title: Predictive value of actin-free Gc-globulin in acute liver failure.
abstract: Serum concentrations of the actin scavenger Gc-globulin may provide prognostic information in acute liver failure (ALF). The fraction of Gc-globulin not bound to actin is postulated to represent a better marker than total Gc-globulin but has been difficult to measure. We tested a new rapid assay for actin-free Gc-globulin to determine its prognostic value when compared with the King's College Hospital (KCH) criteria in a large number of patients with ALF. A total of 252 patients with varying etiologies from the U.S. ALF Study Group registry were included; the first 178 patients constituted the learning set, and the last 74 patients served as the validation set. Actin-free Gc-globulin was determined with a commercial enzyme-linked immunosorbent assay kit. The median (range) actin-free Gc-globulin level at admission for the learning set was significantly reduced compared with controls (47 [0-183] mg/L vs. 204 [101-365] mg/L, respectively, P < 0.001). Gc-globulin levels were significantly higher in spontaneous survivors than in patients who died or were transplanted (53 [0-129] mg/L vs. 37 [0-183] mg/L, P = 0.002). A receiver operating characteristic curve analysis showed that a 40 mg/L cutoff level carried the best prognostic information, yielding positive and negative predictive values of 68% and 67%, respectively, in the validation set. The corresponding figures for the KCH criteria were 72% and 64%. A new enzyme-linked immunosorbent assay for actin-free Gc-globulin provides the same (but not optimal) prognostic information as KCH criteria in a single measurement at admission.
authors.affiliation: Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA. schiodt@get2net.dk
authors.forename: Frank V
authors.initials: FV
authors.lastname: Schiødt
authors.forename: Kristian
authors.initials: K
authors.lastname: Bangert
authors.forename: A Obaid
authors.initials: AO
authors.lastname: Shakil
authors.forename: Timothy
authors.initials: T
authors.lastname: McCashland
authors.forename: Natalie
authors.initials: N
authors.lastname: Murray
authors.forename: J Eileen
authors.initials: JE
authors.lastname: Hay
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000145:classification; D017114:Liver Failure, Acute / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D014809:Vitamin D-Binding Protein / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014809:Vitamin D-Binding Protein