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Comparison of patients with fulminant versus near-miss fulminant druginduced hepatitis

Yilmaz Bilgic, Sami Akbulut, Orkide Kutlu, Cengiz Yilmaz, Cemil Colak, Mehmet Veysi Deviren, Yasir Furkan Cagin, Y

This study aimed to investigate and compare clinical and laboratory properties of patients with fulminant versus near-miss fulminant drug-induced hepatitis and the effect of these properties on mortality. Drug-induced hepatitis is the most common cause of acute liver failure in western countries. In severe drug-induced hepatitis, once encephalopathy develops, prognosis is poor without liver transplantation. Therefore, it is important to predict prognosis and know the clinical differences between patients developing encephalopathy and patients without encephalopathy. Patients with severe drug-induced hepatitis were researched retrospectively. The identified patients were divided into two groups: with encephalopathy (fulminant hepatitis; 25 patients) and without encephalopathy (near-miss fulminant hepatitis; 48 patients). The clinical properties and biochemical results of the two groups were compared, and parameters that could have an effect on mortality were evaluated. Hemoglobin, platelet count, albumin, and fibrinogen levels were found to be decreased, whereas, International Normalized Ratio (INR), total bilirubin, AST, LDH, lactate, and ammonia levels were found to be increased significantly in the fulminant hepatitis group. Creatinine, Model for End-Stage Liver Disease (MELD) score, and platelet count were found to be independent risk factors on mortality. The development of hepatic encephalopathy negatively impacts patient survival. Therefore, the prediction of a progression to fulminant hepatitis before hepatic encephalopathy develops and the clinical follow-up of patients accordingly are important issues. This study can provide significant insight into patients with severe drug-induced hepatitis.