center for Liver, Biliary and Pancreatic Diseases, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501 |
Vol 14 - N° 2
P. 181-197 - avril 1998 Retour au numéro
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- UROSEPSIS IN THE CRITICAL CARE UNIT
- Franco Paradisi, Giampaolo Corti, Valerio Mangani
- ANTIBIOTIC RESISTANCE PROBLEMS IN THE CRITICAL CARE UNIT
- Jean Luc Mainardi, Jean Carlet, Jacques Acar
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