Severity Indices of Takahashi et al for Fulminant Viral Hepatitis B

Evaluation: A patient with fulminant non-A, non-B viral hepatitis on the day of onset for encephalitis.

Parameters:

(1) total bilirubin

(2) ratio of total to direct bilirubin

(3) age in years

(4) white blood cell count

(5) hazardous comorbid disease

(6) percent of prothrombin activity present (from 0 to 100)

(7) serum ALT relative to the upper limit of normal

ratio of total to direct serum bilirubin =

= (total serum bilirubin) / (direct serum bilirubin)

ratio of serum ALT to the upper limit of normal =

= (serum ALT) / (upper limit of normal)

where:

• The percent prothrombin activity is based on a clotting test with clotting time plotted as a function of the concentration of normal factor levels. As the percent decreases the clotting sections will be prolonged.

• Hazardous conditions include: cancer, aplastic anemia, malignant lymphoma, leukemia, cerebral or aortic aneurysm, coronary artery disease, valvular heart disease, chronic renal failure, hyperthyroidism, severe burn, severe trauma, autoimmune disease treated with immunosuppressive agents and pregnancy (column 1, page 1067).

total score =

= (2.75 * (points for total bilirubin)) + (2.75 * (points for total to direct bilirubin ratio)) + (2.7 * (points for age)) + (2.3 * (points for white blood cell count)) + (1.67 * (points for hazardous condition)) + (1.56 * (points for ALT ratio)) - (0.098 * (percent prothrombin activity)) - 0.88

Interpretation:

• The cutoff is > 0, with a positive score associated with increased mortality (identified 90% of the patients who died)..

• This can help identify a patient who should be evaluated for liver transplant early in the clinical course.

Performance:

• The sensitivity was 94% and specificity 77%.

• The positive predictive value is 90% and the negative predictive value is 86%.