Biochemical prognostic markers of outcome in non-paracetamol???induced fulminant hepatic failure
- 1 January 2004
- journal article
- Published by Wolters Kluwer Health in Transplantation
- Vol. 77 (2) , 200-205
- https://doi.org/10.1097/01.tp.0000100466.22441.37
Abstract
Background. Fulminant hepatic failure (FHF) is associated with major metabolic disturbances, the onset and severity of which can predict clinical outcome. This study uses admission blood samples to identify early biochemical markers of clinical outcome in patients with non-paracetamol–induced FHF. Patients and Methods. Fifty-nine patients admitted to the Scottish Liver Transplant Unit with non-paracetamol–induced FHF were studied. Plasma samples were collected at a median of 5.4 hr after admission to our unit and analyzed using conventional laboratory tests and nuclear magnetic resonance spectroscopy. Results. A total of 19 patients underwent transplantation, 15 patients died without undergoing transplantation, and 25 patients survived with medical management alone. There were significantly lower levels of lactate, alanine, valine, and bilirubin and significantly higher levels of pyruvate and albumin in patients who survived spontaneously compared with the other two groups. By use of multiple logistic regression analysis, an equation was devised that best predicted clinical outcome: 0.5×(albumin [g/L])−2×(lactate [mmol/L])−36×(valine [mmol/L])−38×(pyruvate [mmol/L]). Values of less than 2 were associated with poor clinical outcome and had a positive predictive value of 91%, a negative predictive value of 86%, a sensitivity of 94%, and a specificity of 86% for death or transplantation. This algorithm can be applied on admission, thus expediting decision-making. Conclusion. We identified biochemical markers that may be useful in predicting outcome in patients with non-paracetamol–induced FHF and should be evaluated further in a different patient population.Keywords
This publication has 22 references indexed in Scilit:
- Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort studyThe Lancet, 2002
- Referral patterns and social deprivation in paracetamol-induced liver injury in ScotlandThe Lancet, 2001
- Etiology and outcome for 295 patients with acute liver failure in the united statesLiver Transplantation and Surgery, 1999
- The management of acute liver failureAlimentary Pharmacology & Therapeutics, 1998
- Early indicators of prognosis in fulmitant hepatic failure: an assessment of the King's criteriaJournal of Hepatology, 1997
- Hepatitis BHepatology, 1995
- Emergency liver transplantation for acute liver failure: Evaluation of London and Clichy criteriaJournal of Hepatology, 1993
- Early indicators of prognosis in fulminant hepatic failureGastroenterology, 1989
- Lactic acidosis in fulminant hepatic failureJournal of Hepatology, 1985
- Acid-base and metabolic disturbances in fulminant hepatic failure.Gut, 1975