Forms of hepatic failure in patients with liver cirrhosis.

Four pathophysiological types of hepatic failure suffered by 59 patients with liver cirrhosis were defined: chronic-recurrent type (Group A), acute exacerbation of chronic (Group B), post-operative type (Group C) and terminal type (Group D). The etiological, clinical and prognostic characteristics of the four types of hepatic failure were examined. More patients of Group C were seen in recent years than former years, but the opposite trend was observed in Group D. Direct causes or precipitating factors of hepatic failure differed depending upon the type of hepatic failure. Mortality rates were higher than 80% in the acute types of hepatic failure (Groups B, C and D), but were 50% in the chronic type (Group A). The association of multiple organ failure was frequently observed in Groups C (67%) and D (39%). Lactulose, nonabsorbable antibiotics and branched-chain amino acid solutions were used in combination for the treatment of patients of Groups A and D, with rates of arousal from encephalopathy of 75% and 29%, respectively. Even though further therapeutic maneuvers for acute hepatic failure were employed in Groups B and C, only low arousal rates of 38% and 27%, respectively, were obtained.