812 Applicability of MELD scoring system to predict prognosis in patients with acute liver failure

Abstract

Plasma levels of growth factors may be important in determining the extent of liver regeneration in patients with fulminant hepatic failure and in this study human hepatocyte growth factor and biliprotein (bilirubin covalently bound to albumin) were determined in patients with fulminant hepatic failure, mainly as a result of acetaminophen overdose. Admission values for plasma human hepatocyte growth factor were significantly raised, although with a wide range in acetaminophen-induced fulminant hepatic failure (median 7.4 ng/ml, range 0.45–48.4 ng/ml, n=34) and in fulminant hepatic failure from other causes (3.8 ng/ml, 1.72–25.1 ng/ml, n=9) as compared to normal subjects (0.24 ng/ml, 0–0.5 ng/ml, n=30). Higher plasma human hepatocyte growth factor was observed in patients who died (10.1 ng/ml, 3.8–48.4 ng/ml, n=19) than in those who survived (4.3 ng/ml, 0.45–25.1 ng/ml, n=22, p<0.02), which may reflect lack of hepatic clearance in the former group. The median plasma biliprotein on admission (13.2 mg/l, range 6.3–100.7 mg/l, n=43) was significantly increased compared to normal subjects (1.3 mg/l, 0–4.1 mg/l, n=7, p<0.001) with no difference between patients who survived or died, although when plasma biliprotein results were expressed as a percentage of the total bilirubin, the values were slightly higher in survivors (median 14.4%, range 10.8–40.5%, n=23) compared to those who died (12.1%, 7.7–20.9%, n=20, p=0.004). In cases where serial analyses during the course of illness were available, plasma human hepatocyte growth factor tended to decrease during the course of the illness in survivors and increase in those who died, whereas the biliprotein expressed as a percentage of total bilirubin increased in survivors with little change in non-survivors.