Coagulation factor V levels as a prognostic indicator in fulminant hepatic failure

✍ Scribed by S Izumi; P G Langley; J Wendon; A J Ellis; R Pernambuco; R D Hughes; R Williams

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 183 KB
• Volume: 23
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510230630

✦ Synopsis

Data reported by Bernuau et al. have strongly sup-those patients who would most benefit from this proceported the measurement of coagulation factor V as the dure. Of the various factors suggested as prognostic best prognostic indicator in fulminant hepatic failure indicators, measurements of the components of the co-(FHF) and as the test on which selection for urgent liver agulation system 1-3 have been considered the most valtransplantation should be made. In this study, we have uable. Many of these are synthesized in the liver and measured plasma factor V in 110 patients with FHF, in show a rapidly falling level as the synthetic function grades I-IV coma, in 88 of whom the etiology was acetof the liver fails. In a study of 115 patients with FHF aminophen overdose. On admission, patients who did due to hepatitis B, Bernuau et al. 1 showed that a denot survive had significantly lower factor V levels (mecreased factor V level was the most sensitive indicator dian, 5%; range, 1-27; n Å 49), compared with those who of liver failure and proposed a factor V level of õ20% did (median, 10%; range, 2-70; P õ .001). In the 81 patients with acetaminophen-induced FHF who did not receive (õ30% if the age was greater than 30 years) as the a transplant, there was no cutoff level of factor V that main criteria for transplantation selection in patients clearly separated the patients. On statistical analysis, a with confusion. The majority of the patients seen in positive predictive value (the mortality in patients prethis center with FHF have an acetaminophen-induced dicted to have a poor prognosis) of 0.49 was calculated liver necrosis; in such a group, we found 3 that metabolic for factor V õ20% and 0.57 for factor V õ10%. If the progacidosis (pH õ 7.3) was highly predictive of a fatal nostic criteria included deep coma (grades III and IV) outcome. In those patients without this, the combinaas well as factor V õ20%, a positive predictive value of tion of an international normalized ratio (INR) ú6.5 0.73 was calculated. This compared with a value of 0.92

PATIENTS AND METHODS

Abbreviations: FHF, fulminant hepatic failure; INR, international normalized ratio.

Of the 110 patients with FHF as defined by Trey and Da-From the Institute of Liver Studies, King's College Hospital and School of vidson, 6 the cause of FHF was an acetaminophen overdose Medicine and Dentistry, London, England.