FHA:
Indicadores pronósticos y de trasplante hepático
Indicador |
Etiología |
Criterios de trasplante |
King's College |
Paracetamol
|
pH < 7.3(Arterial) o |
Todos los siguientes:
Creatinina > 3.4 mg/dl
TP>100s. (INR >6.5)
EH grado III-IV
|
No Paracetamol |
TP>100s. (INR >6.5) o |
Tres de los siguientes: Etiologia NoA/NoB/Drogas/halotano
Ictericia > de 7 días antes de EH Edad < 10 o >40 TP>50s. (INR >3.5) Br >17.4 mg/dl (308 μMl/L)
|
Factor V |
Viral |
Edad < 30 años : FcV < 20% |
Cualquier edad: FcV<30% + EH III-IV |
Cociente FcVII/V |
Paracetamol |
>30 |
Biopsia hepática |
variada |
Necrosis
hepatocito > 70% |
Indice de severidad |
NANB,VHB |
Sin
referencias |
Fosfato arterial |
Paracetamol |
>1.2
mmol/L |
Lactato arterial |
Paracetamol |
>3.5
mmol/L |
Amonio arterial |
Variada |
>150-200
μMl/L |
APACHE II |
Paracetamol |
Score >
15 |
MELD/ΔMELD |
Paracetamol |
MELD>33,
ΔMELD>-0.4 |
Referencias
-
O’Grady JG, Alexander GJ,
Hayllar KM, et al: Early indicators of prognosis in fulminant hepatic
failure. Gastroenterology 1989;
97:439–445
-
Bernuau J, Goudeau A,
Poynard T, et al: Multivariate analysis of prognostic factors in
fulminant hepatitis B. Hepatology 1986;
6:648–651
-
Bernuau J, Samuel D,
Durand F, et al: Criteria for emergency liver transplantation in
patients with acute viral hepatitis and factor V below 50% of normal: A
prospective study. Abstr. Hepatology
1991; 14:49A
-
Pereira LM, Langley PG,
Hayllar KM, et al: Coagulation factor V and VIII/V ratio as predictors
of outcome in paracetamol-induced fulminant hepatic failure: Relation to
other prognostic indicators. Gut 1992;
33:98–102
-
Donaldson BW, Gopinath R,
Wanless IR, et al: The role of transjugular liver biopsy in fulminant
liver failure: Relation to other prognostic indicators.
Hepatology 1993; 18:1370–1376
-
Takahashi Y, Kumada
H, Shimizu M, et al: A multicenter study on the prognosis of fulminant
viral hepatitis: Early prediction for liver transplantation.
Hepatology 1994; 19:1065–1071
-
Schmidt LE, Dalhoff K:
Serum phosphate is an early predictor of outcome in severe acetaminophen-induced
hepatotoxicity. Hepatology 2002;
36:659–665 Bernal W, Donaldson N, Wyncoll D, et al: Blood lactate as an
early predictor of outcome in paracetamol-induced acute liver failure: A
cohort study. Lancet 2002; 359:558–563
-
Clemmesen JO, Larsen FS,
Kondrup J, et al: Cerebral herniation in patients with acute liver
failure is correlated with arterial ammonia concentration.
Hepatology 1999; 29:648–653
-
Mitchell I, Bihari
D, Chang R, et al: Earlier identification of patients at risk from
acetaminophen-induced acute liver failure. Crit Care Med 1998; 26:279–284
-
Schmidt LE, Larsen FS:
MELD score as a predictor of liver failure and death in patients with
acetaminophen-induced liver injury. Hepatology
2007; 45:789–79
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