Phosphorus ans an early predictive factor in patients with acute liver failure.
BACKGROUND
This study analyzes the prognostic significance of serum phosphorus in patients with acute liver failure (ALF).


METHODS
We performed a retrospective analysis of 112 patients with ALF. Univariate and bivariate analyses based on Kaplan-Meier recovery curves and a multivariate Classification Tree Structure Survival Analysis were performed to identify independent predictors of outcome. The variables analyzed were age, gender, race, ABO blood group, etiology of liver disease, grade of encephalopathy, serum bilirubin, prothrombin time, creatinine, serum phosphorus, phosphorus administered, phosphorus binders, and hemodialysis.


RESULTS
The median follow-up time was 5 days, the median age was 28 years, and 62% of the patients were female. The patients' outcomes were as follows: 28% recovered, 52% required orthotopic liver transplantation, and 20% died. White patients showed the best prognosis (58% recovered in the first week), and Hispanics showed the worst prognosis (0.3% recovered at 1 week) (P=0.0001). Encephalopathy and bilirubin were significant predictors of recovery (P<0.0001 and P=0.004). The analysis of the serum phosphorus showed a statistically significant better prognosis in patients with low phosphorus (P<0.001). The recovery rate at 1 week was 74% in patients with serum phosphorus less than 2.5 mg/dL, 45% if phosphorus ranged between 2.5 to 5 mg/dL, and 0% if phosphorus was more than 5 mg/dL. The bivariate analysis on the effects of phosphorus administration showed that phosphorus replacement was associated with a significant improvement in recovery in patients with low (P<0.004) or normal serum phosphorus levels (P<0.017)


CONCLUSIONS
Hypophosphatemia and early phosphorus administration are associated with a good prognosis in ALF, whereas hyperphosphatemia is predictive of poor recovery.
Baquerizo
Angeles
A
Department of Surgery, Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. Angeles.Baquerizo@cshs.org
Anselmo
Dean
D
Shackleton
Christopher
C
Chen
Teng-Wei
TW
Cao
Carlos
C
Weaver
Michael
M
Gornbein
Jeffrey
J
Geevarghese
Sunil
S
Nissen
Nicholas
N
Farmer
Douglas
D
Demetriou
Achilles
A
Busuttil
Ronald W
RW
D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017674:Hypophosphatemia / Q000097:blood* / Q000175:diagnosis; D017114:Liver Failure, Acute / Q000097:blood* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D010710:Phosphates / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D015415:Biomarkers; D010710:Phosphates