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 symptoms
77
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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.
Content published before 2002 is available via pay-per-view purchase only.
Subscribe:
Subscribe to Critical Care ClinicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Fulminant hepatitis A in intravenous drug users with chronic liver disease.Ann Intern Med. 1989; 110: 838-839
- Characterization of the molecular forms of fibronectin in fulminant hepatic failure.Hepatology. 1986; 6: 1340-1345
- The brain in fulminant hepatic failure.Lancet. 1991; 338: 156-157
- Fulminant herpes simplex hepatitis in an adult: Report of a case in renal transplant recipient.Gastroenterology. 1976; 70: 425
- Metabolic inhibition of polymorphonuclear leukocytes in fulminant hepatic failure.Lancet. 1976; 1: 1162-1163
- Multivariate analysis of prognostic factors in fulminant hepatitis B.Hepatology. 1986; 6: 648-651
- Fulminant and sub-fulminant liver failure: Definitions and causes.Semin Liver Dis. 1986; 6: 97-106
- Complications of intracranial pressure monitoring in fulminant hepatic failure.Lancet. 1993; 341: 157-158
- Cerebral edema and intracranial hypertension in acute liver failure: Distinct aspects of the same problem.Hepatology. 1991; 13: 376-379
- Serum alpha-fetaprotein in patients with massive hepatic necrosis.Gastroenterology. 1977; 72: 479-492
- Fulminant hepatic failure: The role of liver transplantation as primary therapy.Am J Surg. 1987; 154: 137-141
- Controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure.Gut. 1982; 23: 625-629
- Adenovirus hepatitis in an immunosuppressed adult patient.Am J Clin Pathol. 1979; 71: 352-355
- Liver transplantation for acute hepatic failure.Lancet. 1990; 335: 32-35
- Paracetamol-induced acute renal failure in the absence of fulminant liver damage.Br Med J. 1982; 284: 21-22
- Effect of posture on intracranial pressure and cerebral perfusion pressure in patients with fulminant hepatic failure and renal failure after acetaminophen self poisoning.Crit Care Med. 1990; 18: 286-289
- Early changes in intracranial pressure during machine and continuous haemofiltration.Int J Artif Organs. 1989; 12: 439-444
- Liver transplantation for fulminant hepatic failure in the United States: October 1987 through December 1991.Clin Transpl. 1994; 8: 274-280
- Brain water and acute liver failure: the emerging role of intracranial pressure monitoring.Hepatology. 1992; 16: 267-268
- Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure.J Hepatol. 1986; 2: 43-51
- Liver transplantation in the management of fulminant hepatic failure.Gastroenterology. 1989; 96: 1583-1588
- Randomized trial of steroid therapy in acute liver failure.Gut. 1979; 20: 620-623
- Fulminant viral hepatitis.(Review) Br Med Bull. 1990; 46: 462-480
- Persistence of hepatitis A virus in fulminant hepatitis and after transplantation.J Med Virol. 1990; 30: 131-136
- Hepatitis C virus-associated fulminant hepatic failure.N Engl J Med. 1996; 335: 631-634
- Tiopental infusion in the treatment of intracranial hypertension complicating fulminant hepatic failure.Hepatology. 1989; 10: 306-310
- Late onset hepatic failure: Clinical, serological and histological features.Hepatology. 1986; 6: 288-294
- Clinical and prognostic differences in fulminant hepatitis type A, B, and non-A non-B.Gut. 1983; 249: 1194-1198
- Chaparral ingestion: The broadening spectrum of liver injury caused by herbal medications.JAMA. 1995; 273: 489-490
- Renal function in fulminant hepatic failure: Haemodynamics and renal prostaglandins.Gut. 1987; 28: 1643-1647
- Failure of insulin and glucagon to stimulate liver regeneration in fulminant hepatic failure.J Hepatol. 1990; 10: 332-336
- Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of N-acetylcysteine.Lancet. 1990; 335: 1572-1573
- Serial prothrombin time as prognostic indicator in paracetamol induced fulminant hepatic failure.Br Med J. 1990; 301: 964-966
- Toxicity and deaths from 3,4-methylenedioxymethamphetamine (ecstasy).Lancet. 1992; 340: 384-387
- Hepatitis E as a cause of acute non-A, non-B hepatitis.Arch Intern Med. 1993; 153: 773-775
- Electron microscopic study of brain capillaries in cerebral edema from fulminant hepatic failure.Pediatr Res. 1992; 15: 1060-1066
- Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: A prospective controlled trial.Br Med J. 1991; 303: 1026-1029
- Intracranial and cerebral perfusion pressure changes before, during and immediately after orthotopic liver transplantation for fulminant hepatic failure.Q J Med. 1991; 79: 425-433
- Amanita poisoning: Treatment and role of liver transplantation.Am J Med. 1989; 86: 187-193
- Thrombin-antithrombin III complex in fulminant hepatic failure: Evidence for disseminated vascular coagulation and relationship to outcome.Eur J Clin Invest. 1990; 20: 627-631
- Hepatitis after germander administration: Another instance of herbal medicinal hepatotoxicity.Ann Intern Med. 1992; 117: 139-142
- Nucleotide sequence analysis of the precore region in patients with fulminant hepatitis B in the United States.Gastroenterology. 1993; 105: 1173-1178
