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ISSN: 2161-0711
Journal of Community Medicine & Health Education
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About the Evaluation of Liver Disease by the Monitoring of Mahalanobis Distance: Examination for Acute Hepatic Failure

Hisato Nakajima1* Kouya Yano2 Ichirou Takagi3

1Department of Medical Insurance Guidance Room, The Jikei University Hospital, Japan

2Department of Industrial Engineering and Management, College of Industrial Technology, Nihon University, Japan

3Department of Gastroentero logy and Hepatology, The Jikei University School of Medicine, Japan

Corresponding Author:
Hisato Nakajima
Department of Medical Insurance Guidance Room
The Jikei University Hospital, Japan
E-mail: [email protected]

Received Date: May 18, 2013; Accepted Date: June 21, 2013; Published Date: June 24, 2013

Citation: Nakajima H, Yano K, Uetake S, Takagi I (2013) About the Evaluation of Liver Disease by the Monitoring of Mahalanobis Distance: Examination for Acute Hepatic Failure. J Community Med Health Educ 3:220. doi: 10.4172/2165-7904.1000220

Copyright: © 2013 Nakajima H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

It is Mahalanobis-Taguchi (MT) system to give the standard to evaluate a process of diagnosis of the doctor commonly. When Mahalanobis distance (MD) is calculated using MT system, it can be grasped as a unitary statistic. MD was calculated using data of fulminant hepatitis and acute on chronic hepatic failure, and a change of MD was compared with the outcome of patients. As a result, it was expressed for the numerical unified value that the data which changed complicatedly. When MD increase, the condition of a patient turns worse. When MD decreases, the condition of a patient is improved. This judgment was enabled easily and was useful as information in the medical treatment.

Keywords

Mahalanobis distance; Mahalanobis-taguchi system; Acute hepatic failure

Introduction

It may be said that the process of thinking that a doctor unifies majority items such as physical views, clinical examination, image diagnosis, and medical care is pattern recognition. It is Mahalanobis- Taguchi (MT) system [1] to give the standard to evaluate that is common to this pattern recognition. Kanetaka [2] used MT system for the judgment of medical examination for the first time. We also reported judgment and cost reduction [3-5] of the medical examination, future prediction of the health condition [6], pathologic grasp and diagnosis of liver disease [7,8]. Particularly, we pointed out that it was the index of liver transplant when a value of Mahalanobis distance (MD) by MT system continued over 1,000 for hepatic failure or hepatocellular carcinoma [9]. Furthermore, for autoimmune liver disease, we reported that the diagnosis of border line of autoimmune liver disease was possible by the reversion of the pattern of figure of factor effect made in MT system [10].

When this MT system is used, and MD is calculated by clinical data, the grasp as the unitary statistic of clinical data becomes possible [8-10]. We calculated MD using clinical data of fulminant hepatitis and acute on chronic hepatic failure this time, and we compared the change of value of MD with the outcome of patient. It was expressed for the numerical unified value that clinical data to change complicatedly. And a pathologic evaluation and a judgment of the curative effect were enabled easily. Because such system was useful as information in the medical treatment, we report it.

Methods

Nineteen acute hepatic failure used for this examination was 15 fulminant hepatitises and four acute on chronic hepatic failure. The details of 19 cases were shown in Table 1. The survivors were four fulminant hepatitises and were one acute type, three subacute type. The death was 15 cases and was three fulminant hepatitises acute type, eight subacute type and four acute on chronic hepatic failure.

Case Sex Age Diagnosis and type Cause Prognosis
1 Male 24 Fluminant hepatitius acute HBV alive
2 Female 22 Fluminant hepatitius subacute HBV alive
3 Male 50 Fluminant hepatitius subacute drug alive
4 Male 51 Fluminant hepatitius subacute unknown alive
5 Male 48 Fluminant hepatitius acute HBV dead renal failure
6 Male 54 Fluminant hepatitius acute unknown dead hepatic failure
7 Female 45 Fluminant hepatitius acute unknown dead hepatic failure
8 Male 32 Fluminant hepatitius subacute HBV dead hepatic failure
9 Male 73 Fluminant hepatitius subacute HBV dead hepatic failure
10 Male 73 Fluminant hepatitius subacute HBV dead renal failure
11 Male 28 Fluminant hepatitius subacute HBV dead GI bleeding
12 Female 71 Fluminant hepatitius subacute drug dead hepatic failure
13 Male 34 Fluminant hepatitius subacute unknown dead hepatic failure
14 Male 40 Fluminant hepatitius subacute unknown dead hepatic failure
15 Male 57 Fluminant hepatitius subacute unknown dead GI bleeding
16 Male 50 Acute on chronic Budd Chiari dead renal failure
17 Male 51 Acute on chronic cirrhosis dead GI bleeding
18 Female 71 Acute on chronic HBV dead renal failure
19 Female 62 Acute on chronic alcohol dead renal failure

Table 1: The details of 15 cases of fluminant hepatitis and 4 cases of acuto on chronic.

