Acute Liver Failure and Dengue: Alcohol Matters

Debes, José D.; Ashhab, Ashraf A.

doi:10.4269/ajtmh.16-0985a

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…Previous epidemiologic studies have shown that a predisposing background of subclinical steatosis due to obesity, unestablished alcohol intake, or asymptomatic hepatitis B virus infection might modify the course or severity of acute liver insults. ( ) In some countries, such as the United States, it is estimated that the prevalence of nonalcoholic fatty liver disease in the general population could be approximately 20% in adults ( ) and the prevalence of unhealthy alcohol intake has increased over the past decade. ( ) Because people with nonalcoholic fatty liver disease and those that drink excessive quantities of alcohol may also suffer from acute liver insults, the assessment of serologic fibrosis markers at first presentation to hospital in patients with ALF may help evaluate background hepatic status more precisely, thereby improving predictive accuracy (Fig.…”

Section: Discussionmentioning

confidence: 99%

Liver Fibrosis Markers Improve Prediction of Outcome in Non‐Acetaminophen‐Associated Acute Liver Failure

Ugamura

Chu

Nakamoto

et al. 2018

Hepatology Communications

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A prognostic system for acute liver failure (ALF) with a higher predictive value is urgently needed. The role of extracellular matrix (ECM) remodeling in ALF has not been fully elucidated. We hypothesized that serologic fibrosis markers, which reflect ECM remodeling, are predictive of ALF outcome at first presentation. This observational study included 110 patients with acute liver dysfunction, of which 73 had non‐acetaminophen‐associated ALF (NAA‐ALF). We evaluated serum levels of hyaluronic acid, 7S domain of type IV collagen (4COL7S), and Wisteria floribunda agglutinin‐positive Mac‐2‐binding protein at first presentation to a tertiary center. Serologic fibrosis markers were significantly higher in NAA‐ALF compared with acute hepatitis. Elevated hyaluronic acid and 4COL7S levels at first presentation correlated significantly with worse clinical outcomes. 4COL7S, along with age, ammonia, and the Model for End‐Stage Liver Disease (MELD) score, was a significant prognostic factor in multivariate analysis; 4COL7S correlated significantly with coagulopathy, decreased hepatic synthetic functions, advanced hepatic encephalopathy, and liver atrophy and also predicted 180‐day transplant‐free survival. Cox regression models incorporating 4COL7S with the MELD system had profoundly improved predictive values that significantly surpassed the MELD system alone. Conclusion: Elevation of serologic fibrosis markers reflecting ECM remodeling in NAA‐ALF predicted a worse clinical outcome. Incorporation of 4COL7S at first presentation to a transplant center improves the specificity while retaining the sensitivity of the MELD system. External validation of a fibrosis marker as part of a clinical prediction tool in ALF warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Liver Fibrosis Markers Improve Prediction of Outcome in Non‐Acetaminophen‐Associated Acute Liver Failure

Ugamura

Chu

Nakamoto

et al. 2018

Hepatology Communications

View full text Add to dashboard Cite

show abstract

“…The letter to the editor entitled “Acute liver failure and dengue: alcohol matters” by Debes and Ashhab 1 has addressed the important issue of alcohol intake on potentially more severe liver involvement in dengue infection.…”

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confidence: 99%