Limax as a prognostic marker for survival in acute liver failure

Background Acute liver failure (ALF) is a rare clinical syndrome with high mortality if not treated with state-of-the-art intensive care or emergency liver transplantation. Reliable tools to identify high-risk patients are still required. Thus we aimed to evaluate LiMAx, an accurate measure for liver function, as a predictor of survival in ALF.

Methods Clinical data of 35 patients with ALF or acute hepatitis (AH) was retrospectively analyzed. Liver function tests and transient elastography (TE) were analyzed for associations with clinical outcome. The LiMAx measures cytochrome P4501A2 capacity by determining CO2 in breath after 13C-Methacetin injection. Data were compared between patients with spontaneous recovery (SR) and non-spontaneous recovery (3-month mortality/LTx; NSR)

Results 35 patients (22 ALF, 13 AH; 20 male, 15 female; age 36.18±14.65; 31 SR, 3 NSR) with DILI (n=13), AIH (n=13), AIH-DILI overlap (n=1), viral (n=9) and cryptogenic liver failure (n=1) were analyzed. The LiMax was 198.47 for SR vs. 92.33 for NSR (p=0.0135). Fibrinogen was significantly lower in patients with NSR than in SR patients (216.7 vs. 106.3; p=0.021). Mean liver stiffness by TE was 39.3 for NSR and 16.97 for SR (p=0.2). LiMAx results were positively correlated with serum fibrinogen and ATIII concentrations and negatively correlated with liver stiffness. Neither coagulation parameters nor the MELD Score exhibited differences between SR and NSR.

Discussion/Conclusion Decision making in ALF remains challenging. LiMAx might predict prognosis in patients with ALF and could be an objective tool to decide if liver transplantation is necessary.

Publication History

Article published online:
26 January 2022