TY - JOUR
T1 - A new prognostic formula for adult acute liver failure using computer tomography-derived hepatic volumetric analysis
AU - Yamagishi, Yoshiyuki
AU - Saito, Hidetsugu
AU - Ebinuma, Hirotoshi
AU - Kikuchi, Masahiro
AU - Ojiro, Keisuke
AU - Kanamori, Hideaki
AU - Tada, Shinichiro
AU - Horie, Yoshinori
AU - Kato, Shinzo
AU - Hibi, Toshifumi
N1 - Funding Information:
This study was financially supported by grants from the Japanese Health Labour Sciences Research Grant, and Grant-in-Aid for Scientific Research (C).
PY - 2009
Y1 - 2009
N2 - Background/Aims: King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score are useful and widely employed prognostic markers for acute liver failure (ALF). We previously reported that liver atrophy is an important prognostic factor for ALF. The aim of the present study was to assess the value of liver volumetry and to generate a new prognostic formula. Methods: Computed tomography-derived liver volume (CTLV) and standardized liver volume (SLV) of 30 adult ALF patients were calculated at the time of diagnosis. Patients were assigned to one of two groups: group A consisted of 13 patients who recovered without surgical intervention, and group B consisted of 17 patients who died due to liver failure or who underwent living donor liver transplantation (LDLT). Results: The median CTLV/SLV ratios of groups A and B were 1.019 and 0.757, respectively (P = 0.0009). The difference was most significant (P = 0.0002) at the probability cutoff point of 0.80 for CTLV/SLV ratio; the sensitivity and specificity were 76.5% and 92.3%, respectively. Serum total bilirubin (TB) levels and CTLV/SLV ratio were selected as independent prognostic factors by multivariate analysis. A prognostic formula including volumetric analysis was established: Z = -2.3813 - [0.15234 × TB (mg/dl)] + [4.5734 × CTLV/SLV] (AUC = 0.87783, P = 0.0002). Conclusions: The CTLV/SLV ratio is a very useful marker for predicting the prognosis of adult ALF. Our prognostic formula including only the CTLV/SLV ratio and TB is simple and useful and awaits validation in a future larger-scale prospective study.
AB - Background/Aims: King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score are useful and widely employed prognostic markers for acute liver failure (ALF). We previously reported that liver atrophy is an important prognostic factor for ALF. The aim of the present study was to assess the value of liver volumetry and to generate a new prognostic formula. Methods: Computed tomography-derived liver volume (CTLV) and standardized liver volume (SLV) of 30 adult ALF patients were calculated at the time of diagnosis. Patients were assigned to one of two groups: group A consisted of 13 patients who recovered without surgical intervention, and group B consisted of 17 patients who died due to liver failure or who underwent living donor liver transplantation (LDLT). Results: The median CTLV/SLV ratios of groups A and B were 1.019 and 0.757, respectively (P = 0.0009). The difference was most significant (P = 0.0002) at the probability cutoff point of 0.80 for CTLV/SLV ratio; the sensitivity and specificity were 76.5% and 92.3%, respectively. Serum total bilirubin (TB) levels and CTLV/SLV ratio were selected as independent prognostic factors by multivariate analysis. A prognostic formula including volumetric analysis was established: Z = -2.3813 - [0.15234 × TB (mg/dl)] + [4.5734 × CTLV/SLV] (AUC = 0.87783, P = 0.0002). Conclusions: The CTLV/SLV ratio is a very useful marker for predicting the prognosis of adult ALF. Our prognostic formula including only the CTLV/SLV ratio and TB is simple and useful and awaits validation in a future larger-scale prospective study.
KW - Computed tomography-derived liver volume/standardized liver volume ratio (CTLV/SLV)
KW - King's College Hospital (KCH) criteria
KW - Liver atrophy
KW - Living donor liver transplantation (LDLT)
KW - Model for end-stage liver disease (MELD)
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U2 - 10.1007/s00535-009-0045-7
DO - 10.1007/s00535-009-0045-7
M3 - Article
C2 - 19373430
AN - SCOPUS:67449105521
SN - 0944-1174
VL - 44
SP - 615
EP - 623
JO - Journal of gastroenterology
JF - Journal of gastroenterology
IS - 6
ER -