- Predicting survival in fulminant hepatic failure using serum Gc protein concentration.Hepatology. 1995; 21: 101-105
- Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure.Hepatology. 1992; 16: 1-7
- H2 receptor antagonists in the prevention of acute upper gastrointestinal hemorrhage in fulminant hepatic failure.Gastroenterology. 1978; 74: 464-469
- Fulminant hepatitis: An ultrastructural study.J Hepatology. 1986; 369: 276-290
- Early changes in the permeability of the blood-brain produced by toxins associated with liver failure.Pediatr Res. 1990; 28: 227-231
- Recovery of failing liver after auxiliary heterotopic liver transplantation.Lancet. 1990; 335: 1156-1157
- Aetiology and management of renal failure in acute liver failure.in: Williams R. Hughes R.D. Acute liver failure: Improved understanding and better therapy. Miter Press, London1991: 47-53
- Heterotopic liver transplantation for fulminant hepatic failure—a bridge to recovery.Transplantation. 1990; 50: 524-526
- Elevated intracranial pressure and computed tomography of the brain in fulminant hepatic failure.Hepatology. 1991; 13: 209-212
- Serum and urinary zinc in fulminant hepatic failure.J Gastroenterol Hepatol. 1989; 4: 209-213
- Neurological sequelae in patients recovered from fulminant hepatic failure.Gut. 1987; 28: 93-95
- Early indicators of prognosis in fulminant hepatic failure.Gastroenterology. 1989; 97: 439-445
- Outcome of orthotopic liver transplantation in the aetiological and clinical variants of acute liver failure.QJ Med. 1988; 69: 817-824
- Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure.Gastroenterology. 1988; 94: 1186-1192
- Coagulopathy of FHF.Semin Liv Dis. 1986; 6: 159-163
- Fulminant hepatic failure.in: Schiff L. Schiff E. Diseases of the Liver. ed 7. J.B. Lippincott, Philadelphia1993: 1082-1090
- Acute liver failure: Redefining the syndromes.Lancet. 1993; 342: 273-275
- Protein turnover in acute and chronic liver disease.Acta Chir Scand. 1981; 91: 91-101
- Liver transplantation for severe Amanita phalloides mushroom poisoning.Am J Surg. 1990; 159: 493-499
- Acute hepatic failure: The emerging role of orthotopic liver transplantation.Mayo Clin Proc. 1989; 64: 424-428
- Acid-base and metabolic disturbances in fulminant hepatic failure.Gut. 1975; 16: 144-149
- Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant liver failure.Hepatology. 1993; 17: 196-201
- Prospective study of bacterial infection in acute liver failure: An analysis of fifty patients.Hepatology. 1990; 11: 49-53
- Serologic markers with fulminant hepatitis in persons positive for hepatitis B surface antigen: A worldwide epidemiologic and clinical survey.Ann Intern Med. 1988; 108: 380-383
- Fulminant hepatic failure and orthotopic liver transplantation.Semin Liver Dis. 1989; 9: 189-194
- A randomized controlled trial of prostaglandin E2(PEG2) in the treatment of fulminant hepatic failure.Hepatology. 1992; 16: 88A
- Fulminant hepatic failure.in: Diseases of the Liver and Biliary System. Blackwell, Oxford1993: 102-113
- Immunoglobulin M antibody against hepatitis B core antigen for the diagnosis of fulminant type B hepatitis.Gastroenterology. 1983; 84: 604
- Biochemical and clinical response of fulminant viral hepatitis to administration of prostaglandin.Eur J Clin Invest. 1989; 84: 1063-1069
- Fulminant hepatitis.Springers Seminars in Immunopathology. 1990; 12: 33-45
- Fulminant hepatitis in primary human herpesvirus-6 infection.N Engl J Med. 1991; 324: 1290
- Acute liver failure following influenza B infection (Letter).NZ Med J. 1994; 107: 382
- Electron microscopic evaluation of brain edema in rabbits with galactosamine-induced fulminant hepatic failure: Ultrastructure and integrity of the blood-brain barrier.Hepatology. 1987; 7: 1272-1277
- Incidence and pathophysiology of pulmonary edema in fulminant hepatic failure.Gastroenterology. 1978; 74: 859-865
- The management of fulminant hepatic disease.in: Popper H. Schaffner F. Progress in Liver Disease, vol 3. Grune & Stratton, New York1970: 282-298
- Nonsurgical management of fulminant hepatic failure.Current Opin Gastroenterol. 1996; 12: 231-236
- Amatoxins, phallotoxins, phallolysin, and antamanide: The biologically active components of poisonous Amanita mushrooms.CRC Crit Rev Biochem. 1978; 5: 185-260
- Intensive liver care and management of acute hepatic failure.Dig Dis Sci. 1991; 36: 820-826
- Indications for orthotopic liver transplant in fulminant liver failure.Hepatology. 1994; 20: S5-10
- Acute hepatitis associated with the Chinese herbal product Jin Bu Huan.Ann Intern Med. 1994; 121: 729-735
- Hepatitis B virus and apparent fulminant non-A, non-B hepatitis.Lancet. 1992; 339: 952-955
- Contribution of hepatitis C virus to non-A non-B fulminant hepatitis in Japan.Hepatology. 1994; 19: 829-835
- Chinese herbal medicine, fulminant hepatitis and liver transplantation.Am J Gastroenterol. 1996; 91: 2647-2648
Article info
Footnotes
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
Identification
Copyright
© 1998 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.
