Predictive formula of coma onset and prothrombin time to distinguish patients who recover from acute liver injury
| Autor: | Yasuhiro Miyamoto, Keisuke Kakisaka, Kojiro Kataoka, Yohei Okada, Hidekatsu Kuroda, Yuji Suzuki, Yasuhiro Takikawa |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Bilirubin Autoimmune hepatitis Gastroenterology 03 medical and health sciences chemistry.chemical_compound Liver disease 0302 clinical medicine Internal medicine medicine Coagulopathy Hepatic encephalopathy Coma Prothrombin time Hepatology medicine.diagnostic_test business.industry Incidence (epidemiology) digestive oral and skin physiology medicine.disease respiratory tract diseases Surgery chemistry 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology medicine.symptom business |
| Zdroj: | Journal of Gastroenterology and Hepatology. 33:277-282 |
| ISSN: | 0815-9319 |
| Popis: | Background and aim Acute liver failure (ALF) is defined as acute liver injury (ALI) associated with coagulopathy. A follow-up strategy for ALI and characterization of ALI patients with a risk of progressing to ALF have never been established. To establish predictive markers for progression from ALI to ALF, this study compared the clinical characteristics and laboratory data on the day of registration to data from a regional referral system of patients with ALI. Methods This prospective, observational study enrolled 365 consecutive patients with ALI/ALF between 2007 and 2016. We evaluated 109 ALI patients, 27 of whom satisfied the ALF criteria during observation and another 82 patients who recovered without progression to ALF. Results Four patients died; all were in the ALF group. The variables of age, incidence of autoimmune hepatitis, model of end-stage liver disease score, values for total bilirubin and prothrombin time (PT)-international ratio, and Japan Hepatic Encephalopathy Prediction Model (JHEPM) probability at registration were significantly higher in ALF patients than in ALI patients. In multivariate analysis, PT and JHEPM were identified as risk factors for progression to ALF. The cut-off values of 13%, 4.9%, 65%, and 1.32% for the model of end-stage liver disease score, JHEPM probability, PT, and PT-international ratio values, respectively, had high negative predictive values. Furthermore, among patients whose JHEPM was underestimated, none died due to ALF. Conclusion The JHEPM probability is a predictive parameter that can be used to decide a follow-up treatment strategy for ALI patients. |
| Databáze: | OpenAIRE |
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