Risk Factors for Mortality in Patient with Paracetamol-Induced Fulminant Hepatic Failure

 

Parameters on admission:

(1) Factor V activity in percent of normal

(2) ratio of Factor VIII activity to Factor V activity

(3) arterial pH

(4) Grade III or IV hepatic encephalopathy

 

Parameter	Finding	Points
Factor V activity	<= 10%	1
	> 10%	0
ratio of Factor VIII to Factor V	<= 30	0
	> 30	1
arterial pH	>= 7.3	0
	< 7.3	1
Grade III or IV encephalopathy	absent	0
	present	1

 

where:

• Patients who died had an elevated Factor VIII activity (up to 360%)

 

total number of poor prognostic factors =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 4

• The prognosis is worse as the number of risk factors increase.

• Another approach based on the performance features below is to do the factor ratio first. If positive then the mortality risk is 100%. The other factors could then help identify those with a negative ratio who are at risk.

 

Performance of each parameters:

• The sensitivity for arterial pH was 82% and the specificity was 82%

• The sensitivity for Factor V was 91% and the specificity was 55%.

• The sensitivity for the factor ratio was 91% and the specificity was 100%.

• The sensitivity for encephalopathy was 82% with specificity of 91%.