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Transjugular diagnostics in acute liver failure including measurements of hepatocentral venous biomarker gradients
Author(s) -
Wang Martin Chong,
Wandrer Franziska,
Schlué Jerome,
Voigtländer Torsten,
Lankisch Tim Oliver,
Manns Michael Peter,
Bantel Heike,
Hahn Thomas
Publication year - 2018
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13185
Subject(s) - medicine , biomarker , gastroenterology , etiology , liver transplantation , liver biopsy , vein , inferior vena cava , necrosis , pathology , cardiology , biopsy , transplantation , biochemistry , chemistry
Aim Acute liver failure (ALF) is a syndrome of severe liver injury that may need urgent liver transplantation and is associated with significant risk of death. Early outcome prediction and further possibilities to increase accuracy of prognosis scores are important. Methods We examined 30 patients with ALF, according to the novel criteria of the Intractable Hepato‐Biliary Diseases Study Group, who underwent transjugular liver biopsy (TJLB) and investigated the relevance of histology for correct diagnosis and etiology. We assessed the suitability of necrosis (%), hepatic venous pressure gradients (HVPG), and hepatocentral venous gradients of serum biomarkers for outcome prediction. For this purpose, we calculated the difference of biomarker levels between hepatic vein (HV) and superior vena cava (SVC) blood samples. Results Histology of TJLB specimens contributed to finding the etiology in 83%. Necrosis (%) and HVPGs were not significantly different between outcome groups. In gradient measurements, caspase 3/7 activity and total cytokeratin 18 (CK‐18) (M65) had significant and relevant levels different from zero. Although they were not accurate for outcome prediction, differences between outcome groups were detected in caspase activation: levels of caspase 3/7 activity in the HV and caspase‐cleaved CK‐18 (M30) in the SVC were significantly higher in spontaneously recovered patients. Conclusions Our results underline the role of caspase activation in spontaneous recovery from ALF. Furthermore, the calculation of hepatocentral venous biomarker gradients could represent a new diagnostic tool whose clinical potential needs to be further investigated.