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Altered iron parameters predict acute liver failure outcomes

Alterations in iron parameters correlated with 3-week outcomes in patients with acute liver failure and may serve as a useful component in prognostic scores, according to a study published in Hepatology.

“Multiple studies demonstrated that parameters of iron metabolism represent useful predictors of liver disease outcome,” Igor Spivak, MD, from the University Hospital Aachen in Germany, and colleagues wrote. “Our study demonstrated that ALF patients display markedly altered iron parameters. However, the observed changes clearly differed from the alterations seen in other liver disorders.”

To determine the role of iron parameters in ALF, Spivak and colleagues analyzed serum samples from 121 patients. The cause for ALF was acetaminophen or acetaminophen overdose in 66 patients.

Spontaneous survival occurred more often among patients with acetaminophen-induced AFL compared with patients with other etiologies (57.6% vs 38.2 %; P = .05), and more often among women (84.7% vs. 64.5%; P < .05) and those with lower bilirubin, international normalized ratio and MELD scores.

Patients who achieved spontaneous survival also had lower transferrin saturation levels (60.9% vs. 79.1%; P < .01) and lower serum iron levels (29.1 vs. 34.5 µmol/L; P < .05) compared with the rest of the cohort. In contrast, spontaneous survivors had higher hepcidin values (8.2 vs. 2.7 ng/mL; P < .001) and hepcidin/ferritin ratios (0.0047 vs. 0.0009; P < .0001).

Multivariate analysis showed that log INR (P < .05), coma grade 3/4 (P < .001), platelet count (P < .001), acetaminophen etiology (P < .01) and log hepcidin+1 (P < .05) correlated independently with spontaneous survival at 21 days follow-up.

Those factors combined as a predictive model achieved higher sensitivity (81%), specificity (79.6%), and area under the curve (0.87; 95% CI, 0.8-0.93) compared with MELD (AUC = 0.76) and ALF Study Group (AUC = 0.85) scores.

“Hepcidin levels were particularly low in [non-spontaneous survivors] and hepcidin constituted an independent predictor of ALF-related survival,” Spivak and colleagues wrote. “While serum hepcidin and ferritin significantly correlate in healthy subjects, this relationship is altered in advanced liver disease and even more in ALF, that displays low hepcidin, but strongly elevated ferritin as a surrogate of the hepatocellular injury.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.