The data of following 18 items were used for this examination. There was the item in hepatic coma grade (coma), ammonia (NH3) microgram/dl, number of platelets (PLT) 109/L, prothrombin time (PT) %, hepaplastin test (HPT)%, aspartate aminotransferase (AST)/ IU/L, alanine aminotransferase (ALT) IU/L, lactate dehydrogenase (LDH) IU/L, cholinesterase (ChE) IU/L, total bilirubin (T.B) mg/dl, alkaline phosphatase (ALP) IU/L, leucineaminopeptidase (LAP) IU/L, gamma-glutamyltranspeptidase (rGT) IU/L, Urea nitrogen(UN) mg/ dL, creatinine (Cr) mg/dL, total cholesterol (T.C) mg/dL, total protein (T.P) g/dL, albumin (ALB) g/dL.

The unit space of MT system is defined individually. In addition, it is evaluated how much an object is away from the unit space by a level of MD. MT system is divided into MT method, MT Ajoint method, Taguchi-Schmidt method and Taguchi method. The MT method used this time is a method using an inverse matrix using MD, and it’s precision is higher than other methods. It is the characteristic of this method that the target average by unit space becomes “MD=1”. The data of 18 items of 30 physically normal people were shown in Table 2, and these data were used for making of the unit space. In addition, the data of each case used for examination were shown in Tables 3-5. The data of 18 items of these 19 cases were used, and MD was calculated by MT method. Hepatic coma grade assumed it a five level from zero, and numerical value data were just used for other 17 items.

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
0 38 20.4 97 74 14 6 219 580 0.2 299 187 18 9 0.6 187 6.7 3.8
0 35 33.3 87 88 17 21 217 334 0.6 332 225 44 19 0.4 200 6.9 4.1
0 29 24.9 87 100 12 10 216 385 0.4 306 195 17 15 0.5 198 6.7 3.5
0 21 24.8 93 100 23 26 206 598 0.5 287 210 25 8 1 214 8.2 4.3
0 35 20.5 100 94 19 15 215 378 0.4 386 207 26 14 0.9 202 7.1 3.7
0 24 31.2 94 96 28 21 226 505 0.7 312 227 23 9 0.3 216 6.7 3.9
0 39 25.4 70 90 17 13 226 361 0.7 178 186 10 14 0.4 149 6.8 4.1
0 20 22.8 84 81 16 14 223 427 0.4 261 240 48 15 0.6 208 7.1 4.1
0 40 26.1 100 100 13 12 205 568 0.3 300 267 8 10 0.8 213 7.8 4.7
0 31 22.1 89 93 12 14 144 336 0.8 136 143 38 17 0.7 147 6.9 4.5
0 39 27.4 87 81 11 9 145 280 0.2 140 137 2 18 0.8 139 6.9 3.9
0 29 20.9 97 100 18 16 194 623 0.8 201 208 23 15 0.7 183 7.2 4.1
0 38 24.4 100 100 24 23 242 556 0.8 194 182 10 17 0.4 218 7.2 4.4
0 47 29.1 94 94 21 21 176 700 0.4 267 161 11 18 0.5 189 6.8 4.2
0 20 28.4 86 93 13 11 199 486 0.5 400 229 8 14 0.6 133 7.1 4.1
0 38 31.3 87 100 10 6 170 614 0.2 315 169 13 11 0.3 199 7.2 4.1
0 47 33.6 93 93 12 12 236 518 1.1 246 179 19 19 0.4 193 7.2 4.4
0 44 18.2 81 100 21 19 240 700 0.5 204 202 17 17 0.5 195 7.9 4.4
0 36 33.6 90 100 12 22 169 433 0.7 305 171 28 18 0.8 160 7.2 4.2
0 50 21.2 87 100 13 17 194 671 0.6 273 204 41 8 0.6 200 7.5 4.4
0 34 30.9 96 100 10 4 230 546 0.8 346 213 41 16 1 213 6.7 4.2
0 21 35.5 100 100 18 21 210 658 0.5 171 194 17 12 0.9 193 7.8 5.1
0 27 18.9 96 100 27 27 205 483 1.1 336 189 51 11 0.8 174 7.1 4.2
0 32 19.6 86 84 15 17 182 524 0.7 258 165 4 12 0.7 138 7.1 4.2
0 45 19.3 100 100 12 9 183 593 0.7 192 155 13 11 0.8 202 7.1 4.2
0 26 17.9 100 95 17 14 224 644 0.4 252 178 34 20 0.6 202 6.9 4.5
0 45 25.7 90 90 16 17 237 463 0.6 162 225 21 17 0.5 216 7.4 4.3
0 26 27.3 89 100 21 19 196 549 8 221 170 26 16 0.7 213 7.7 5.1
0 41 31.7 97 100 6 2 141 314 0.3 185 172 5 14 0.8 141 7.1 3.8
0 30 28.1 100 100 14 7 215 290 0.7 214 158 6 10 0.7 175 7.5 3.7

Table 2: The data of 18 items of 30 physically normal people who underwent a medical examination.

