Clinical Prognostic Indicators (CPI) of Dhiman et al for a Patient with Fulminant Hepatic Failure

 

Patient selection: fulminant hepatic failure (includes presence of hepatic encephalopathy)

 

Prognostic indicators:

(1) age in years

(2) jaundice-encephalopathy interval in days (JEI, time between detection of jaundice and the onset of the hepatic encephalopathy)

(3) cerebral edema (based on the presence of any of the following: bradycardia, hypertension, increased muscle tone, unequal or abnormally reacting pupils, neurogenic hyperventilation, myoclonus, spontaneous decerebrate posturing)

(4) prothrombin time (PT) in seconds

(5) serum creatinine in mg/dL

(6) grade of hepatic encephalopathy (from 1 to 4)

 

Parameter	Finding	Points
age in years	< 50 years	0
	>= 50 years	1
jaundice to encephalopathy interval	<= 7 days	0
	> 7 days	1
cerebral edema	absent	0
	present	1
prothrombin time	< 35 seconds	0
	>= 35 seconds	1
serum creatinine	< 1.5 mg/dL	0
	>= 1.5 mg/dL	1
hepatic encephalopathy	1 to 2	0
	3 or 4	1

 

total CPI =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum CPI: 0

• maximum CPI: 6

• A CPI >= 3 was associated with mortality.

 

Performance:

• The presence of any 3 factors had a sensitivity of 74% and specificity of 87% for death, with a diagnostic accuracy of 79%.