Study of prognostic factors in patients with fulminant Hepatitis Waiting for Liver Transplantation

• Grant number: 11/22470-3
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: February 01, 2012
• End date: November 30, 2013
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Estela Regina Ramos Figueira
• Grantee: Adriana Rochetto Assalin
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Fulminant hepatitis (FH) is defined by the onset of encephalopathy during the course of jaundice in patients without prior liver disease. FH has a survival rate of spontaneous recovery of about 20%. Liver transplantation (LT) is the only treatment option for severe cases. Prognostic criteria were established to select patients requiring LT. In this scenario, the King's College Hospital criteria, largely used to indicate LT, are based on the following parameters: patient age, etiology of acute hepatitis, the interval between the onset of jaundice/onset of encephalopathy, bilirubin level, and prothrombin time. The Clichy criteria, also frequently used, is based on the factor V level and degree of encephalopathy. However, these criteria only categorize the FH patients into two groups, good and poor prognosis, indicating LT in the latter group. However, there are no validated prognostic scores to select among patients referred to LT the sickest ones, in other words, those with a higher mortality rate that should be transplanted first. Objective: To identify prognostic factors for survival in patients with indication for LT for FH. Methods: This is an observational analytical retrospective study to evaluate 101 patients listed for urgent transplantation for FH, admitted to the Liver Transplant Unit from HCFMUSP, from February 2002 to June 2011. All enrolled patients were advised to LT according to the O'Grady criteria. We will analyze all the medical records and the electronic database HCMED. The following parameters will be recorded: onset of jaundice/ onset of hepatic encephalopathy interval, degree of encephalopathy, date of transplant indication, date of LT surgery, date of patient discharge, date of death, INR, total bilirubin, serum creatinine, serum lactate, AST, ALT, and MELD. Statistical analysis: It will be investigated prognostic factors associated with survival between LT indication and hospital discharge and the one-year survival. Survival curves will be analyzed using the Kaplan-Meier method and the univariate and multivariate analyses will be performed in the logistic regression analysis to identify factors of poor prognosis. P values <0.05 will be considered significant.(AU)