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
1 8 6.4 23 13 1292 3004 509 243 8.7 639 408 46 12 1.1 70 5.8 3.6
1 84 8.6 36 20 400 1770 270 258 8.2 623 284 47 9 1 68 6 3.3
1 92 9.4 62 23 194 1393 239 312 8 623 3.6 47 10 1 99 7 3.9
2 54 9.9 84 61 89 429 235 400 5.7 479 236 36 11 0.8 120 6.1 3.8
3 82 13.4 96 80 60 388 218 443 7.1 479 275 57 12 1 120 7.4 3.9
2 36 17.6 97 83 46 323 220 474 5.4 479 294 88 11 1 128 7.1 4.3
1 36 18.6 100 93 37 205 200 450 5.2 463 300 100 12 1.1 130 7 4
0 40 20.7 100 93 36 198 197 479 4.1 447 320 107 13 0.6 125 7.1 4.3
0 34 21.3 100 93 40 159 236 513 3.4 431 320 122 13 0.6 130 7.1 4.3
0 34 31.1 96 88 39 122 207 511 2.8 479 345 131 16 0.7 128 7.1 4.3
0 46 34 97 80 36 104 195 495 2.9 431 321 127 12 0.8 140 7 4
0 46 34.3 100 102 33 65 146 533 2.1 415 316 107 13 0.9 153 6.7 4.1
0 34 30.4 96 100 33 58 197 461 1.6 431 325 70 13 0.8 150 7.1 4.5

Case 1: acute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
4 150 1.2 13 10 290 1350 1234 6.5 29.4 670 322 44 9.2 1.1 135 7 4.2
4 160 1.6 20 10 134 245 955 5.3 18.4 399 157 11 18 1.2 151 6.9 4
4 173 1.3 15 10 91 88 652 7.3 14.2 351 172 22 20 1.2 124 6.2 3.9
4 140 1.6 20 15 100 143 620 7.1 15.6 335 283 71 29 1 124 6.7 3.9
4 150 1.2 25 18 120 209 715 7.5 19.4 447 400 116 23 0.9 145 6.9 3.8
4 127 1 43 25 122 256 864 7.2 22.4 463 436 138 23 0.9 140 7.1 4.3
3 110 1.7 50 35 58 121 589 7.5 12.4 319 296 97 15.8 0.8 135 7 4
1 80 1.6 55 40 98 246 694 7.6 27 590 454 213 18 1 151 7.1 4.3
1 75 3.1 65 50 90 188 486 6.6 17.8 638 357 264 25 0.8 124 7 4
0 60 2.4 100 80 86 168 389 6.5 9.6 702 486 349 21.4 0.9 124 7.1 4.3
0 55 1.8 90 80 107 236 375 6 7.1 862 681 442 18 0.7 130 7.2 4.2
0 61 1.6 80 70 119 252 455 5 8.1 926 742 475 19.9 0.7 140 7.1 4.3
0 60 1.9 93 85 57 172 460 5.2 6.4 1069 822 529 19 0.7 135 7 4
0 60 1.8 72 65 39 91 537 7.1 6.1 1117 868 554 19.5 0.6 151 7.1 4.3
0 78 2.2 70 65 36 68 466 6.9 4.1 1054 747 527 18 0.7 124 7.2 4.2

Case 2: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 94 13.6 44 29 374 605 333 259 20.4 702 484 257 14 1.3 130 6.2 3
2 80 15.5 40 27 232 433 288 263 23.3 718 489 263 10 1.1 131 6.5 3
2 100 15.6 44 27 168 348 262 253 23.8 750 455 229 16 1.4 120 6.3 3
2 82 18 49 28 118 268 239 254 21.6 654 459 209 18 1 117 6 2.8
2 102 12.7 46 33 83 197 269 318 23.6 702 476 175 17 1 135 6.8 3.3
1 60 16.5 47 31 58 88 231 350 12 622 619 120 18 1 160 6 3.1
1 80 11.1 46 30 64 78 280 301 8.1 574 367 122 16 1.1 141 5.8 2.9
0 70 11 53 30 50 52 211 269 8.2 686 375 140 23 1 139 5.8 2.9
0 74 6.5 58 35 43 41 194 255 7 622 345 125 25 1 140 5.8 2.6
0 80 8.5 72 45 45 37 253 223 3.7 782 366 94 16 1 129 5.4 2.5

Case 3: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 150 8 30 20 670 845 242 179 0.3 559 237 171 48 1.1 63 6.4 2.9
2 87 6.6 35 29 255 391 306 148 23.2 512 193 148 37 0.7 59 5.7 2.3
2 80 5.7 35 28 212 233 286 143 26.2 522 162 106 28 0.7 56 5.9 2.2
1 62 5.5 35 30 159 144 244 110 28.9 506 142 61 44 1.3 56 5.7 2.1
0 39 3.3 40 34 108 72 224 143 26.6 461 156 52 43 1.5 60 6 2.6
0 40 1.5 35 32 99 56 230 148 27.9 500 170 60 45 1.4 69 6 2.5
0 50 3.4 40 35 92 50 200 201 22.2 450 160 50 39 1.3 80 6.3 2.7
0 55 7.7 45 40 73 40 210 254 22.4 460 170 50 45 1.5 95 6.3 2.8
0 60 10.6 40 29 63 33 196 380 26 398 152 37 40 1.3 146 7.3 3.1
0 60 10.5 55 50 36 19 203 349 13.7 256 150 23 45 1.4 121 6 3.4
0 62 11.8 75 70 68 31 169 370 13.5 315 193 41 40 1.4 120 6.9 3.5
0 55 15.4 60 52 59 27 183 349 10.2 334 201 45 35 1.3 110 7.6 3.6
0 50 13.5 80 74 141 53 206 444 9.6 449 276 86 45 1.2 162 6.8 4.7
0 50 14.2 90 86 144 62 201 491 9.5 471 322 80 58 1.6 202 9.5 4.6
0 45 10 65 50 89 47 167 333 10 390 257 76 23 1 154 7.9 3.5
0 40 27.3 75 62 50 24 169 233 6.1 299 230 63 12 0.9 140 7.3 3.2
0 45 24.5 70 60 45 20 156 190 4.5 260 205 58 11 0.9 137 6.4 2.8
0 50 11.8 70 62 40 16 136 190 2.8 271 219 65 14 1 176 6.7 2.9
0 41 12.3 75 65 37 19 149 201 1.8 301 243 74 14 1 204 7.5 3.3

