Factors Predicting Fulminant Course of Acute Hepatitis A with Special Emphasis on Predictors of Mortality in Egyptian Children

Background/Aims: Hepatitis A virus (HAV), a non enveloped RNA virus, is particularly resistant and contagious. The infection is spread chiefly by feco-oral transmission and is a public health problem throughout the world. The main complication of HAV infection is fulminant hepatitis (FH). Methods: This study was done on 80 children aged from 1 to 17 years, 50 with acute hepatitis A virus and 30 acute hepatitis A who developed fulminant hepatic failure (FHF), 52 males and 28 females. In fulminant group 12 recovered with normal liver function, but 18 were died (case fatality 18/ 80 22.5%). Children recovered from fulminant liver failure had encephalopathy grade 1 or 2. Results: The study showed statistically significant differences between acute hepatitis A virus and low socioeconomic level and bad hygiene (p 0.004), children received anti convulsive therapy p 0.009 and also with diabetic children p 0.004. Total bilirubin 9.56, Direct bilirubin 5.11, ALT 1365.7, AST 1635.78, prothrombin time prolonged more than 25.87 seconds are indices for increasing the risk for developing fulminant hepatic failure in children with acute HAV (p 0.000001, p 0.00001, p 0.00001, p 0.0001, p 0.00001 respectively). Mortality rates was statistically significant related to prolonged prothrombin time, decreased ALT and AST, elevation of serum bilirubin and blood urea and serum creatinine and also with high grade of coma (grade 3 and 4). Conclusion: This study emphasize that early detection of FHF can be detected by simple tests and appropriate medical treatment could block further liver destruction and prevent development of FHF.