Bernuau et al identified prognostic factors for patients with fulminant hepatitis B. These can help identify patients who may require more aggressive management such as liver transplantation. The authors are from Hopital Beaujon (Clichy), Hopital Antoine Beclere (Clamart) and the Facultes de Medecine et de Pharmacie (Tours) in France.


Prognostic factors for poor survival identified on multivariate analysis:

(1) low Factor V levels

(2) normal or slightly increased serum alpha-fetoprotein (AFP) level

(3) HBsAg detectable in the serum using radioimmunoassay (RIA)

(4) older age


For the implementation the following values have been used to indicate poor prognosis:

(1) Factor V < 20% of normal

(2) serum alpha fetoprotein <50 ng/mL (2.5 times the upper limit of normal)

(3) age >= 45 years



• The age range for survivors was 30 +/- 12 years. the age range for nonsurvivors was 45 +/- 19 years.

• The reference range for AFP was <= 20 ng/mL. The mean for nonsurvivors was 16 ng/mL and for survivors was 140 ng/mL but the observed ranges were large.

• The absence of detectable HBsAg is a favorable prognostic sign, so the presence of detectable HBsAg is unfavorable.


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