Early identification using the referral system prolonged the time to onset for hepatic encephalopathy after diagnosing severe acute liver injury

Keisuke Kakisaka,Yuji Suzuki,Yasuhiro Takikawa,Takuya Watanabe,Hiroki Sato,Hiroaki Abe,Kenji Yusa

doi:10.1038/s41598-020-74466-2

Keisuke Kakisaka, Yuji Suzuki + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-74466-2

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Journal: Scientific Reports	Publication Date: Oct 14, 2020
Citations: 4	License type: open-access

Affiliation: Iwate Medical University

Abstract

In 2004, we implemented a referral system for patients with acute liver injury (ALI) based on an established formula that estimates the risk of progression to acute live failure (ALF); however, the benefits of the system for patients with severe acute liver injury (SLI) remain unclear. We have evaluated the clinical significance of the referral system for SLI patients. Patients with ALI/SLI who were consecutively and prospectively listed on the system between 2004 and 2018 were analyzed. Of the 371 ALI/SLI/ALF patients on the system, 124 satisfied the criteria for SLI; 34 of these 124 progressed to SLI after registration. Multivariate analysis using age, sex, AST, ALT, creatinine, total bilirubin, prothrombin, presence of hepatic encephalopathy (HE), and SLI at registration revealed that HE was associated with high mortality. Among the 23 patients who developed HE, five who progressed to SLI after registration showed an increased time to HE development compared with patients who had SLI at the time of registration. However, there was no significant difference in survival time after HE development. We concluded that early identification of SLI patients using the referral system increased the time from SLI diagnosis to HE development.

Highlights

In 2004, we implemented a referral system for patients with acute liver injury (ALI) based on an established formula that estimates the risk of progression to acute live failure (ALF); the benefits of the system for patients with severe acute liver injury (SLI) remain unclear
Binominal logistic regression analysis using laboratory data at the time of SLI diagnosis, sex, age, and development of hepatic encephalopathy (HE) as explanatory variables revealed the development of HE to be the only factor associated with poor prognosis
Our previous study reported a decrease in the rate of HE development after implementing the referral system, where preemptive therapy for HE to the ALI patients was suggested to improve the clinical course of patients with SLI

Summary

Introduction

In 2004, we implemented a referral system for patients with acute liver injury (ALI) based on an established formula that estimates the risk of progression to acute live failure (ALF); the benefits of the system for patients with severe acute liver injury (SLI) remain unclear. To predict the development of HE, we established a method to evaluate the probability of HE onset based on age, etiology, and total bilirubin and prothrombin activity; it is referred to as the Japan Hepatic Encephalopathy prediction (JHEP) m odel[8]. Using this model, we prospectively collected data from patients with ALI in the Northern Tohoku area in Japan, including age, sex, etiology of ALI, laboratory data, treatment, and outcome. To understand potential indications for liver transplantation in patients with ALF who are listed on the referral system, the risk factors associated with poor prognosis must be investigated. The effect of the referral system on the clinical course of such patients needs to be evaluated

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