Clinical Management of Severe Acute Hepatic Failure with Special Reference to Liv.52 Therapy

Sethi, J.P., M.D., M.A.M.S., F.C.A.I. and Madhulika Sharma, M.D. Department of Medicine, S.M.S. Medical College and Hospital, Jaipur, India.

OBSERVATIONS AND RESULTS

Sixteen patients with acute hepatic failure were studied. There were 10 males and 6 females. The following Table shows the age incidence:

Table 1
Sl. No.	Age Groups	No. of cases in each group
1.	15 – 25	4
2.	26 – 35	6
3.	36 – 45	4
4.	46	2

Therapeutic categorisation was made into 2 groups. Patients in group ‘A’ (9 patients) in addition to general symptomatic and supportive treatment received prednisolone in usual dosage. Patients in group `B’ (7 patients) in addition to routine therapy received Liv.52 as concentrated drops. All the patients were of Grade IV coma. Duration of coma before the initiation of therapy could not be definitely established because of indefinite replies in majority of the cases. Serum bilirubin levels could not be used as indices for severity of encephalopathy since there had been no correlation between the level of serum bilirubin and the extent of mental aberration.

Table 2: Showing serum bilirubin levels and severity of encephalopathy
Group ‘A’ (9 cases)		Group ‘B’ (7 cases)
Coma grade	Serum Bilirubin levels in mg%	Coma grade	Serum Bilirubin levels in mg%
4	6.2	4	18.0
4	8.8	4	7.5
4	4.6	4	13.0
4	19.6	4	6.4
4	16.0	4	5.2
4	7.0	4	18.0
4	6.9	4	14.4
4	13.0
4	23.0

Results of therapy are shown in Table 3.

Table 3: Showing the results of therapy (Total number of cases 16)
Therapeutic grouping	No. of cases in each group	No. of cases who recovered	%
A (on Corticosteroids)	9	3	33%
B (On Liv.52)	7	3	43%

It is seen from Table 4 that the recovery from coma was earlier in cases on Liv.52 therapy. Average duration of the coma period with Liv.52 was 5.2 days as against 6 days with corticosteroids.

Table 4: Duration of coma in cases who recovered (Total number of cases who recovered, 6)
Therapeutic grouping	No. of cases in each group	No. of cases who recovered in each group	Duration of coma in days (Average)
A (on Corticosteroids)	9	3	6 days
B (On Liv.52)	7	3	5.2 days

DISCUSSION

Survival of patients with acute hepatic failure is variably reported in literature. In grade IV or V coma, it is of the order of 12.20%. However, since acute hepatic failure is potentially reversible, adequate therapy to prevent further liver damage and to promote liver cell regeneration will enhance the recovery rate in such cases. Liv.52 was used in this study to achieve these objectives. Its therapeutic efficacy was also compared with corticosteroid administration. Overall recovery rate in the study (both groups together) was about 37%. In the group treated with corticosteroids it was about 33% while in Group B treated with Liv.52 it was about 43%. Though there is not much significant difference in the recovery rate in the two groups, nevertheless it has been observed that the duration of coma after initiation of therapy in cases who survived was less in patients treated with Liv.52 than in those treated with corticosteroids. Thus, in patients who ultimately survived, recovery seemed to commence relatively earlier with Liv.52. Though, at present it is difficult to determine the value of this type of therapy from such a limited study, nevertheless it indicates the relative utility of Liv.52 in promoting early recovery. However, further controlled study on a larger group of patients with different grades of coma is needed before any definite conclusions can be drawn. In those who recovered on Liv.52 no side effects were noted. SUMMARY AND CONCLUSIONS Sixteen cases of hepatic coma of grade IV severity have been studied from the view point of therapy with corticosteroids and Liv.52. Nine cases received corticosteroids while Liv.52 was given to 7 cases. Three out of 9 cases (33%) on corticosteroid therapy recovered; while 3 out of 7 (43%) receiving Liv.52 recovered. Average duration of coma was 5.2 days in those recovering in Liv.52 group while it was observed to be 6 days in the corticosteroid group. Thus, this pilot study indicates the value of Liv.52 in promoting early recovery.


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