Association Between Plasma Level of Galectin-9 and Survival of Patients With Drug-Induced Acute Liver Failure.
OBJECTIVE
Fewer than 50% of patients with acute liver failure (ALF) recover spontaneously, and ALF has high mortality without liver transplantation. Kupffer cells have been reported to mediate liver inflammation during drug-induced injury. Galectin-9 is produced by Kupffer cells and has diverse roles in regulating immunity. We investigated whether plasma levels of galectin-9 are associated with outcomes of patients with ALF.


METHODS
We analyzed plasma samples (collected at time of hospital admission) and clinical data from 149 patients included in the Acute Liver Failure Study Group from July 2006 through November 2010 (110 had acetaminophen-induced hepatotoxicity and 39 had nonacetaminophen drug-induced liver injury). We compared data with those from all patients enrolled in the study (from July 1, 2006 through October 30, 2013), and from healthy individuals of similar ages with no evidence of liver disease (control subjects). Plasma levels of galectin-9 were measured using a polyclonal antibody and colorimetric assay.


RESULTS
Patients with ALF had statistically higher plasma levels of galectin-9 than control subjects, but levels did not differ significantly between patients with acetaminophen-induced liver injury and drug-induced liver injury. A level of galectin-9 above 690 pg/mL was associated with a statistically significant increase in risk for mortality or liver transplantation caused by ALF. Competing risk analyses associated level of galectin-9 with transplant-free survival, independently of Model For End-Stage Liver Disease score or systemic inflammatory response syndrome.


CONCLUSIONS
A one-time measurement of plasma galectin-9 level can be used to assign patients with ALF to high-, intermediate-, and low-risk groups. The combination of galectin-9 level and Model For End-Stage Liver Disease score was more closely associated with patient outcome than either value alone. These data might be used to determine patient prognoses and prioritize patients for liver transplantation. ClinicalTrials.gov ID NCT00518440.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado, Aurora, Colorado; Integrated Program in Immunology, University of Colorado, Aurora, Colorado. Electronic address: hugo.rosen@ucdenver.edu.
Hugo R
HR
Rosen
Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado, Aurora, Colorado.
Scott W
SW
Biggins
Department of Immunology, Kagawa University, Kagawa, Japan; GalPharma Co., Kagawa, Japan.
Toshiro
T
Niki
University of Colorado Denver, Department of Pediatrics, Aurora, Colorado; University of Colorado Denver, Department of Biostatistics and Informatics, Aurora, Colorado.
Jane
J
Gralla
Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Holly
H
Hillman
Department of Immunology, Kagawa University, Kagawa, Japan; GalPharma Co., Kagawa, Japan.
Mitsuomi
M
Hirashima
Division of Digestive Diseases and Section of Transplantation and Immunology, Departments of Medicine and Surgery, Yale University Medical Center, New Haven, Connecticut.
Michael
M
Schilsky
Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
William M
WM
Lee
D000082:Acetaminophen / Q000009:adverse effects; D000328:Adult; D058633:Antipyretics / Q000009:adverse effects; D015331:Cohort Studies; D003124:Colorimetry; D005260:Female; D037161:Galectins / Q000097:blood*; D006801:Humans; D007118:Immunoassay; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry*; D011379:Prognosis; D016019:Survival Analysis
D058633:Antipyretics; D037161:Galectins; C105032:LGALS9 protein, human; D000082:Acetaminophen
Innate Immune Responses; Prediction; SIRS; Stratification