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Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure
BACKGROUND: Distinguishing those patients with fulminant hepatic failure (FHF) and who require transplantation from those FHF patients who will survive with receiving only intensive medical care remains problematic, and this distinction is important because of the chronic shortage of donor livers. M...
Autores principales: | , , , , |
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Formato: | Texto |
Lenguaje: | English |
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The Korean Association of Internal Medicine
2007
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687618/ https://www.ncbi.nlm.nih.gov/pubmed/17616024 http://dx.doi.org/10.3904/kjim.2007.22.2.93 |
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author | Choi, Won-Choong Arnaout, Walid C. Villamil, Federico G. Demetriou, Achilles A. Vierling, John M. |
author_facet | Choi, Won-Choong Arnaout, Walid C. Villamil, Federico G. Demetriou, Achilles A. Vierling, John M. |
author_sort | Choi, Won-Choong |
collection | PubMed |
description | BACKGROUND: Distinguishing those patients with fulminant hepatic failure (FHF) and who require transplantation from those FHF patients who will survive with receiving only intensive medical care remains problematic, and this distinction is important because of the chronic shortage of donor livers. METHODS: To assess the applicability of two prognostic scoring systems, referred to as the London and Clichy criteria, we compared using both systems, at the time of admission, for 43 FHF patients (15 M/28 F; age: 3716 yrs). Acetaminophen (ACM) was the etiology for 16 patients, while the remaining 27 had other etiologies. All the patients received intensive care, and 18 (8 ACM/10 non-ACM) had investigational BAL support. RESULTS: For the ACM toxicity, neither the London nor the Clichy criteria exhibited acceptable sensitivity (71 vs 86%, respectively), specificity (78 vs 56%, respectively), a positive predictive value (71 vs 60%, respectively), a negative predictive value (78 vs 83%, respectively) or predictive accuracy (75 vs 69%, respectively) to predict patient survival without transplantation. In contrast, applying the London and Clichy criteria to the FHF patients with non-ACM etiologies showed a sensitivity of 96 vs 80%, respectively, a specificity of 100 vs 100%, respectively, a positive predictive value of 100 vs 100%,, respectively a negative predictive value of 67 vs 29%, respectively and a predictive accuracy of 96% vs 82%, respectively. CONCLUSIONS: Overall, the London criteria more accurately predicted the need for transplantation, and neither the London criteria nor the Clichy prognostic criteria accurately predicted the outcome of those patients who suffered with FHF due to ACM. BAL support may have contributed to the survival of the patients with ACM toxicity and who didn't undergo transplantation, and this survival exceeded the predictions of both prognostic systems. Additional multicenter studies should be conducted to refine these prognostic scoring systems, and this will help physicians rapidly identify those FHF patients who can survive without undergoing liver transplantation. |
format | Text |
id | pubmed-2687618 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2007 |
publisher | The Korean Association of Internal Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-26876182009-06-15 Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure Choi, Won-Choong Arnaout, Walid C. Villamil, Federico G. Demetriou, Achilles A. Vierling, John M. Korean J Intern Med Original Article BACKGROUND: Distinguishing those patients with fulminant hepatic failure (FHF) and who require transplantation from those FHF patients who will survive with receiving only intensive medical care remains problematic, and this distinction is important because of the chronic shortage of donor livers. METHODS: To assess the applicability of two prognostic scoring systems, referred to as the London and Clichy criteria, we compared using both systems, at the time of admission, for 43 FHF patients (15 M/28 F; age: 3716 yrs). Acetaminophen (ACM) was the etiology for 16 patients, while the remaining 27 had other etiologies. All the patients received intensive care, and 18 (8 ACM/10 non-ACM) had investigational BAL support. RESULTS: For the ACM toxicity, neither the London nor the Clichy criteria exhibited acceptable sensitivity (71 vs 86%, respectively), specificity (78 vs 56%, respectively), a positive predictive value (71 vs 60%, respectively), a negative predictive value (78 vs 83%, respectively) or predictive accuracy (75 vs 69%, respectively) to predict patient survival without transplantation. In contrast, applying the London and Clichy criteria to the FHF patients with non-ACM etiologies showed a sensitivity of 96 vs 80%, respectively, a specificity of 100 vs 100%, respectively, a positive predictive value of 100 vs 100%,, respectively a negative predictive value of 67 vs 29%, respectively and a predictive accuracy of 96% vs 82%, respectively. CONCLUSIONS: Overall, the London criteria more accurately predicted the need for transplantation, and neither the London criteria nor the Clichy prognostic criteria accurately predicted the outcome of those patients who suffered with FHF due to ACM. BAL support may have contributed to the survival of the patients with ACM toxicity and who didn't undergo transplantation, and this survival exceeded the predictions of both prognostic systems. Additional multicenter studies should be conducted to refine these prognostic scoring systems, and this will help physicians rapidly identify those FHF patients who can survive without undergoing liver transplantation. The Korean Association of Internal Medicine 2007-06 2007-06-30 /pmc/articles/PMC2687618/ /pubmed/17616024 http://dx.doi.org/10.3904/kjim.2007.22.2.93 Text en Copyright © 2007 The Korean Association of Internal Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Choi, Won-Choong Arnaout, Walid C. Villamil, Federico G. Demetriou, Achilles A. Vierling, John M. Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure |
title | Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure |
title_full | Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure |
title_fullStr | Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure |
title_full_unstemmed | Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure |
title_short | Comparison of the Applicability of Two Prognostic Scoring Systems In Patients with Fulminant Hepatic Failure |
title_sort | comparison of the applicability of two prognostic scoring systems in patients with fulminant hepatic failure |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687618/ https://www.ncbi.nlm.nih.gov/pubmed/17616024 http://dx.doi.org/10.3904/kjim.2007.22.2.93 |
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