Twenty patients with acute fulminant hepatic failure and stage II, III, or IV hepatic encephalopathy attributable to viral hepatitis were studied to assess the risk factors, as well as the affects of vigorous medical management. These patients were treated according to a protocol that directed aggressive medical management of fluid balance with electrolyte solutions, plasma, and blood; acid-base balance; coagulation defects with fresh frozen plasma; blood replacement as needed; dietary protein elimination; and orally administered neomycin sulfate.
Among the 20 patients there were eight survivors (40%). Seven of the 13 patients who were positive for the hepatitis B surface antigen (HBsAg) survived (54%), while one of the seven patients who were negative for HBsAg survived (14%). The stage of encephalopathy on admission did not correlate with survival. Patients under the age of 40 years had a 43% survival rate, while those over 40 years had a 33% survival rate. Conservative but vigorous medical management may improve survival in fulminant hepatic failure.
(Arch Intern Med 137:599-601, 1977)