Changes in alpha‐foetoprotein and Gc‐globulin in relation to outcomes in non‐acetaminophen acute liver failure

Background Changes in Gc‐globulin (Gc) and in alpha‐foetoprotein (AFP) have been shown to be related to outcome in patients with acute liver failure (ALF). Gc is a serum protein that complexes with intravascular actin released during cellular necrosis. AFP, also made by hepatocytes, is associated wi...

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Bibliographic Details
Published in:Liver international 2019-12, Vol.39 (12), p.2368-2373
Main Authors: Singh, Sundeep, Hynan, Linda S., Rule, Jody A., Lee, William M.
Format: Article
Language:English
Subjects:
Acetaminophen
Acetylcysteine
Actin
acute liver failure
AFP
Analgesics
Drug overdose
Gc‐globulin
Globulins
Hepatocytes
Intravenous administration
Liver
Liver failure
Markers
Necrosis
Regeneration
Regression analysis
Survival
Transplantation
Transplants & implants
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Summary:Background Changes in Gc‐globulin (Gc) and in alpha‐foetoprotein (AFP) have been shown to be related to outcome in patients with acute liver failure (ALF). Gc is a serum protein that complexes with intravascular actin released during cellular necrosis. AFP, also made by hepatocytes, is associated with hepatocellular growth and regeneration. Previously, low absolute levels or decreases over time in either AFP or Gc portended to be a poor outcome. Methods In a retrospective analysis of the double‐blind trial of intravenous N‐acetylcysteine (NAC) for ALF not because of acetaminophen, sera on days 1 and 3 or days 2 and 4 following admission were available to measure AFP in 70 patients and Gc in 66 patients. Mann‐Whitney U tests were performed on the admission values, the absolute change and the fractional change of AFP and Gc to compare TFS (transplant‐free survival) and non‐TFS (death or transplantation). Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the markers in comparison and in addition to King's College Criteria (KCC). Results Transplant‐free survival patients were characterized by increases in AFP, whereas non‐TFS had significantly different (negative) absolute and fractional changes (P 70%). Gc globulin values did not differ between TFS and non‐TFS in the 2‐day intervals studied (P> .2). Conclusion In this comparison of two prognostic markers in patients with non‐acetaminophen‐induced ALF, rising AFP but not rising Gc levels was associated with TFS. Trial Registration: ClinicalTrials.gov number NCT00004467.
ISSN:1478-3223
1478-3231
DOI:10.1111/liv.14216