Case 4: subacute type

Table 3: The data of 4 survival cases of fluminant hepatitis used for examination.

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 140 9.3 10 10 7611 4665 7006 431 5.6 1070 1133 108 25 1.2 75 6.7 3.6
3 152 5.2 10 10 5470 3060 5620 368 6.9 894 525 81 19 2.1 61 5.3 3.7
3 146 5.5 10 10 3249 2620 1844 228 8.2 639 638 56 17 2.8 57 5.5 3.1
5 508 6.8 10 10 1000 1330 632 198 10.5 575 415 41 14 4.8 116 5.3 3.3
5 214 8 17 18 325 281 1404 288 7 149 245 18 12 7.7 88 4.7 2.6

Case 5: acute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 117 13.5 18 10 296 247 400 107 17.3 471 304 28 5 0.4 87 5.4 2.5
2 138 13.2 22 12 197 182 354 175 15.1 412 275 26 16 0.8 89 5 2.2
3 107 8.3 24 17 44 54 306 474 12.3 303 182 23 14 0.5 187 5.4 3
3 180 8.6 24 14 45 50 325 437 11.3 255 169 18 10 0.6 155 5.3 3
4 138 8.2 23 16 184 128 417 472 10.2 245 163 21 16 0.8 153 5.1 2.7
5 107 5.7 22 15 274 196 547 481 10.9 258 182 29 14 0.5 161 5.3 3
5 180 6.5 24 14 256 184 540 438 11.4 287 215 32 10 0.6 169 5.8 2.3

Case 6: acute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 100 28.1 10 10 1440 1455 1748 274 10 814 267 43 25 0.5 103 5.9 3
2 110 15.7 12 5 299 341 516 374 5.7 415 157 21 30 0.7 110 5.8 3.1
4 201 13 14 4 226 240 349 342 9.3 463 184 17 27 0.6 140 5.8 2.9
4 209 5 10 6 160 250 451 360 9.2 463 190 16 28 0.6 150 5.7 3
4 133 6 10 4 64 116 448 432 12.8 447 449 250 32 0.7 140 5.5 2.8
4 150 7 12 5 31 41 400 456 8 527 170 502 31 0.7 130 5.6 2.8
5 210 5 14 10 43 55 398 420 13.2 511 210 676 29 0.6 140 5.4 2.7
5 230 6 10 10 231 96 420 498 11.2 571 190 1638 35 0.8 135 5.5 2.6

Case 7: acute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 170 22.1 19.9 10 342 353 533 158 35.2 2603 431 22 8 1.2 89 5.1 3.3
2 185 16.7 44.1 30 277 177 676 155 26.4 1517 299 12 9 1.1 107 5.5 3.6
3 148 16.1 54.2 45 343 210 699 160 26 1781 265 8 9 1 149 6.7 4.2
5 120 18.4 34.4 30 382 217 699 145 25.5 1533 261 9 23 1.8 132 5.9 3.3
5 150 8.9 44.1 35 129 254 844 150 18.9 1628 252 4 33 2.1 181 6.3 3.8
5 43 6.5 24 15 210 99 580 120 23.2 1837 286 11 51 3.5 137 5.6 3.5
5 85 6.9 28.3 25 437 165 1478 135 19.6 1438 256 6 49 2.5 135 5.6 3.5
5 63 6.6 26.7 25 284 312 1725 145 22.2 1724 284 11 43 1.9 176 5.6 3.3
5 57 4.7 24 20 144 209 2024 130 26.8 2178 327 14 55 2.4 193 6.2 3.7

