Estela Regina Ramos Figueira1,2, Joel Avancini Rocha-Filho3,4, Cinthia Lanchotte3, Lucas Souto Nacif3,5, Luciana Bertocco de Paiva Haddad3,5, Adriana Rochetto Assalin6, Yumi Ricucci Shinkado6, Agustin Moscoso Vintimilla3, Flavio Henrique Ferreira Galvao3,5, Luiz Augusto Carneiro D'Albuquerque3,5. 1. Divisão de Cirurgia do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - HCFMUSP, Av. Dr. Arnaldo 455, 3rd floor, office 3222, Sao Paulo, SP, Zip code: 01246-903, Brazil. estelafigueira@me.com. 2. Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - HCFMUSP, Sao Paulo, SP, Brazil. estelafigueira@me.com. 3. Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - HCFMUSP, Sao Paulo, SP, Brazil. 4. Disciplina de Anestesiologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - HCFMUSP, Sao Paulo, SP, Brazil. 5. Serviço de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - HCFMUSP, Sao Paulo, SP, Brazil. 6. Faculdade de Medicina da Universidade de Sao Paulo - FMUSP, Sao Paulo, SP, Brazil.
Abstract
BACKGROUND: The aim of this study was to analyze prognostic indicators of in-hospital mortality among patients listed for urgent liver transplantation (LT) for non-acetaminophen (APAP)-induced acute liver failure (ALF). METHODS: ALF patients listed for LT according to the King's College Criteria were retrospectively reviewed. Variables were recorded from medical records and electronic databases (HCMED and RedCap). RESULTS: The study included 100 patients, of which 69 were subject to LT and 31 died while waiting for LT. Patients were 35.5 ± 14.73 years old, and 78% were females. The main etiologies were virus (17%), drug-induced (32%), autoimmune (15%), and indeterminate hepatitis (31%). The prioritization-to-LT time interval was 1.5 days (0-9). The non-LT patients showed higher lactate (8.71 ± 5.36 vs. 4.48 ± 3.33 mmol/L), creatinine (229 ± 207 vs. 137 ± 136 µm/L), MELD (44 ± 8 vs. 38 ± 8), and BiLE scores (15.8 ± 5.5 vs. 10.3 ± 4.1) compared to LT patients (p < 0.05). Multiple logistic regression analysis identified creatinine and lactate as independent prognostic factors, and a creatinine-lactate (CL) score was developed. ROC analysis showed that creatinine, lactate, MELD, BiLE, and CL scores had considerable specificity (71-88%), but only BiLE, lactate, and CL presented high sensitivities (70%, 80%, and 87% respectively). AUCs were 0.696 for creatinine, 0.763 for lactate, 0.697 for MELD, 0.814 for BiLE, and 0.835 for CL. CONCLUSIONS: CL and BiLE scores predict mortality with more accuracy than MELD in patients with ALF during prioritization time. Creatinine and lactate are independent prognostic factors for mortality.
BACKGROUND: The aim of this study was to analyze prognostic indicators of in-hospital mortality among patients listed for urgent liver transplantation (LT) for non-acetaminophen (APAP)-induced acute liver failure (ALF). METHODS:ALFpatients listed for LT according to the King's College Criteria were retrospectively reviewed. Variables were recorded from medical records and electronic databases (HCMED and RedCap). RESULTS: The study included 100 patients, of which 69 were subject to LT and 31 died while waiting for LT. Patients were 35.5 ± 14.73 years old, and 78% were females. The main etiologies were virus (17%), drug-induced (32%), autoimmune (15%), and indeterminate hepatitis (31%). The prioritization-to-LT time interval was 1.5 days (0-9). The non-LT patients showed higher lactate (8.71 ± 5.36 vs. 4.48 ± 3.33 mmol/L), creatinine (229 ± 207 vs. 137 ± 136 µm/L), MELD (44 ± 8 vs. 38 ± 8), and BiLE scores (15.8 ± 5.5 vs. 10.3 ± 4.1) compared to LT patients (p < 0.05). Multiple logistic regression analysis identified creatinine and lactate as independent prognostic factors, and a creatinine-lactate (CL) score was developed. ROC analysis showed that creatinine, lactate, MELD, BiLE, and CL scores had considerable specificity (71-88%), but only BiLE, lactate, and CL presented high sensitivities (70%, 80%, and 87% respectively). AUCs were 0.696 for creatinine, 0.763 for lactate, 0.697 for MELD, 0.814 for BiLE, and 0.835 for CL. CONCLUSIONS: CL and BiLE scores predict mortality with more accuracy than MELD in patients with ALF during prioritization time. Creatinine and lactate are independent prognostic factors for mortality.
Authors: Michael Linecker; Tanja Krones; Thomas Berg; Claus U Niemann; Randolph H Steadman; Philipp Dutkowski; Pierre-Alain Clavien; Ronald W Busuttil; Robert D Truog; Henrik Petrowsky Journal: J Hepatol Date: 2017-11-11 Impact factor: 25.083
Authors: Panagiotis Fikatas; Frank Ulrich; Ji-Eun Lee; Igor M Sauer; Sascha Chopra; Sven C Schmidt; Andreas Pascher; Johann Pratschke Journal: Ann Transplant Date: 2011 Jan-Mar Impact factor: 1.530
Authors: Walter K Kremers; Marrije van IJperen; W Ray Kim; Richard B Freeman; Ann M Harper; Patrick S Kamath; Russell H Wiesner Journal: Hepatology Date: 2004-03 Impact factor: 17.425