Hepatology Xagena

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High blood lactate levels may indicate poor prognosis in fulminant hepatic failure

A study on fulminant hepatic failure ( FHF ) examined whether patients would benefit from a transplant.
The results, published in the journal Liver Transplantation, showed that elevated blood lactate levels indicate a poor prognosis and thus the need for a transplant.

Although it is rare, fulminant hepatic failure is the reason that up to 7 percent of liver transplants are performed.
However, because life-threatening complications can quickly develop with the disorder, coupled with the fact that some patients recover without having to undergo a transplant, time is of the essence in determining whether or not to perform the surgery.
Various criteria have been used to establish a prognosis, the most widely applied of which is the King's College Hospital criteria, which can be helpful in indicating the need for a transplant, but do not predict patients who will not survive without one.

The study was led by Gerry C. MacQuillin, of the Sir Charles Gairdner Hospital in Nedlands, Australia, while working in Birmingham UK.
Researchers examined two markers that could play a role in predicting fulminant hepatic failure outcomes: serum phosphate and serum blood lactate levels.

The study included 83 patients with fulminant hepatic failure admitted at Queen Elizabeth Hospital in Birmingham, England, between August 2000 and March 2003.
Patients were divided into those who survived with medical treatment, those who underwent a liver transplant, and those who died.
Patients were also grouped according to whether or not they had overdosed on Paracetamol, a common cause of fulminant hepatic failure.

Of the 83 patients, 58 percent survived with medical treatment, 23 percent underwent liver transplants, and 19 percent died.
Those who had overdosed on Paracetamol had a much higher recovery rate: 73 percent survived with medical treatment, compared to 26 percent of those who had not overdosed.

The results showed that serum phosphate levels were significantly higher in those who died or underwent a transplant, but there was not a significant difference when comparing those who died to those who were treated without having a transplant.

Lactate levels were significantly higher during the 12 hour period following admission to the hospital in those who died or underwent a transplant, and this difference was also seen between those who died and those who survived without a transplant, whether or not they had overdosed.

The authors surmise that high blood lactate levels were an accurate predictor of a poor outcome in fulminant hepatic failure patients.

" Our data has showed that serial blood lactate measurements were higher in nonsurvivors, with increasing significance in relation to time," they state. " This raises the importance of close monitoring of serial arterial blood lactate levels."

The authors conclude by proposing that curves of blood lactate levels, which would need to be examined in further studies, be established to predict fulminant hepatic failure outcomes.

An accompanying editorial by A. Obaid Shakil at the University of Pittsburgh School of Medicine notes that in determining the need for a transplant, the window for decision-making in fulminant hepatic failure is short compared to other liver diseases, and the criteria currently used are inadequate.

" The current study provides further evidence of the prognostic value of serum lactate during the early phase of fulminant hepatic failure," he states. " If validated by well-powered prospective studies, blood lactate level may serve as an additional criteria to the well-tested King's College Hospital criteria."

Obaid Shakil cautions, however, that clinicians should not rely solely on these tests, but should use them in combination with all other available information.

Source: Liver Transplantation, 2005