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BMJ. 1990 Oct 27;301(6758):964-6.

Serial prothrombin time as prognostic indicator in paracetamol induced fulminant hepatic failure.

Author information

1
Liver Unit, King's College Hospital School of Medicine and Dentistry, London.

Abstract

OBJECTIVE:

To find out whether changes in the daily prothrombin time are of prognostic importance in patients with paracetamol induced fulminant hepatic failure.

DESIGN:

Retrospective study.

SETTING:

The Liver Unit, King's College Hospital, London.

PATIENTS:

150 Consecutive patients with paracetamol induced fulminant hepatic failure admitted between October 1986 and February 1989.

MAIN OUTCOME MEASURE:

Death.

RESULTS:

Of the 150 patients, 72 (48%) died. In all, 34 of the 37 (92%) patients with a peak prothrombin time of greater than or equal to 180 seconds died as did 20 of the 41 (49%) with a time of 130-179 seconds, nine of the 25 (36%) with a time of 90-129 seconds, and nine of the 47 (19%) with a time of less than 90 seconds. Of the 42 patients with a continuing rise in prothrombin time between days 3 and 4 after overdose, 39 died (93%) compared with 21 of the 96 (22%) in whom the prothrombin time fell.

CONCLUSIONS:

These data indicate that a continued increase in prothrombin time on day 4 after overdose and a peak prothrombin time of greater than or equal to 180 seconds identify at an early stage those patients with a less than 8% chance of survival. Liver transplantation should be considered in patients meeting either of these criteria.

PMID:
2249026
PMCID:
PMC1664194
[Indexed for MEDLINE]
Free PMC Article
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