FHA: Indicadores pronósticos y de necesidad de transplante hepático

  Indicador Etiología Criterios de transplante
King's College Paracetamol
 		 pH (Arterial )< 7.3 ó
Todos los siguientes:
  creatinina > 3.4 mg/dl
  TP>100s. (INR >6.5)
  Encefalopatia grado III-IV
No Paracetamol TP>100s. (INR >6.5) ó
Tres de los siguientes
  NoA/NoB/Drogas/halotano
  Ictericia o encef. > de 7 dias
  Edad < 10 ,>40
  TP>50s. (INR >3.5)
  Br >17.4 mg/dl
Factor V Viral Edad < 30 años : Fc V < 20%
Cualquier edad: Fc V<30% + encef. III-IV
Cociente Fc VII/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 mc-mol/L
APACHE II Paracetamol Score > 15
MELD/ΔMELD Paracetamol MELD>33, ΔMELD>-0.4

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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