Prognostic implications of lactate, bilirubin, and etiology in German patients with acute liver failure.
OBJECTIVE
Among the potentially helpful indicators of poor prognosis in acute liver failure (ALF) are etiology, encephalopathy grade, blood lactate, and King's College Criteria (KCC). The accuracy of these parameters in predicting transplantation or death shows significant variation in different countries.


METHODS
We retrospectively analyzed 102 patients with ALF treated at our institution between 1996 and 2005. Baseline parameters, simplified acute physiology score III (SAPS-III), KCC, Model for End-Stage Liver Disease (MELD) score, and a novel score of bilirubin, lactate, and etiology (BiLE score) were compared between transplant-free survivors and patients who required liver transplantation or died, by using multivariate linear regression analysis and receiver operating characteristics (ROC).


RESULTS
The most common causes of ALF were indeterminate liver failure (21%), acute hepatitis B (18%), acetaminophen ingestion (16%), and Budd-Chiari syndrome (9%). Transplantation-free survival was 38%, 44% of patients underwent liver transplantation, and 18% died without transplantation. Eight-week survival was 77%. The BiLE score was the best predictor of death or need of transplantation, with 79% sensitivity and 84% specificity. ROC analysis revealed a better performance of BiLE score when compared with bilirubin, lactate, MELD score, and SAPS-III (area under the curve: 0.87 +/- 0.04, 0.73 +/- 0.51, 0.73 +/- 0.52, 0.71 +/- 0.05, and 0.68 +/- 0.59, respectively).


CONCLUSIONS
The simple, combined BiLE score emerged as the best predictor of poor outcome in our patient cohort and should be prospectively evaluated in other populations.
Hadem
Johannes
J
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. hadem.johannes@mh.hannover.de
Stiefel
Penelope
P
Bahr
Matthias J
MJ
Tillmann
Hans L
HL
Rifai
Kinan
K
Klempnauer
Jürgen
J
Wedemeyer
Heiner
H
Manns
Michael P
MP
Schneider
Andrea S
AS
D000082:Acetaminophen / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000378:metabolism; D006502:Budd-Chiari Syndrome / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019344:Lactic Acid / Q000097:blood*; D017114:Liver Failure, Acute / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D018712:Analgesics, Non-Narcotic; D015415:Biomarkers; D019344:Lactic Acid; D000082:Acetaminophen; D001663:Bilirubin