title: Study of Carnitine/Acylcarnitine and Amino Acid Profile in Children and Adults With Acute Liver Failure.
abstract: Fatty acid oxidation defects (FAODs) may underlie or modify the course of acute liver failure (ALF). Overall significance of carnitine/acylcarnitine and amino acid profile in ALF is similarly undetermined. Thus, this study was undertaken to study the abnormalities in carnitine/acylcarnitine and amino acid profile in ALF.
  
  
  
  A prospective study was performed including all patients with ALF, and detailed evaluation including metabolic testing was done.
  
  
  
  A total of 55 patients (33 pediatric and 22 adult patients) were included in the study. Three patients (a 1-year 6-month-old child, a 13-year-old adolescent, and a 21-year-old adult, ie, 5.5% of all) were identified for the study with underlying metabolic etiology, that is, carnitine palmitoyl transferase-1 deficiency, based on the abnormal carnitine/acylcarnitine profile. Almost three-fourths of patients (78%) had evidence of serum hyperaminoacidemia. Thirty-one patients (56%) had evidence of abnormal carnitine/acylcarnitine profile with predominant abnormality being low free carnitine (C0). Higher levels of serum tyrosine (P = 0.002) and lower levels of serum C0 (P = 0.032) in children and higher levels of serum phenyalanine (P = 0.047) in adults predicted poor outcome (death/liver transplant) on univariate analysis.
  
  
  
  FAODs are not uncommon in ALF with a suggested prevalence of approximately 5.5%. FAODs can cause ALF or modify the natural course of ALF caused by other etiologies. Serum hyperaminoacidemia and low serum free carnitine may predict poor outcome in patients with acute liver failure.
authors.affiliation: *Department of Pediatric Hepatology †Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi ‡Ionics Research Laboratory, Gurgaon, Haryana §Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Vikrant
authors.initials: V
authors.lastname: Sood
authors.forename: Dinesh
authors.initials: D
authors.lastname: Rawat
authors.forename: Rajeev
authors.initials: R
authors.lastname: Khanna
authors.forename: Shvetank
authors.initials: S
authors.lastname: Sharma
authors.forename: Prem K
authors.initials: PK
authors.lastname: Gupta
authors.forename: Seema
authors.initials: S
authors.lastname: Alam
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000293:Adolescent; D000328:Adult; D000596:Amino Acids / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002331:Carnitine / Q000031:analogs & derivatives* / Q000097:blood*; D002334:Carnitine O-Palmitoyltransferase / Q000097:blood / Q000172:deficiency*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007223:Infant; D008052:Lipid Metabolism, Inborn Errors / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D017114:Liver Failure, Acute / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D062072:Patient Acuity; D011446:Prospective Studies
chemical_list: D000596:Amino Acids; D015415:Biomarkers; C116917:acylcarnitine; D002334:Carnitine O-Palmitoyltransferase; D002331:Carnitine