Appraisal of the Mortality in Acute Fulminant Viral Hepatitis

Abstract

In the period from January 1, 1966, to June 30, 1967, 16 of the 816 patients admitted to the Los Angeles County—University of Southern California Medical Center with a diagnosis of viral hepatitis acquired acute hepatic failure with encephalopathy. Six patients survived, and 10 died. All survivors had liver biopsies revealing changes characteristic of hepatitis of moderate severity, whereas all patients autopsied (five in number) had massive liver-cell necrosis. At the time of coma, however, there were no distinguishing clinical features or laboratory tests that allowed prediction of survival. Three patients had exchange transfusions; all died. The survival rate in our series of patients treated conservatively compares favorably with that in patients treated by exchange transfusion reported elsewhere, indicating that the effectiveness of new methods of therapy needs to be evaluated in a controlled trial.