Predicting the prognosis in acute liver failure: results from a retrospective pilot study using the LiMAx test
Journal Title: Annals of Hepatology - Year 2013, Vol 12, Issue 4
Abstract
Background. Acute liver failure (ALF) is a rare but potentially life-threatening condition and liver transplantation (LTX) remains frequently the only effective therapy. Nevertheless, some patients recover without LTX but the individual indication for or against LTX remains difficult. Aim. To evaluate maximal liver function capacity (LiMAx) for predicting the prognosis of ALF. Material and methods. Clinic data of 12 patients was retrospectively analyzed to compare the different liver function test results with the patients’ clinical outcome. Patients were assessed by the LiMAx test, a non-invasive breath test determining cytochrome P450 1A2 capacity using intravenous 13C-methacetin. Statistical analysis compared patients with spontaneous recovery versus non-recovery (LTX or death). Results. Twelve patients (6 male, 6 female; 49 [11-72] years) with viral hepatitis (n = 2), toxic liver injury (n = 3), or cryptogenic liver failure (n = 7) were analyzed. Seven patients fully recovered from ALF and were discharged without LTX. Three patients died and two underwent LTX. The King’s College Criteria (KCC) was fulfilled in only one out of five patients without recovery. The LiMAx was 19 ± 19 (16-62) for non-recovery vs. 94 ± 119 (39-378) μg/kg/h for recovery (P = 0.018). In contrast, all biochemical parameters [bilirubin (P = 0.106), creatinine (P = 0.343), AST (P = 0.53), ALT (P = 0.876) and INR (P = 0.876) were statistically indistinct. Also the Model for End-Stage Liver Disease (MELD) score did not show a difference [35 ± 4.3 (29-40) vs. 30 ± 11.5 (6-40); P = 0.27]. Conclusions. Maximal liver function capacity determined by LiMAx test is severely impaired in patients with ALF. The LiMAx test might be effective in predicting the individual prognosis and the need for LTX in ALF.
Authors and Affiliations
Johan Friso Lock, Amir Nihad Kotobi, Maciej Malinowski, Antje Schulz, Maximilian Jara, Peter Neuhaus, Martin Stockmann
Keywords
Related Articles
- EP ID EP78299
- DOI -
- Views 134
- Downloads 0
The effect of bacterial infections in cirrhotic patients with esophageal variceal bleeding
Background. Cirrhotic patients are prone to having bacterial infections due to impaired innate immunity. This nationwide population-based study aimed to identify the effect of bacterial infections on the mortality of the...
Hepatic dysfunction in children with tuberculosis on treatment with antituberculous therapy
Aim. To determine the incidence and factors associated with drug induced hepatic dysfunction in children on anti-tuberculous treatment (ATT). Setting. Pediatric Tuberculosis Clinic at B.J. Wadia Children’s...
Akin criteria as a predictor of mortality in cirrhotic patients after spontaneous bacterial peritonitis
Background and aims. Spontaneous bacterial peritonitis (SBP) often triggers acute-on-chronic liver failure (ACLF). Acute kidney injury (AKI) is frequent and correlates with higher mortality in such cases. The aim of this...
Treatment of polycystic liver disease: a hypothesis, patient characteristics, short and long-term results
Background. Non-total liver resecting invasive treatment of polycystic liver disease has different recurrence rates. The aim of this study is to illustrate why the recurrence rates are different. We established a hypothe...
When to perform gastroscopy in the PSC patient