Case 8: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 40 18.2 40 33 183 197 346 190 23.3 527 283 47 32 1.7 72 5.6 2.5
2 38 21.3 46 46 140 142 332 266 26.5 606 296 47 17 1.7 84 6 2.7
1 36 17.2 38 37 131 134 322 272 27.2 590 281 46 14 1.5 83 5.9 2.7
2 36 16.8 39 32 110 98 301 277 27.6 606 281 44 11 1.4 85 5.8 2.5
2 36 17.5 45 37 123 112 365 326 35 782 326 52 11 1.3 95 6.7 3
2 28 11.2 72 67 63 48 250 384 23 415 218 30 9 1.6 113 5.6 3
2 28 13 51 65 72 51 279 393 24.5 511 248 37 9 1.5 128 6.3 3.3
1 18 12.7 41 52 66 48 250 394 24.7 590 269 42 10 1.5 116 6.4 3.3
1 24 8.9 34 39 43 27 207 328 17.7 367 168 25 9 1.6 102 5.3 3
2 28 10.3 41 57 44 29 228 326 19.4 415 208 30 9 1.4 106 5.5 3
2 30 11.7 38 54 46 27 241 360 19.7 479 238 37 8 1.4 116 5.6 3.1
2 40 9.7 52 67 34 19 219 375 16.2 351 184 32 7 1.4 128 5.5 3.2
2 36 10.1 41 40 35 21 246 407 19 447 226 38 8 1.4 142 6.1 3.3
2 40 10.4 32 29 31 19 260 411 22.4 479 267 43 8 1.4 136 6.2 3.3
2 40 9.9 37 42 47 19 315 423 22.8 588 267 40 11 1.3 126 6.5 3.5
1 44 8.2 48 37 26 13 248 372 19.4 415 199 30 12 1.3 145 5.9 3.3
1 28 7.1 38 31 30 11 287 377 21.6 479 220 42 9 1.4 129 6 3.2
1 42 6.8 42 29 31 15 307 397 23 511 237 40 13 1.1 131 6.2 3.4
2 32 7.8 42 50 30 12 307 397 23 511 251 52 22 1.2 126 6.6 3.5
2 42 9.3 32 40 33 13 319 432 23.5 542 294 71 29 1.3 111 7.3 3.6
2 56 10.7 37 29 28 9 284 403 22.3 558 276 72 30 1.4 103 6.9 3.6
2 48 10.8 48 42 21 10 291 430 19.8 479 249 47 33 1.2 120 7.1 4
2 52 12.4 38 37 21 5 278 434 20.8 542 267 59 33 1.2 116 6.8 3.9
2 70 12.1 42 31 21 7 276 450 23.6 606 274 54 29 1.2 111 7.4 3.7
2 48 14.7 42 29 60 13 953 369 28 702 316 51 44 1.9 62 7.1 3.5
3 68 18.5 20 30 58 13 507 326 15.9 383 193 25 41 1.8 97 5.7 3.1

Case 9: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
1 126 8.3 10 10 3611 2596 4338 406 9 782 516 117 28 1.6 145 6.2 2.7
1 70 8.4 17 11.5 3061 2040 4846 444 11 766 511 101 26 1.7 145 7 4.1
3 64 6.4 15 12 845 665 1960 460 8.6 782 490 352 16 2.1 160 5.3 3
4 122 6.3 10 10 644 746 1599 422 14.3 574 277 45 10 1.6 181 5.9 3.1
5 122 7.3 14 19.5 109 172 759 357 12.7 351 179 20 10 1.8 156 5.5 3.1
5 160 9.6 21 33 81 73 803 368 11.4 351 164 17 9 2.9 148 6.7 3.7

Case 10: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 136 11.6 22.5 19.8 126 141 476 3.5 22.6 590 323 51 8 0.8 88 5 2.5
2 145 5 17 10 135 133 483 2.7 21 590 301 42 7.6 0.8 73 3.9 2
2 157 4.7 31 21.5 80 80 435 4.6 17.8 399 213 43 8 1 89 4.6 2.8
1 185 5 34 26 115 107 369 4.1 15.4 351 170 45 8.9 0.9 110 5 3.2
2 208 4.2 35 29 50 51 346 8.3 10.4 335 190 40 10.7 0.7 153 5.2 3.5
3 211 4.6 25 21 52 58 364 8.3 10.8 351 205 43 13.4 0.8 130 5.3 3.4
3 256 6 23 13 54 72 383 7.9 12.3 383 213 45 15 0.7 175 5.6 3.5
3 199 7.2 22.5 21 63 79 390 8.7 14.4 383 170 55 12.2 0.7 154 5.3 2.9
4 157 8.8 22 11.5 79 94 467 9 15.8 415 250 70 13.8 0.6 145 5.2 3
3 228   21 20.5 67 86 445 8.7 16.4 367 358 95 15 0.7 140 5 3.1
5 238 10.2 23 26.5 56 64 480 8.5 13.1 271 221 42 12.7 0.6 134 4.9 2.8

Case 11: subacute type

Table 4: The data of 7 dead cases of fluminant hepatitis used for examination.

Coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 70 6 61 40 742 537 652 177 13.9 443 387 65 5 0.4 109 5.5 2.8
3 90 6.5 46 31 647 540 644 167 18.7 391 375 63 16 0.8 117 5.4 2.9
4 107 6.6 40 30 334 321 592 184 21.4 326 332 59 14 0.5 125 5.1 2.4
5 180 5.2 35 25 214 204 548 143 25 367 401 120 10 0.6 100 4.9 2.1

