Subacute Hepatic Failure: Is It a Distinct Entity?

We prospectively studied patients with subacute hepatic failure due to subacute hepatitis to find out 1) its relative prevalence compared to acute liver failure due to fulminant hepatitis and chronic liver failure due to chronic active hepatitis; 2) its clinical, biochemical, and morphological characteristics; 3) the role of virus B in its etiology; and 4) its prognosis and whether there were any predictors of bad prognosis.Thirty-three patients with subacute hepatic failure were registered during a 3-year period. Persistent or progressively deepening jaundice of 8 weeks duration and development of moderate to severe ascites in patients starting otherwise with typical features of acute viral hepatitis, defined the subacute hepatic failure group. The characteristic features included moderate to deep icterus, ascites, and peripheral edema; encephalopathy and gastrointestinal bleeding were infrequent. Liver function tests were abnormal but not diagnostic. Submassive and bridging necrosis of the liver were the main histological findings. Virus B etiology was recorded in 42% of the patients. Mortality was 66%. This condition is highly fatal and not infrequent in India.