{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T11:44:46Z","timestamp":1768995886625,"version":"3.49.0"},"reference-count":22,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1992,1]]},"abstract":"<jats:p>The value of coagulation factor V and VIII\/V levels as prognostic indicators was assessed in 27 patients with fulminant hepatic failure and compared with other predictive indices. Admission factor V levels were significantly reduced in 22 patients with paracetamol induced hepatic failure compared with a healthy control group (median 9.5% v 103%, respectively; p less than 0.001) and with lower values in non-A non-B hepatitis (median 2.7%). Values in the seven patients who died after paracetamol overdose, considered together with the four who underwent liver transplantation (group median 5.1%), were significantly lower than in the 11 who survived (median 11.8%; p less than 0.01). Median admission factor VIII was higher in those who died or received a transplant than in those who survived (298% v 162%; p less than 0.05), with both results higher than in healthy volunteers (median 104%; p less than 0.01) but lower than in non-A non-B hepatitis (median 340%). The ratio of factor VIII\/V on admission was less than 30 in all patients who survived paracetamol overdose (median 17) with corresponding values greater than 30 in 10 of 11 of those who died (median 39). A factor V result less than or equal to 10% on admission predicted an adverse outcome in 10 of 11 fatal cases, a 91% sensitivity which was greater than for the previously defined indicator of an arterial blood pH less than 7.30 on admission (sensitivity 82%). Prothrombin time at admission or on day 4 did not usefully predict outcome in our series. Predictive accuracy was 73% and 82% for factor V and admission acidosis respectively and 95% for factor V in conjunction with admission coma grade III or IV and factor VIII (ratio &gt; 30). These criteria may be useful in selecting patients with paracetamol induced fulminant hepatic failure for transplantation.<\/jats:p>","DOI":"10.1136\/gut.33.1.98","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"98-102","source":"Crossref","is-referenced-by-count":128,"title":["Coagulation factor V and VIII\/V ratio as predictors of outcome in paracetamol induced fulminant hepatic failure: relation to other prognostic indicators."],"prefix":"10.1136","volume":"33","author":[{"given":"L M","family":"Pereira","sequence":"first","affiliation":[]},{"given":"P G","family":"Langley","sequence":"additional","affiliation":[]},{"given":"K M","family":"Hayllar","sequence":"additional","affiliation":[]},{"given":"J M","family":"Tredger","sequence":"additional","affiliation":[]},{"given":"R","family":"Williams","sequence":"additional","affiliation":[]}],"member":"239","published-online":{"date-parts":[[1992,1,1]]},"reference":[{"key":"ref_1","first-page":"95","article-title":"Paracetamol poisoning","volume":"21","author":"Scott, D.K.; Vale, J.A.","year":"1990","unstructured":"Scott DK, Vale JA. 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Lancet 1990; 335: 1572-3.","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1136\/bmj.301.6758.964","article-title":"Serial prothrombin ratios: a prognostic indicator in paracetamol induced fulminant hepatic failure","volume":"301","author":"Harrison, P.M.; O'Grady, J.G.; Alexander, G.J.M.","year":"1990","unstructured":"Harrison PM, O'Grady JG, Alexander GJM, et al. Serial prothrombin ratios: a prognostic indicator in paracetamol induced fulminant hepatic failure. BMJ 1990; 301: 964-6.","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1136\/gut.17.7.489","article-title":"Factor VII levels as guide to prognosis in fulminant hepatic failure","volume":"17","author":"Gazzard, B.G.; Henderson, J.M.; Williams, R.","year":"1976","unstructured":"Gazzard BG, Henderson JM, Williams R. Factor VII levels as guide to prognosis in fulminant hepatic failure. Gut 1976; 17: 489-91.","journal-title":"Gut"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1055\/s-0038-1642778","article-title":"The effect of fulminant hepatic failure on protein C antigen and activity","volume":"59","author":"Langley, P.G.; Williams, R.","year":"1988","unstructured":"Langley PG, Williams R. The effect of fulminant hepatic failure on protein C antigen and activity. Thromb Haemost 1988; 59: 316-8.","journal-title":"Thromb Haemost"},{"key":"ref_21","first-page":"48","article-title":"Low antithrombin III in acute hepatic failure at term","volume-title":"ScandJ Haematol","volume":"29","author":"Mosvold, J.; Abildgaard, V.; Jenssen, H.","year":"1982","unstructured":"Mosvold J, Abildgaard V, Jenssen H, et al. Low antithrombin III in acute hepatic failure at term. 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