Prediction of Hepatic Encephalopathy Development in Patients With Severe Acute Hepatitis

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Abstract
To identify factors predicting the development of hepatic encephalopathy, 164 patients with severe acute hepatitis (SAH), defined as acute hepatitis having a prolonged prothrombin time (PT) of < 40% activity but without hepatic encephalopathy, were prospectively observed at 57 major liver centers in Japan. From the data of 65 patients enrolled from 1997 to 1998, a prediction equation was developed by multiple logistic regression analysis and prospectively evaluated using the data of 99 patients since 1999. Of the 164 patients with SAH, 51 (31%) developed hepatic encephalopathy. From the etiologic viewpoint, the percentages of patients developing encephalopathy were highest in non–A-E hepatitis (41.9%). A predictive model, logit(p) = 0.084 × age (year)+ 0.129 × serum total bilirubin (TB, in mg/dL)–0.158× prothrombin time (%)–2.434, was developed. In conclusion, old age, prolonged PT, elevation of TB, and non–A-E hepatitis are potential risk factors for developing encephalopathy in SAH.