Predictive value of serum actin-free Gc-globulin for complications and outcome in acute liver failure.
This prospective study was designed to evaluate whether early changes in actin-free Gc-globulin levels were associated with complications and outcomes and to identify factors associated with persistent low actin-free Gc-globulin levels in acute liver failure (ALF). Thirty-two consecutive ALF patients admitted from October 2011 to December 2012 were followed up until death or complete recovery. All had serum actin-free Gc-globulin estimation at admission and at day three or expiry. Logistic regression analysis was performed to identify independent predictors of mortality. A receiver operating characteristic curve analysis was also performed. Nonsurvivors had significantly lower median actin-free Gc-globulin levels than survivors (87.32 vs 180 mg/L; P < 0.001). A receiver operating characteristic curve analysis revealed an area under curve (AUC) of 0.771 and showed that serum actin-free Gc-globulin level of ≤124 mg/L would predict mortality with 92% sensitivity and 71.4% specificity. Patients with lower serum actin-free Gc-globulin levels and decreasing trend in serum actin-free Gc-globulin levels were found to have more mortality and developed more complications. Logistic regression analysis showed that serum actin-free Gc-globulin, total leucocyte count and serum creatinine at admission were independent predictors of mortality. Incorporating these variables, a score predicting mortality risk at admission was derived. The scoring system was compared to MELD score and King's College Criteria as individual predictor of mortality. Serum actin-free Gc-globulin level at presentation is predictive of outcome and can be used for risk stratification. Its persistent low-level predicts mortality and is correlated with various complications.
General Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India.
A
A
Bagchi
S
S
Kumar
P C
PC
Ray
B C
BC
Das
P K
PK
Gumma
P
P
Kar
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D017114:Liver Failure, Acute / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D044967:Serum / Q000737:chemistry*; D016019:Survival Analysis; D014809:Vitamin D-Binding Protein / Q000097:blood*; D055815:Young Adult
D015415:Biomarkers; D014809:Vitamin D-Binding Protein; D003404:Creatinine
actin-free Gc-globulin; acute liver failure