Clinical and Laboratory Determinants of Short-Term Transplant-Free Survival in Acute Liver Failure in India—A Prospective Study

Abstract

Background and Aim: Acute Liver Failure (ALF) is a serious syndrome with high mortality, caused mainly by viral hepatitis and toxins in India. Though MELD score and KCH criteria are commonly used as indicators of prognosis in ALF, there is a need for determining their prognostic accuracy in this population. The study was done to identify the etiology and the factors associated with the outcome and to evaluate MELD score and KCH criteria, in ALF. Methods: A prospective observational study was conducted between September 2015 to August 2016 including all patients satisfying the criteria for ALF (altered mental status, INR ≥ 1.5, duration of illness <26 weeks), in the department of Medicine and Medical Gastroenterology in JIPMER. Results: A total of 84 patients (mean age 38 ± 14.9, 55males) were included in the study, 56 patients (66.66%) survived with medical therapy and 23 patients (27.38%) died in hospital, while 5 patients discontinued hospital admission before the end of treatment and were excluded from the final analysis. Etiology was ascertained in 61 patients (77.21%); Viral hepatitis in 37 patients (46.83%) and Toxin intake in 24 patients (30.37%). The viral hepatitis was due to isolated infections in 21 patients and co-infections 16 patients. Multivariate logistic regression showed that the presence of at least 3 of the following – Creatinine ≥1.5 mg/dL, Platelet count <175,000/mm3, Na+ < 135 mEq/L and Serum albumin < 3 g/dL, predicted the short-term outcome with an accuracy of 84.81%. MELD score ≥ 33 and KCH criteria had a prognostic accuracy of 62.02% and 65.82% respectively. This criteria (AUC, 0.842) was superior to MELD (AUC, 0.655) and KCH criteria (AUC, 0.631) (P = 0.0037 and P = 0.0019 respectively) (Table 1).Table 1Causes of Viral Hepatitis.No.Viral hepatitisTotalSurvivorsNon survivors1.Total373072.HAV alone8803HBV alone6514.HEV alone7525.HAV + HBV8536.HAV + HEV7707.HBV + HEV101 Open table in a new tab Conclusions: Viral hepatitis constitutes nearly one-half of the cases of ALF. Presence at admission of at least 3 of the 4 variables has more accuracy in predicting 28-day patient mortality irrespective of the cause of ALF (Figure 1). The authors have none to declare.