Marker Shows Prognosis for Liver Failure

Elevated levels of blood lactate indicate a poor prognosis for patients with fulminant hepatic failure (FHF) and, therefore, the need for a transplant, according to a new study appearing in the September 2005 issue of Liver Transplantation (Wiley Interscience).

FHF is rare but is the cause of up to 7% of liver transplants. Because life-threatening complications can develop suddenly, it is critical to determine quickly whether or not to perform surgery. The most widely used criterion to decide on a transplant is that of
King's College Hospital (London, UK), but it does not predict patients who will not survive without a transplant.

In the current study, UK researchers examined two markers that could play a role in predicting FHF outcomes: serum phosphate and serum blood lactate levels. They divided 83 patients with FHF into three groups: those with medical treatment, those who underwent a transplant, and those who died. Of the 83, 58% survived with medical treatment, 23% underwent transplants, and 23% died. The results showed that serum phosphate levels were significantly higher in those who died or underwent a transplant, but showed little difference between those who died and those treated without a transplant. Lactate levels, in contrast, were significantly higher in patients who died or underwent a transplant, and this difference was also seen between those who died and those who survived without a transplant.

The investigators surmise that high blood lactate levels were an accurate predictor of a poor outcome in FHF patients. "This raises the importance of close monitoring of serial arterial blood lactate levels,” they observed. They propose that curves of blood lactate levels be established to predict FHF outcomes. Their study was conducted in the liver unit of the Queen Elizabeth Hospital (Birmingham, UK), led by Gerry C. MacQuillan, of the department of gastroenterology and hepatology in the Sir Charles Gairdner Hospital (Nedlands, Australia).




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