Taylor et al identified prognostic factors for a patient with fulminant hepatitis A virus (HAV). This can help to identify a patient who may benefit from more aggressive management. The authors are multiple hospitals in the United States and the U.S. Acute Liver Failure Study Group.
Patient selection: fulminant viral hepatitis A
Parameters:
(1) serum ALT in IU/L
(2) serum creatinine in mg/dL
(3) intubation
(4) pressors
Parameter
Findings
Points
serum ALT
< 2,600 IU/L
1
>= 2,600 IU/L
0
serum creatinine
<= 2.0 mg/dL
0
> 2.0 mg/dL
1
Intubation
no
0
yes
1
pressors required
no
0
yes
1
total number of risk factors =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the number of risk factors the worse the prognosis.
Performance:
• A score >= 2 had an AUC 0.90 for transplantation or death. The sensitivity was 92% and specificity 88%.
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