Glasgow coma scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure

• Published in: Hepatobiliary & pancreatic diseases international 2013-12, Vol.12 (6), p.589-593
• Main Authors: Guler, Necdet, Unalp, Omer, Guler, Ayse, Yaprak, Onur, Dayangac, Murat, Sozbilen, Murat, Akyildiz, Murat, Tokat, Yaman
• Format: Article
• Language: English
• Subjects: acute; acute liver failure; Adolescent; Adult; APACHE; APACHE-II; Child; Child, Preschool; coma; Endocrinology & Metabolism; failure; Female; Follow-Up Studies; Gastroenterology and Hepatology; Glasgow; Glasgow Coma Scale; Humans; Kaplan-Meier Estimate; liver; Liver Failure, Acute - mortality; Liver Failure, Acute - surgery; Liver Transplantation; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; scale; Survival Rate; time; transplantation; Treatment Outcome; waiting; waiting time; Young Adult
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(13)60093-4

BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure.METHOD:A total of 25 patients with acute liver failure were retrospectively analyzed according to age,etiology,time to transplantation,coma scores,complications and mortality.RESULTS:Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants.The mean duration of follow-up after liver transplantation was 39.86±40.23 months.Seven patients died within the perioperative period and the 1-,3-,5-year survival rates of the patients were72%,72%and 60%,respectively.The parameters evaluated for the perioperative deaths versus alive were as follows:the mean age of the patients was 33.71 vs 28 years,MELD score was 40 vs32.66,GCS was 5.57 vs 10.16,APACHE-II score was 23 vs 18.11,serum sodium level was 138.57 vs 138.44 mmol/L,mean waiting time before the operation was 12 vs 5.16 days.Low GCS,high APACHE-II score and longer waiting time before the operation(P<0.01)were found as statistically significant factors for perioperative mortality.CONCLUSION:Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.