Case 12: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT ON Cr T.C. T.P. Alb
2 160 22.9 21 10 682 666 701 2.5 30.2 718 261 12 8 0.8 82 5 2.9
2 153 20.9 20 14.5 583 648 635 2.4 32 783 322 14 7.2 0.8 88 5 2.9
1 179 18.8 38 17.5 353 302 604 2.4 25 495 255 5 5.8 0.7 88 5 3.3
2 190 14.8 21 17 296 241 476 6 23.8 495 253 32 8.1 0.7 119 5 3.3
2 160 10.2 25 21 264 193 563 8.3 22 479 268 31 10 0.6 136 5 3.2
2 257 15.2 22 16.5 345 192 598 8.3 20.7 415 224 30 10.8 0.8 135 5.2 3.4
2 287 11.8 28 21.5 319 174 646 7.9 18.9 399 222 16 10 0.7 151 4.6 2.99
2 104 3.4 10 13.5 340 177 730 6.4 21 447 214 16 12.4 0.9 124 4.7 2.99
3 93 3.4 11 18 244 156 637 6.4 22.4 447 259 16 14.4 0.3 124 4.8 2.9
5 87 8.8 17.5 18.2 221 147 798 5.2 26.6 527 262 20 17.4 1 116 5.2 2.8
5 135 9.1 18 17 180 107 942 5.1 23.8 574 247 15 17.1 1.1 109 4.7 2.6
5 150 5.5 10 10 943 285 3924 4 18 1453 243 5 22.1 4.1 81 3.8 2.4

Case 13: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
3 90 8 29 20 670 845 242 179 0.3 559 237 171 5 0.4 63 6.4 2.9
3 110 6.6 17 29 255 391 306 148 15.7 512 193 148 16 0.8 59 5.7 2.3
4 107 5.7 16 28 212 233 286 142 26.2 522 162 106 14 0.5 56 5.9 2.2
5 180 5.5 15 30 159 140 244 111 28.9 687 298 189 10 0.6 56 5.4 2.1

Case 14: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 66 10.5 30 38 102 94 351 200 36.1 638 340 81 25 2.1 79 6.6 2.8
2 50 10.9 29 27 77 86 366 216 30.1 591 342 82 19 1.8 79 5.7 2.6
2 40 10.5 60 66 59 63 346 204 27.4 453 338 72 18 1.5 85 5.2 2.4
2 30 11.6 63 31 37 40 360 322 22.8 390 282 52 25 1.7 85 5 2.3
2 74 11 50 40 53 57 571 319 25.2 431 328 91 21 1.6 100 5.1 2.4
2 42 9.2 60 65 37 29 348 260 21 367 251 60 22 2 112 5 2.7
2 54 8.9 50 39 36 29 303 316 22.6 335 237 40 22 1.9 100 5.5 2.9
2 55 9 50 40 43 28 361 336 31.3 448 209 54 21 1.8 102 6.1 3.4
2 64 9 35 30 28 22 283 337 16.5 255 199 31 20 1.7 95 5.6 3.4
2 65 9 40 30 26 21 309 319 15.4 303 231 36 21 1.6 100 6.2 3.5
2 65 9.9 33 25 28 22 267 347 15.8 479 278 47 23 1.3 131 5.9 3.6
2 66 7.7 55 54 31 18 262 262 19.9 287 214 43 20 1.2 99 5 2.9
2 54 9 26 25 35 34 246 332 22.5 149 246 50 17.8 1.2 100 5.7 3.3
2 76 8.7 30 24 40 34 234 300 24.4 367 243 40 18 1.3 95 6.1 3.8
2 66 9.1 23 25 38 17 213 310 26.9 367 249 46 19 1.3 100 6.2 3.7
4 54 9.2 30 34 29 7 238 326 22.6 335 225 35 20 1.2 129 6.5 3.9
5 88 8.9 19 15 31 12 183 204 23.3 271 196 40 20 1.4 110 5.2 3.1

Case 15: subacute type

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
4 202 0.8 53 48 21 10 334 103 23.5 1357 248 11 102 4.5 55 5.4 2.3
2 85 1.3 45 40 28 7 510 110 27.9 1581 263 10 111 5.5 47 5.6 2.1
2 64 1.3 48 45 33 10 331 113 33.7 1357 277 15 131 3.7 38 5.7 2.2
2 70 1 40 35 33 15 236 65 37 1038 277 10 133 4.2 40 6 2.3
2 84 1.8 45 40 40 16 250 124 38.5 1117 281 4 106 4.2 39 5.9 2.2
2 56 1.9 45 40 38 10 280 133 44 1197 295 3 127 3.7 41 6.3 2.5
2 26 3.5 68 50 33 16 264 270 35.6 1117 270 5 111 2.6 60 6.6 2.6
3 30 3.8 40 35 29 12 298 207 31.9 862 262 3 119 3.5 80 6 2.5
5 214 2.6 30 25 279 89 1425 240 28.5 1038 249 6 112 4.3 70 5.9 2.2

Case 16: Acute on chronic

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 117 5.6 12.5 10 1644 765 1079 32 35.7 1676 268 18 5 0.4 44 7.7 3.1
2 138 6.4 12 10 1105 575 674 48 37.3 1309 296 17 16 0.8 54 8 3.2
2 107 9.3 9.9 8 488 367 668 44 36.1 1373 230 16 14 0.5 41 6.2 3.1
5 180 8.4 16.5 15 415 219 1182 48 26.5 942 164 7 10 0.6 80 5.3 3

