title: Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure.
abstract: BACKGROUND
  Acute liver failure (ALF) is an acute severe deterioration of liver function with high mortality. Early and accurate prognostic assessment of patients with ALF is critically important. Although the model for end-stage liver disease (MELD) scores and King's College Hospital (KCH) criteria are well-accepted as predictive tools, their accuracy is unsatisfactory. The indocyanine green (ICG) clearance test (ICGR15, ICG retention rate at the 15 minutes) is a sensitive indicator of liver function. In this study, we investigated the efficacy of the ICGR15 for the short-term prognosis in patients with ALF. We compared the predictive value of ICGR15 with the MELD scores and KCH criteria.
  
  
  METHODS
  Sixty-nine patients who had been diagnosed with ALF were recruited retrospectively. ICGR15 had been performed by ICG pulse spectrophotometry and relevant clinical and laboratory indices were analyzed within 24 hours of diagnosis. In addition, the MELD scores and KCH criteria were calculated.
  
  
  RESULTS
  The three-month mortality of all patients was 47.83%. Age, serum total bilirubin and creatinine concentrations, international normalized ratio for prothrombin time, ICGR15, MELD scores and KCH criteria differed significantly between surviving and deceased patients. A positive correlation was observed between ICGR15 and MELD scores (r=0.328, P=0.006). The ICGR15-MELD model, Logit(P)=0.096XICGR15+0.174XMELD score-9.346, was constructed by logistic regression analysis. The area under the receiver operating characteristic curve was 0.855. When set the cut-off point to -0.4684, the sensitivity was 87.90% and specificity, 72.20%. The area under the receiver operating characteristic curve of the ICGR15-MELD model (0.855) was significantly higher than that of the ICGR15 (0.793), MELD scores (0.776) and KCH criteria (0.659). Based on this cut-off value, the patients were divided into two groups. The mortality was 74.36% in the first group (ICGR15-MELD≥-0.4686) and 13.33% in the second group (ICGR15-MELD<-0.4686), with a significant difference between the two groups (X(2)=25.307, P=0.000).
  
  
  CONCLUSIONS
  The ICGR15-MELD model is superior to the ICGR15, MELD scores, and KCH criteria in predicting the short-term prognosis of patients with ALF.
authors.affiliation: Intensive Care Unit, Tianjin Second People's Hospital, Tianjin 300192, China. crbicu@163.com.
authors.forename: Hong-Ling
authors.initials: HL
authors.lastname: Feng
authors.forename: Qian
authors.initials: Q
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Gui-Yu
authors.initials: GY
authors.lastname: Yuan
authors.forename: Wu-Kui
authors.initials: WK
authors.lastname: Cao
mesh_terms: D000328:Adult; D000367:Age Factors; D019540:Area Under Curve; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004396:Coloring Agents; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D019934:International Normalized Ratio; D008099:Liver / Q000378:metabolism* / Q000503:physiopathology; D017114:Liver Failure, Acute / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011517:Prothrombin Time; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013053:Spectrophotometry; D013997:Time Factors
chemical_list: D015415:Biomarkers; D004396:Coloring Agents; D003404:Creatinine; D007208:Indocyanine Green; D001663:Bilirubin