Abstract:

BACKGROUND: End-stage liver disease model has been extensively applied due to little affected by subjective factors, and existing evidence shows that it has no obvious advantage in assessing the prognosis of live failure.
OBJECTIVE: To investigate the application value of laboratory-related indicators in predicting clinical outcome of liver failure.
METHODS: One hundred and seventy-nine patients with liver failure admitted at the Department of Gastroenterology, the First Affiliated Hospital of Hainan Medical University were selected, including 142 males and 37 females, with a mean age of (38.6±7.9) years. The study was approved by the Ethics Committee of the First Affiliated Hospital of Hainan Medical University, and all patients and their families signed the informed consents. According to the stage of liver failure, the patients were divided into three groups: early-, middle- and end-stage groups. The patients were divided into the survival group and the death group based on 8-week prognosis following the admission. The laboratory-related indicators was collected and compared. Risk factors influencing the clinical outcomes were selected and the correlation between the staging and indicators were analyzed using logistic multivariate regression analysis. Receiver operating characteristic curve was used to analyze the predictive ability of risk factors for clinical outcomes.
RESULTS AND CONCLUSION: (1) The total bilirubin, international normalized ratio and urea nitrogen in the survival group were significantly lower than those in the death group. Alpha fetoprotein, albumin, fibrinogen and cholinesterase in the survival group were significantly higher than those in the death group (all P < 0.05). (2) Logistic regression analysis showed that international normalized ratio, albumin, alpha fetoprotein, and cholinesterase had an impact on the clinical outcome of liver failure. Further analysis found that cholinesterase and alpha fetoprotein were the first two indicators influencing clinical outcome of liver failure based on the OR value. (3) The serum markers of cholinesterase, alpha fetoprotein and albumin in the early-, middle- and late-stages showed a downward trend, while the international normalized ratio showed an upward trend (all P < 0.05). Pairwise comparison was performed between the levels of cholinesterase, alpha fetoprotein, international normalized ratio and albumin in different stages, and the differences were significant (P < 0.05). Stages were negatively correlated with cholinesterase, alpha fetoprotein and albumin (all P < 0.001). International normalized ratio was positively correlated with the stage (r=0.548, P < 0.001). (4) The area under the receiver operating characteristic curve: the best diagnostic point for alpha fetoprotein was 141.51 μg/L, with a sensitivity of 97.6% and a specificity of 64.9%. The best diagnostic point for cholinesterase was 3.89 kU/L, with a sensitivity of 90.7%, and a specificity of 59.8%. Alpha fetoprotein combined with cholinesterase predicted the clinical outcome of liver failure, with an area under the receiver operating characteristic curve of 0.872, a specificity of 84.5%, and a sensitivity of 76.8%. (5) These results imply that cholinesterase and alpha fetoprotein can be used to predict the clinical outcomes of patients with liver failure. The combination of the two can be more accurate.

Key words: liver failure, laboratory parameters, alpha fetoprotein, cholinesterase, international normalized ratio