Abstract: Objective To investigate the etiology, clinical outcome and influencing factors of 58 cases with acute hepatic failure (AHF) were reviewed. Methods A total of 58 patients with AHF (27 males and 31 females) admitted to our hospital from January 2015 to December 2020 were included, with an average age of 45 (28, 66) years. According to the clinical outcome, they were divided into survival group and death group. The clinical data of the two groups were compared and analyzed by multiple factors. Results According to the medical history information of patients, 44 cases with known causes and 14 cases with unknown causes. Etiology included drug sources, viral hepatitis and other causes. Drug sources included Chinese herbal medicine (10 cases, 17.4%), acetaminophen (7 cases, 12.1%), antibacterial drugs (4 cases, 6.9%), anti-tuberculosis drugs (2 cases, 3.4%), anti-tumor chemotherapy drugs (1 case, 1.7%) and anticoagulant drugs (phenylpropyl coumarin) (1 case, 1.7%). Viral hepatitis included 5 cases of hepatitis B virus (HBV) (8.6%), 2 cases of hepatitis E virus (HEV) (3.4%) and 1 case of hepatitis A virus (HAV), cytomegalovirus and EB virus (1.7%), respectively. There were 3 cases of extrahepatic malignant tumor metastasis (5.2%), 2 cases of alcoholism (3.4%), 2 cases of severe biliary tract infection (3.4%), 1 case of Budd-Chiari syndrome and 1 case of heart failure (1.7%). Comparing the clinical data, the age of survival group [40 (28, 58) years] was significantly lower than that of death group [47 (36, 66) years, Z=-2.205, P<0.05]. In the survival group, the numbers of hepatic encephalopathy in stage ≤2 and stage > 2 were 19 cases (86.4%) and 3 cases (13.6%), while in the death group, the numbers were 9 cases (25.0%) and 27 cases (75.0%), the difference was statistically significant (χ²=20.592, P<0.05). In the survival group, platelet (PLT), low density lipoprotein (LDH), prothrombin activity (PTA), international normalized ratio(INR) and arterial blood ammonia were 120 (88, 225) ×10⁹/L, 260 (124, 443) U/L, 30 (24, 61)%, 1.8 (1.2, 2.3) and 71 (60, 92) μmol/L, compared with the death group [86 (70, 148 ) ×10⁹/L, 382 (227, 593) U/L, 16 (12, 46)%, 3.4 (2.5, 3.83) and 152 (116, 170) μmol/L], the differences were statistically significant (Z=7.052,-9.450,15.600,-23.634 and -25.466, P<0.05). Logistic regression analysis showed that age, stage of hepatic encephalopathy, INR and arterial blood ammonia were independent risk factors for death of AHF patients (P<0.05).Conclusion Etiology of patients with AHF mainly includes drug-induced and viral hepatitis, with Chinese herbal medicine and HBV as the most common causes. In addition, age, stage of hepatic encephalopathy, INR and arterial blood ammonia are independent risk factors for death of AHF patients.

Key words: Acute hepatic failure, Chinese herbal medicine, Arterial blood ammonia