Bridging hepatic necrosis in acute viral hepatitis

Bridging hepatic necrosis has, in the past, been found to be of prognostic significance in patients with acute viral hepatitis. In two studies performed on a selected group of patients with acute viral hepatitis, one-third of the patients with bridging hepatic necrosis developed chronic liver disease. These patients differed from the average hepatitis patient in that they were more severely ill and a higher percentage of them had acute viral hepatitis Type B. As all army personnel in Israel who develop jaundice and are suspected of having acute viral hepatitis are hospitalized, regardless of their clinical state, they constitute a group of patients not preselected for severity of illness. Forty-eight soldiers diagnosed clinically and biochemically as having viral hepatitis were hospitalized during a 27-month period. After giving informed consent, 41 of them underwent a liver needle biopsy within a few days of hospitalization. Each histological specimen was coded, and was then examined for bridging hepatic necrosis by three independent observers. Fourteen patients (34%) were found to have bridging hepatic necrosis. Clinically, these patients could not be clearly separated from the group without bridging hepatic necrosis, although hepatomegaly was more frequent among them, and their mean leukocyte count and bilirubin and alkaline phosphatase levels were higher. During a follow-up of more than 1 year, patients in both groups recovered completely. Four patients, two in each group, consented to a second liver needle biopsy, which was found to be normal. We conclude that bridging hepatic necrosis seems to be more common than expected, and does not seem to have the severe prognostic significance attributed to it in the past.