Case 17: Acute on chronic

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
0 30 6.5 46 31 647 540 644 167 18.7 479 375 63 15 1.1 117 5.4 2.9
2 60 6.6 40 30 334 321 592 184 21.4 399 332 59 23 1.3 125 5.1 2.6
2 46 5.2 43 30 214 204 548 154 21 335 299 50 30 1.4 100 4.9 2.6
2 48 5.5 51 31 338 218 633 250 21.3 383 324 46 30 1.3 123 5.5 2.9
2 66 5.4 53 40 370 225 650 254 20.4 351 289 41 29 1.3 110 5.3 2.7
2 67 7.8 50 41 238 174 606 274 19.6 367 297 42 29 1.3 136 5.2 2.7
2 30 6 64 62 98 77 456 426 11.6 415 239 32 32 1.3 160 5.6 3.2
2 72 9.5 68 50 111 82 432 471 12.6 447 258 45 36 1.2 170 5.9 3.3
2 48 6.7 51 54 201 128 513 412 14.4 447 299 54 21 1.2 202 5.7 3
2 46 5.2 61 57 172 124 542 374 16.9 447 283 48 28 1.2 174 5.2 2.7
2 40 5.3 61 49 150 88 537 360 17.2 335 221 29 29 1.2 148 5.2 2.7
2 48 5.9 65 50 102 76 469 378 23 399 287 40 39 1.1 213 5.7 3.1
2 50 5.5 55 54 199 121 451 363 30 479 303 47 34 1.1 210 5.7 3
2 48 4.7 55 58 123 73 386 378 24.4 351 233 31 34 1.1 144 5.5 3.1
2 50 6.2 50 45 141 94 427 407 30.1 431 267 38 31 1.1 170 5.9 3.1
2 52 4.6 56 53 99 77 386 397 26.9 463 277 39 25 1.1 169 5.6 3.1
2 34 5.1 60 51 164 105 634 370 37.6 495 318 53 39 1.1 168 5.7 2.8
3 70 6.2 58 46 140 81 580 349 34.4 511 326 48 50 1.3 151 5.3 2.8
3 58 4.9 57 46 137 88 607 344 37.4 511 334 47 66 1.4 157 5.2 2.6
3 70 6 48 41 121 87 678 353 35.3 671 369 51 67 1.3 156 5.4 2.6
3 75 3.8 36 31 367 132 1344 324 32.4 703 382 61 99 2.3 119 5.1 2.6

Case 18: Acute on chronic

coma NH3 PLT PT HPT AST ALT LDH ChE T.B. ALP LAP rGT UN Cr T.C. T.P. Alb
2 108 7.6 37 38 104 19 438 101 32.2 1277 460 503 73.6 3.1 160 4.5 2.1
2 90 14.2 35 35 89 22 531 95 30.4 1357 470 407 103 4.3 152 5.2 2.7
1 68 10 36 35 71 26 508 113 38.4 1245 450 461 106 3.4 150 5 2.5
2 62 6 36 32 40 25 495 128 34 1293 479 378 110 4.1 149 5.4 3.1
3 48 7 35 40 31 24 336 132 33.9 1197 420 320 113 2.6 145 5 2.6
3 130 6.2 43 50 40 35 350 150 34.8 1117 359 258 137 4 160 5.8 3.9
3 124 9.5 40 45 42 30 345 220 33.3 894 320 223 165 3.4 150 5.9 3
3 72 9.1 27 35 42 20 343 294 20.8 686 279 159 194 4 160 5.8 3.5
3 60 10.9 40 50 33 25 479 260 14.8 878 334 199 260 4.9 155 7 4.8
4 96 4.9 37 41 22 22 363 251 15 798 320 200 294 5.1 163 7.4 5.1
5 100 2.9 34 38 26 28 592 494 16 766 309 199 324 6 160 7 4.5
5 138 2.3 30 28 36 40 550 450 17 846 320 220 378 7.8 150 6.5 4.1

Case 19: Acute on chronic

Table 5: The data of 7 dead cases of fluminant hepatitis used for examination.

This unit space was made by the data of physically normal person. “MD=1” is the center in unit space. When MD increases, it is meant that an object leaves from the physically normal person who is unit space. Therefore, change of MD was compared with a change of clinical data every case and was considered. By MD which was a unitary statistic, pathologic aggravation and grasp of the improvement were considered. In addition, the data of 30 physically normal people and 19 patients were collected in anonymous form. The patient privacy is protected. In addition, t-test was used for significant difference examination. “The MT system 1, MT method” of the software made in oken company was used for a calculation of MD.

Results

The data of 19 cases at the time of hospital discharges or death were shown in Figures 1-5. The change of the data of 18 items was shown in the figure left side. The logarithmic change of MD was shown in the figure right side.

community-medicine-diachronic-change

Figure 1: A diachronic change of coma grade, clinical data level and MD of four fulminant hepatitis survivors. A coma grade and a clinical data level are shown in the left side of each case, and MD is shown in the right side. A broken line means the level of 1,000 of MD.

community-medicine-fulminant-hepatitis

Figure 2: A diachronic change of coma grade, clinical data level and MD of three fulminant hepatitis acute type death cases. A coma grade and a clinical data level are shown in the left side of each case, and MD is shown in the right side. A broken line means the level of 1,000 of MD.

community-medicine-broken-line

Figure 3: A diachronic change of coma grade, clinical data level and MD of four fulminant hepatitis subacute type death cases. A coma grade and a clinical data level are shown in the left side of each case, and MD is shown in the right side. A broken line means the level of 1,000 of MD.

community-medicine-subacute-type

Figure 4: A diachronic change of coma grade, clinical data level and MD of four fulminant hepatitis subacute type death cases. A coma grade and a clinical data level are shown in the left side of each case, and MD is shown in the right side. A broken line means the level of 1,000 of MD.

community-medicine-death-cases

Figure 5: A diachronic change of coma grade, clinical data level and MD of four acute on chronic hepatic failure death cases. A coma grade and a clinical data level are shown in the left side of each case, and MD is shown in the right side. A broken line means the level of 1,000 of MD.

