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Predictive formula of coma onset and prothrombin time to distinguish patients who recover from acute liver injury
Author(s) -
Kakisaka Keisuke,
Suzuki Yuji,
Kataoka Kojiro,
Okada Yohei,
Miyamoto Yasuhiro,
Kuroda Hidekatsu,
Takikawa Yasuhiro
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13819
Subject(s) - medicine , prothrombin time , coma (optics) , liver injury , gastroenterology , physics , optics
Background and Aim Acute liver failure (ALF) is defined as acute liver injury (ALI) associated with coagulopathy. A follow‐up strategy for ALI and characterization of ALI patients with a risk of progressing to ALF have never been established. To establish predictive markers for progression from ALI to ALF, this study compared the clinical characteristics and laboratory data on the day of registration to data from a regional referral system of patients with ALI. Methods This prospective, observational study enrolled 365 consecutive patients with ALI/ALF between 2007 and 2016. We evaluated 109 ALI patients, 27 of whom satisfied the ALF criteria during observation and another 82 patients who recovered without progression to ALF. Results Four patients died; all were in the ALF group. The variables of age, incidence of autoimmune hepatitis, model of end‐stage liver disease score, values for total bilirubin and prothrombin time (PT)‐international ratio, and Japan Hepatic Encephalopathy Prediction Model (JHEPM) probability at registration were significantly higher in ALF patients than in ALI patients. In multivariate analysis, PT and JHEPM were identified as risk factors for progression to ALF. The cut‐off values of 13%, 4.9%, 65%, and 1.32% for the model of end‐stage liver disease score, JHEPM probability, PT, and PT‐international ratio values, respectively, had high negative predictive values. Furthermore, among patients whose JHEPM was underestimated, none died due to ALF. Conclusion The JHEPM probability is a predictive parameter that can be used to decide a follow‐up treatment strategy for ALI patients.