Reduced serum Gc-globulin concentrations in patients with fulminant hepatic failure: association with multiple organ failure.
OBJECTIVE
To evaluate the association between admission serum concentrations of the actin-scavenger, Gc-globulin, and the subsequent development of multiple organ failure in patients with fulminant hepatic failure.


METHODS
Retrospective study.


METHODS
A hepatologic intensive care unit.


METHODS
Seventy-nine patients with hepatic encephalopathy grade 3 or 4.


METHODS
None.


RESULTS
Serum admission concentrations of both total and nonactin-complexed (free) Gc-globulin were determined. The development of cardiovascular failure, renal failure, pulmonary failure, intracranial hypertension, and infections were recorded in each patient. Both total and free Gc-globulin values were significantly lower in the patients, compared with normal controls. The Gc-globulin values were significantly reduced in patients who subsequently developed cardiovascular failure (p < .01), intracranial hypertension (p < .001), and infections (p < .001), compared with those patients who did not. No differences were found between patients with and without pulmonary or renal failure. Patients with total Gc-globulin values in the lowest quintile had on average 2.6 organ failures, whereas patients with Gc-globulin concentrations in the highest quintile had 0.9 organ failures. The corresponding figures for the lowest and highest quintiles of free Gc-globulin were 3.0 and 1.1 organ failures, respectively. Both total and free Gc-globulin were inversely correlated to the number of organ failures (p < .005 in both cases). Patients with multiple organ failure (> or = 2 organ failures) had significantly reduced Gc-globulin values compared with patients without multiple organ failure (p < .0001).


CONCLUSIONS
In patients with fulminant hepatic failure, the lowest admission Gc-globulin concentrations were associated with the subsequent development of cardiovascular failure, intracranial hypertension, and infections. Lack of Gc-globulin correlated significantly with the development of multiple organ failure and may be pathogenetically involved in this condition.
Schiødt
F V
FV
Medical Department A, The National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Ott
P
P
Bondesen
S
S
Tygstrup
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000097:blood* / Q000150:complications*; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011559:Pseudotumor Cerebri / Q000209:etiology; D015203:Reproducibility of Results; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014809:Vitamin D-Binding Protein / Q000097:blood* / Q000172:deficiency*
D014809:Vitamin D-Binding Protein