Elevated FABP1 serum levels are associated with poorer survival in acetaminophen-induced acute liver failure

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Karvella17_Hepatology_FABP1.pdf (460.05 KB)

Date de publication

2017-01-19

Autrices et auteurs

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Contributrices et contributeurs

Direction de recherche

Publié dans

Hepatology

Date de la Conférence

Lieu de la Conférence

Éditeur

Wiley

Cycle d'études

Programme

Affiliation

Université de Montréal. Faculté de médecine. Département de médecine

Mots-clés

  • Liver type fatty acid binding protein
  • Multiorgan failure
  • Prognosis
  • ALFSG index

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Résumé

Résumé

Background/Aim Acetaminophen (APAP)-induced Acute Liver Failure (ALF) is associated with significant mortality. Traditional prognostic scores lack sensitivity. Hypothesis: Serum Liver-type Fatty Acid Binding Protein (FABP1) early (day 1) or late (day 3–5) levels are associated with 21-day mortality in the absence of liver transplant. Methods Serum samples from 198 APAP-ALF patients (nested case control study with 99 survivors, 99 non-survivors) were analyzed by ELISA methods and assessed with clinical data from the US Acute Liver Failure Study Group (ALFSG) Registry (1998–2014). Results APAP-ALF survivors had significantly lower serum FABP1 levels early (238.6 vs. 690.8 ng/ml, p <0.0001) and late (148.4 vs. 612.3 ng/ml, p <0.0001) compared with non-survivors. FABP1 > 350 ng/ml was associated with significantly higher risk of death at early (p=0.0004) and late (p<0.0001) time points. Increased serum FABP1 early (log FABP1 odds ratio (OR) 1.31, p=0.027) and late (log FABP1 OR 1.50, p =0.005) were associated with significantly increased 21-day mortality after adjusting for significant covariates (MELD, vasopressor use). Areas under the receiver-operating curve (AUROC) for early and late multivariable models were 0.778 and 0.907 respectively. AUROC of the King’s College Criteria (KCC) (Early: 0.552 alone, 0.711 with FABP1; Late: 0.604 alone, 0.797 with FABP1) and ALFSG prognostic index (Early: 0.686 alone, 0.766 with FABP1; Late: 0.711 alone, 0.815 with FABP1) significantly improved with the addition of FABP1 (p <0.002 for all). Conclusion In patients with APAP-ALF, FABP1 may have good potential to discriminate survivors from non-survivors and may improve models currently used in clinical practice. Validation of FABP1 as a clinical prediction tool in APAP-ALF warrants further investigation.

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URI

http://hdl.handle.net/1866/24033

DOI

10.1002/hep.28945

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