title: Ratio of circulating follistatin and activin A reflects the severity of acute liver injury and prognosis in patients with acute liver failure.
abstract: OBJECTIVE
  The activin A-follistatin system is known to play a critical role in hepatocyte regeneration during the repair of liver tissue. However, the relationship between blood levels of these compounds and the severity and prognosis of acute liver injury remains unclear. The aim of this study was to evaluate the clinical significance of circulating activin A and follistatin in patients with acute liver disease.
  
  
  METHODS
  Serum activin A and plasma follistatin levels were determined on admission by enzyme-linked immunosorbent assay in 32 patients with acute hepatitis (AH), 23 patients with acute severe hepatitis (ASH) and 16 patients with acute liver failure (ALF).
  
  
  RESULTS
  Both serum activin A and plasma follistatin levels were significantly elevated in patients with ASH and ALF when compared with those in patients with AH and normal controls (NC). Although plasma follistatin levels were significantly and positively correlated with serum activin A levels (r = 0.413, P < 0.001), the follistatin and activin A (F/A) ratio showed distinct deviation from NC between AH and ALF patients. The F/A ratio in AH patients was significantly elevated when compared with NC, but was significantly reduced in ALF patients. Furthermore, the F/A ratio in non-surviving ALF patients was significantly lower than that in survivors. Levels of serum activin A and plasma follistatin were significantly and negatively correlated with prothrombin time (PT) and normotest (NT) levels, while the F/A ratio showed significant and positive correlations with PT and NT.
  
  
  CONCLUSIONS
  Decreased blood F/A ratio in ALF patients may be a reliable indicator of the severity of acute liver injury and prognosis in ALF.
authors.affiliation: First Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Shi De
authors.initials: SD
authors.lastname: Lin
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kawakami
authors.forename: Akira
authors.initials: A
authors.lastname: Ushio
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sato
authors.forename: Sin-Ichiro
authors.initials: S
authors.lastname: Sato
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Iwai
authors.forename: Ryujin
authors.initials: R
authors.lastname: Endo
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takikawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Suzuki
mesh_terms: D028341:Activins / Q000097:blood*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D038681:Follistatin / Q000097:blood*; D006505:Hepatitis / Q000097:blood* / Q000473:pathology; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D028322:Inhibin-beta Subunits / Q000097:blood*; D017114:Liver Failure, Acute / Q000097:blood* / Q000473:pathology; D008115:Liver Regeneration / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D038681:Follistatin; C422405:activin A; D028341:Activins; D028322:Inhibin-beta Subunits