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Predictive model aids in care of ALI to ALF progression

Recently published data showed that Japan Hepatic Encephalopathy Prediction Model, or JHEPM, probability and prothrombin-time international ratio values can be used as predictive measures for the progression from acute liver injury to acute liver failure.

“Because early intervention for ALI/ALF might be beneficial, and prevention of the progression to ALF in ALI patients is possible, strict follow-up for early identification of ALI patients who satisfy the treatment indication is required,” Keisuke Kakisaka, MD, PhD, from the Iwate Medical University, Japan, and colleagues wrote. “Because frequent follow-up of all ALI patients is associated with increased human resources and medical costs in the hospital, it is important to identify patients with ALI that could likely progress to ALF and the markers that can predict disease progression.”

The prospective, observational study comprised 109 patients with ALI who presented for evaluation of liver dysfunction between December 2007 and April 2016. Etiologies included drug-induced liver injury (n = 23), hepatitis B (n = 21), other viral infection (n = 18), autoimmune hepatitis (n = 12), undetermined cause (n = 30) or other (n = 5). Mean patient age was 49 years (range, 16-86 years) and 56 were women.

Prothrombin-time (PT) was above 40% in the study population and the prothrombin-time international ratio (PT-INR) was below 1.5. At registration, PT activity was 66% and PT-INR was 1.29 in patients who progressed to ALF, while those who did not progress had PT activity of 61.1% and PT-INR of 1.36 (P < .05).

Similarly, patients who had progressed to ALF had a lower JHEPM probability (3.8%) and MELD score (10.3) compared with the patients who did not progress (JHEPM probability, 10.3%; MELD score, 12.8; P < .05).

Additionally, patients who progressed from ALI to ALF were older (mean 60.5 years vs. 47.1 years; P < .05) and had a higher incidence of AIH diagnosis (22% vs. 7%; P < .05).

The researchers determined their results indicated PT activity and JHEPM probability were useful for identifying patients whose ALI did not progress to ALF. PT activity did not accurately predict progression to ALF in seven patients, for PT-INR it was four patients and for JHEPM probability it was seven. There was a higher number of patients in the PT-INR group who progressed to ALF and coma and patients who died.

“Hepatic encephalopathy occurs in ALF patients due to impairment of the biochemical function of the liver. Once the biochemical function of the liver collapses, patients with ALF require intensive care in order to recover,” the researchers wrote. “Recently, it has been reported that early intervention in ALI patients can reduce the risk of hepatic coma. Based on these findings, strict follow-up of ALI patients is required for early detection of progression to ALF and check that these patients satisfy the indications for ALI treatment such as high-dose corticosteroid therapy.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.