Admission Factor V Predicts Transplant-Free Survival in Acute Liver Failure

Kavish R. Patidar, Brian C. Davis, James E. Slaven, Marwan S. Ghabril, Chandrashekhar A. Kubal, William M. Lee, Richard T. Stravitz

Research output: Contribution to journalArticle

Abstract

Background and Aims: Traditional laboratory markers are insensitive in distinguishing between patients with acute liver failure (ALF) who will require urgent liver transplantation (LT) from those who will recover spontaneously, particularly within 24 h of presentation. Coagulation factor-V (FV) may improve the accuracy of outcome prediction in ALF due to its predominant synthesis in the liver and short half-life in plasma. Methods: Patients enrolled in the ALF Study Group Registry from a single site had FV determined within 24 h of presentation (Derivation-Cohort). Area under the receiver operating characteristic curves (AUROC) dichotomized by ALF etiology [acetaminophen (APAP) or non-APAP] were constructed to evaluate the diagnostic performance of FV for transplant-free-survival (TFS). Multivariate logistic regression modeling was performed using FV and other clinical variables to predict TFS. Accuracy of FV and multivariable model were performed in a Validation-Cohort from a different site. Results: 90-patients (56% with APAP) were included in the Derivation-Cohort. Median FV was significantly higher in TFS versus those who died/LT (31% vs. 15%, respectively; p = 0.001). When dichotomized by etiology, AUROC for FV was 0.77 for APAP (cutoff, sensitivity, specificity 10.5%, 79%, 69%, respectively) and 0.77 for non-APAP (22%, 85%, 67%, respectively). When the optimal cutoffs for FV in the Derivation-Cohort were applied to the Validation-Cohort (N = 51; 59% with APAP), AUROC for FV was 0.75 for APAP (sensitivity/specificity 81/44) and 0.95 for non-APAP (sensitivity/specificity 90/73). In multivariate analyses, AUROC for FV model was 0.86 in the Derivation-Cohort and 0.90 in the Validation-Cohort. Conclusion: Admission FV may improve selection of patients who are likely to improve without LT.

Original languageEnglish (US)
JournalDigestive diseases and sciences
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Acetaminophen overdose
  • Fulminant liver failure
  • Intensive care unit
  • Kings College Criteria
  • Liver transplantation
  • MELD

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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    Patidar, K. R., Davis, B. C., Slaven, J. E., Ghabril, M. S., Kubal, C. A., Lee, W. M., & Stravitz, R. T. (Accepted/In press). Admission Factor V Predicts Transplant-Free Survival in Acute Liver Failure. Digestive diseases and sciences. https://doi.org/10.1007/s10620-020-06197-3