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Admission Factor V Predicts Transplant-Free Survival in Acute Liver Failure

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Abstract

Background and Aims

Traditional laboratory markers are insensitive in distinguishing between patients with acute liver failure (ALF) who will require urgent liver transplantation (LT) from those who will recover spontaneously, particularly within 24 h of presentation. Coagulation factor-V (FV) may improve the accuracy of outcome prediction in ALF due to its predominant synthesis in the liver and short half-life in plasma.

Methods

Patients enrolled in the ALF Study Group Registry from a single site had FV determined within 24 h of presentation (Derivation-Cohort). Area under the receiver operating characteristic curves (AUROC) dichotomized by ALF etiology [acetaminophen (APAP) or non-APAP] were constructed to evaluate the diagnostic performance of FV for transplant-free-survival (TFS). Multivariate logistic regression modeling was performed using FV and other clinical variables to predict TFS. Accuracy of FV and multivariable model were performed in a Validation-Cohort from a different site.

Results

90-patients (56% with APAP) were included in the Derivation-Cohort. Median FV was significantly higher in TFS versus those who died/LT (31% vs. 15%, respectively; p = 0.001). When dichotomized by etiology, AUROC for FV was 0.77 for APAP (cutoff, sensitivity, specificity 10.5%, 79%, 69%, respectively) and 0.77 for non-APAP (22%, 85%, 67%, respectively). When the optimal cutoffs for FV in the Derivation-Cohort were applied to the Validation-Cohort (N = 51; 59% with APAP), AUROC for FV was 0.75 for APAP (sensitivity/specificity 81/44) and 0.95 for non-APAP (sensitivity/specificity 90/73). In multivariate analyses, AUROC for FV model was 0.86 in the Derivation-Cohort and 0.90 in the Validation-Cohort.

Conclusion

Admission FV may improve selection of patients who are likely to improve without LT.

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Abbreviations

ALF:

Acute liver failure

HE:

Hepatic encephalopathy

TFS:

Transplant-free survival

LT:

Liver transplantation

FV:

Factor V

NAC:

N-acetylcysteine

APAP:

N-acetyl-p-aminophenol (acetaminophen)

INR:

International normalized ratio of the prothrombin time

VCU:

Virginia Commonwealth University

IU:

Indiana University Hospital

SD:

Standard deviation

IQR:

Interquartile range

AUROC:

Area underneath the receiver characteristic

CI:

Confidence interval

Sens:

Sensitivity

Spec:

Specificity

NPV:

Negative predictive value

PPV:

Positive predictive value

AIC:

Akaike information criterion

MELD:

Model for end-stage liver disease

ALFSG:

Acute liver failure study group prognostic index

KCC:

Kings College Criteria

References

  1. Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. Hepatology. 2012;55:965–967.

    Article  Google Scholar 

  2. Reuben A, Tillman H, Fontana RJ, et al. Outcomes in adults with acute liver failure between 1998 and 2013: an observational cohort study. Ann Intern Med. 2016;164:724–732.

    Article  Google Scholar 

  3. Bernal W, Wendon J, Rela M, Heaton N, Williams R. Use and outcome of liver transplantation in acetaminophen-induced acute liver failure. Hepatology. 1998;27:1050–1055.

    Article  CAS  Google Scholar 

  4. O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–445.

    Article  Google Scholar 

  5. McPhail MJ, Wendon JA, Bernal W. Meta-analysis of performance of Kings’s College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure. J Hepatol. 2010;53:492–499.

    Article  Google Scholar 

  6. Koch DG, Tillman H, Durkalski V, Lee WM, Reuben A. Development of a model to predict transplant-free survival of patients with acute liver failure. Clin Gastroenterol Hepatol. 2016;14(1199–1206):e1192.

    Google Scholar 

  7. Bernuau J, Goudeau A, Poynard T, et al. Multivariate analysis of prognostic factors in fulminant hepatitis B. Hepatology. 1986;6:648–651.

    Article  CAS  Google Scholar 

  8. Bismuth H, Samuel D, Castaing D, et al. Orthotopic liver transplantation in fulminant and subfulminant hepatitis. The Paul Brousse experience. Ann Surg. 1995;222:109–119.

    Article  CAS  Google Scholar 

  9. Bismuth H, Samuel D, Gugenheim J, et al. Emergency liver transplantation for fulminant hepatitis. Ann Intern Med.. 1987;107:337–341.

    Article  CAS  Google Scholar 

  10. Pereira LM, Langley PG, Hayllar KM, Tredger JM, Williams R. Coagulation factor V and VIII/V ratio as predictors of outcome in paracetamol induced fulminant hepatic failure: relation to other prognostic indicators. Gut. 1992;33:98–102.

    Article  CAS  Google Scholar 

  11. Izumi S, Langley PG, Wendon J, et al. Coagulation factor V levels as a prognostic indicator in fulminant hepatic failure. Hepatology. 1996;23:1507–1511.

    Article  CAS  Google Scholar 

  12. Devictor D, Desplanques L, Debray D, et al. Emergency liver transplantation for fulminant liver failure in infants and children. Hepatology. 1992;16:1156–1162.

    Article  CAS  Google Scholar 

  13. Harrison PM, Wendon JA, Gimson AE, Alexander GJ, Williams R. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med. 1991;324:1852–1857.

    Article  CAS  Google Scholar 

  14. Lee WM, Hynan LS, Rossaro L, et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology. 2009;137:856–864.

    Article  CAS  Google Scholar 

  15. Yantorno SE, Kremers WK, Ruf AE, Trentadue JJ, Podesta LG, Villamil FG. MELD is superior to King’s college and Clichy’s criteria to assess prognosis in fulminant hepatic failure. Liver Transplant. 2007;13:822–828.

    Article  Google Scholar 

  16. Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis. 1970;3:282–298.

    CAS  PubMed  Google Scholar 

  17. Conn HO, Leevy CM, Vlahcevic ZR, et al. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology. 1977;72:573–583.

    Article  CAS  Google Scholar 

  18. Stravitz RT, Lisman T, Luketic VA, et al. Minimal effects of acute liver injury/acute liver failure on hemostasis as assessed by thromboelastography. J Hepatol. 2012;56:129–136.

    Article  Google Scholar 

  19. Holland LL, Foster TM, Marlar RA, Brooks JP. Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios. Transfusion. 2005;45:1234–1235.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, USA

    Kavish R. Patidar & Marwan S. Ghabril

  2. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA

    Brian C. Davis & Richard T. Stravitz

  3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    James E. Slaven

  4. Division of Transplant Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Chandrashekhar A. Kubal

  5. Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX, USA

    William M. Lee

Authors
  1. Kavish R. Patidar
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  2. Brian C. Davis
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  3. James E. Slaven
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  4. Marwan S. Ghabril
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  5. Chandrashekhar A. Kubal
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  6. William M. Lee
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  7. Richard T. Stravitz
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Contributions

Study Concept and Design: KRP and RTS, Data Analysis: KRP, MSG, JES and RTS, Manuscript Preparation: KRP, JES, and RTS, Manuscript Review: All authors.

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Correspondence to Kavish R. Patidar.

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Patidar, K.R., Davis, B.C., Slaven, J.E. et al. Admission Factor V Predicts Transplant-Free Survival in Acute Liver Failure. Dig Dis Sci 66, 619–627 (2021). https://doi.org/10.1007/s10620-020-06197-3

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  • DOI: https://doi.org/10.1007/s10620-020-06197-3

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