Biochemical and clinical response of fulminant viral hepatitis to administration of prostaglandin E. A preliminary report

Abstract

The effect of PG on patients with fulminant and subfulminant viral hepatitis (FHF) was studied. 17 patients presented with FHF secondary to hepatitis A (n = 3), hepatitis B (n = 6), and non-A, non-B (NANB) hepatitis (n = 8). 14 of the 17 patients had stage III or IV hepatic encephalopathy (HE). At presentation the mean aspartate transaminase (AST) was 1,844 ± 1,246 U/liter, bilirubin 232 ± 135 μmol/liter, prothrombin time (PT) 34 ± 18, partial thromboplastin time (PTT) 73 ± 26 s, and coagulation Factors V and VII 8 ± 4 and 9 ± 5%, respectively. Intravenous PGE1 was initiated 24-48 h later after a rise in AST (2,195 ± 1,810), bilirubin (341 ± 148), PT (36 ± 15), and PTT (75 ± 18). 12 of 17 responded rapidly with a decrease in AST from 1,540 ± 833 to 188 ± 324 U/liter. Improvement in hepatic synthetic function was indicated by a decrease in PT from 27 ± 7 to 12 ± 1 s and PTT from 61 ± 10 to 31 ± 2 s, and an increase in Factor V from 9 ± 4 to 69 ± 18% and Factor VII from 11 ± 5 to 71 ± 20%. Five responders with NANB hepatitis relapsed upon discontinuation of therapy, with recurrence of HE and increase in AST and PT, and improvement was observed upon retreatment. After 4 wk of intravenous therapy oral PGE2 was substituted. Two patients with NANB hepatitis recovered completely and remained in remission 6 and 12 mo after cessation of therapy. Two additional patients continued in remission after 2 and 6 mo of PGE2. No relapses were seen in the patients with hepatitis A virus and hepatitis B virus infection. Liver biopsies in all 12 surviving patients returned to normal. In the five nonrsponders an improvement in hepatic function was indicated by a fall in AST (3,767 ± 2,611 to 2,142 ± 2,040 U/liter), PT (52 ± 25 to 33 ± 18 s), and PTT (103 ± 29 to 77 ± 44 s), but all deteriorated and died of cerebral edema (n = 3) or underwent liver transplantation (n = 2). These results suggest efficacy of PGE for FHF, and further investigation is warranted.