As shown in Figure 1, MD of the early period of onset of four fulminant hepatitis survivors was more than several thousand. With case 1 and 4, the data level of 18 items decreased generally. Data fluctuated with case 2 and 3 complicatedly up and down, but MD decreased smoothly. And MD approached to the unit space according to improvement of hepatic failure of the patient.

Three death cases of fulminant hepatitis acute type were shown in Figure 2. With case 5, the data of 18 items improved by treatment, and MD reflected this improvement and as a result MD decreased. Just before the death, MD level was 1,318 amd this MD meant a terminal liver disease and the patient died by renal failure. Case 6 and 7 improved the data of 18 items by an effect of treatment once. However, the data turned worse with progress of hepatic failure and, as a result, MD level showed more than 1,000 again, and the patients died by hepatic failure.

Eight death cases of fulminant hepatitis subacute type were shown in Figures 3 and 4. Case 10, 12 and 14 reflected curative effect, and the data of 18 items were improved. However, MD level of case 10 decreased to 906 just before the death, but the patient died by renal failure not hepatic failure. In addition, MD level of case 12 was 1,571, and MD level of case 14 was 1,385. Their MD showed terminal level of 1,000 or more and died by hepatic failure. Data of other five cases turned worse according as pathologic aggravation. It was reflected on increase of MD, and the patient died.

Four death cases of acute on chronic hepatic failure were shown in Figure 5. In these four cases, 18 items accept a complicated change. On the other hand, MD decreased by treatment slightly once. However, the disease turned worse, and MD level increased about 2,000 and the patient died.

The MD level was divided into survival case and death case, and a logarithm of MD was shown in Figure 6. MD level of four survivors decreases to an average of 68, standard deviation of 94 at the time of hospital discharge and was normalized afterwards. On the other hand, MD level in 15 death was an average of 2,227, standard deviation of 2,274. This MD level was significantly higher than survivors by t-test (p=0.003), and MD level of 12 cases were more than 1,000. Three MD decreased with progress, but in the death of three cases, MD level of case 9 increased to 390, MD level of case 15 to 922. The change of these MD reflected pathologic aggravation. In the death, MD level of case 10 decreased to 906 from 7,173, but the patient died by renal failure not hepatic failure.

community-medicine-standard-deviation

Figure 6: The distribution of MD of four survivors and 15 death cases of acute hepatic failure. In MD of survivors were an average of 68, standard deviation of 94, the death cases were an average of 2,227 standard deviation of 2274, and there were significantly difference (p=0.003). In the death cases, MD of 12 cases were over 1,000.

Consideration

As for the characteristic of MT system, the unit space is made using the data of physically normal person. MD for this unit space is calculated by the data of patient “individual”, not statistical “group”, and is evaluated, and as a results, “individual changes” of patient are judged as a unitary statistic. In addition, the correlation of data of patient individual is examined in MT system. We examined change of MD in the liver disease until now. And we reported about increase of MD showed pathologic aggravation, and decrease of MD showed pathologic improvement [7,8]. In addition, MD level more than 1,000 means terminal liver diseases. And MD level more than 1,000 became the index of liver transplantation [9].

In this study, clinical data fluctuated complicatedly by clinical course, and a judgment of improvement or aggravation of these diseases are difficult. Each clinical data are unified into MD, and evaluate MD. As a result, pathologic grasp becomes easy using a common evaluation standard for doctor. MD decreased with this four survivors immediately, and the condition of a patient was improved. In the case of 5, 10, 17, MD level decreased, but it was still more than 1,000 at death time. In addition, case 5 and 10 died by renal failure, and case 17 died by gastrointestinal bleeding, not hepatic failure.

The unit space of MT system was defined each time. This 18 items were for the evaluations of hepatic failure. The hepatic failure of case 5,10,17 was improved, however, these cause of death was renal failure and gastrointestinal bleeding, not hepatic failure. Renal failure and gastrointestinal bleeding were hard to evaluate in these 18 items, as a results, the evaluation of MD was low grade. For the renal failure, only two items of UN and Cr are insufficient. The datas such as quantity of glomerulus filtration, volume of urine or edema increase may becomes a more accurate index. For the gastrointestinal bleeding, the much frequent endoscopy is difficult, so datas such as blood UN level, an occult bleeding reaction or melena will be necessary in future.

The clinical datas of 13 death cases was complicated, and pathologic grasp was difficult. However, pathologic grasp becomed easy with one numerical value by unifying those clinical datas into MD. By treatment, MD decreased 13 cases temporarily, however MD gradually increased with pathologic aggravation and the patients died.

When MD unifying clinical datas as above is calculated, pathologic grasp to change complicatedly becomes easy. And the evaluation standard that is common to the diagnosis of the doctor is given.

Conclusion

“Individual changes” are evaluated as a unitary statistic in MD. Using MD from the unit space of physically normal person, complicated pathologic grasp of acute hepatic failure becomes much easy.

References

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