Results: The mortality (50.0%) of patients in lamivudine group with MELD score from 30 to 40 was lower than that (86.1%) of control group ( 2 =23.319, P=0.000). Univariate analysis showed that mortality was significantly related to age (P=0.005), MELD score (P=0.009), treatment method (P=0.000), pretreatment HBV DNA load (P=0.000), the decline of HBV DNA load during therapy (P=0.006) and encephalopathy (P=0.007). In multivariate analysis, in patients with MELD scores 30-40, treatment method (P=0.004), pretreatment HBV DNA load (P=0.009), decline of HBV DNA load during therapy (P=0.014) and encephalopathy (P=0.019) were independent predictors of mortality; for MELD scores above 40, only MELD score (P=0.015) was independent predictive. Conclusions: Lamivudine treatment significantly decreases the 3 month's mortality of patients with MELD score 30-40, and a low viral load pre-treatment and quick decline of HBV DNA load are good predictors for the survival of lamivudine treatment. Background/Aims: Early identification of patients with Fulminant hepatic failure (FHF) who need a liver transplantation is very important. To construct a prediction model for early diagnosis and prognosis of FHF, we studied dynamics of metabolic profiles using a D-galactosamine/lipopolysaccharide (GalN/LPS)-treated mouse model. Methods: BALB/c mice were used to construct FHF model and sacrificed for blood collection at 4, 5, and 6 hour after treatment, respectively. Levels of plasma metabolites were quantified using gas chromatography/time-of-flight mass spectrometry and data were processed using partial least squares discriminant analysis (PLS-DA). Results: Distinct clustering differences were observed 5 and 6 h after treatment between survival and dead groups. At 5 h, plasma levels of some metabolites differed significantly between survival, dead and control groups. Ketogenesis and the TCA cycle were inhibited in both survival and dead groups, but in dead group, the urea cycle was also inhibited and glycolysis was elevated. PLS-DA indicated that principal component weighting was greatest for plasma levels of phosphate, -hydroxybutyrate, urea, glucose and lactate. The Y-predicted scatter plot in PLS model assigned samples to survival or dead groups using an apriori cutoff of 0.10 with 100% sensitivity and specificity. Similar results were observed in 11 FHF patients with different outcomes.