The incidence of fulminant hepatic failure in acute viral hepatitis in Taiwan: Increased risk in patients with pre-existing HBsAg carrier state

The incidence of fulminant hepatitis in Taiwan was studied in a series of consecutive 523 patients with acute viral hepatitis including 11 with acute hepatitis A, 67 with acute hepatitis B, 124 with acute hepatitis NANB and 321 acute hepatitis in HBsAg carriers (patients who were HBsAg positive but anti-HBc IgM negative). Thirty-eight (7.3%) were recognized as fulminant hepatitis. The incidence of fulminant hepatitis was relatively low in patients with acute hepatitis A, B or NANB (2.0% or 4 out of 202), but was much higher in HBsAg carriers with acute hepatitis (10.6% or 34 out of 321). The incidence of fulminant hepatitis correlated significantly with the pre-existing HBsAg carrier state after adjustment of the confounding effect of age. The incidence of fulminant hepatitis in HBsAg carriers with acute hepatitis showed no significant difference in relation to sex or the presence of anti-delta in serum, but it increased proportionally with age. We concluded that the pre-existing HBsAg carrier state was a major risk factor for development of fulminant viral hepatitis. The etiology of superimposed acute hepatitis leading to fulminant hepatic failure might be varied according to the different geographic origins.