Does the Direct Bilirubin/Total Bilirubin Ratio Reflect Prognosis in Acute Hepatic Failure?

The direct bilirubin/total bilirubin (D/T) ratio, which is not affected by such therapy as plasma exchange (PE), has been need for the determination of severity of acute hepatic failure. We studied 20 patients with acute hepatic failure who had received PE to examine whether the D/T ratio reflects prognosis, in association with tumor necrosis factor-alpha (TNF-a). Total bilirubin before the final PE was significantly higher than that before the initial PE (p=0.0064). No significant difference was observed between the D/T ratios before the initial PE and at the end of PE. No significant difference was observed between TNF-a before the initial PE and before the final PE. No significant correlation was observed among total bilirubin, D/T ratio, and TNF-a. No significant difference was observed between the survivor group and the nonsurvivor group in any factor. In the nonsurvivor group, total bilirubin before the final PE was significantly higher than that before the initial PE (p=0.0217). However, no significant difference was observed between the D/T ratios before the initial PE and before the final PE in the nonsurvivor group. In this study, the rise in total bilirubin reflected ineffectiveness of treatment. However, the D/T ratio failed to become an index of prognosis.