Galactose elimination capacity as a prognostic index in patients with fulminant liver failure.

Ranek, L; Andreasen, Per Buch; Tygstrup, Niels

doi:10.1136/gut.17.12.959

Cited by 90 publications

(35 citation statements)

References 10 publications

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“…90 42 Not reported. [91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106] AH, acute hepatitis; ALF, acute liver failure; FHF, fulminant hepatic failure; HALF, hyperacute liver failure; HE, hepatic encephalopathy; HPT, hepaplastin test; INR, international normalised ratio; PT, prothrombin time; PTA, prothrombin time activity; SALF, subacute liver failure; SubFHF, subacute fulminant hepatic failure.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: acute liver failure – one disease, more than 40 definitions

Wlodzimirow

Eslami

Abu‐Hanna

et al. 2012

Aliment Pharmacol Ther

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Section: Discussionmentioning

confidence: 99%

Systematic review: acute liver failure – one disease, more than 40 definitions

Wlodzimirow

Eslami

Abu‐Hanna

et al. 2012

Aliment Pharmacol Ther

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“…24 Information concerning whether whole-blood or plasma ammonia was used is often not given in the literature, and we therefore included Groups D and E (see Patients and Methods) for comparison with the other groups. In addition, comparison of our ammonia levels to those of other studies is limited by missing information about the site (arterial or venous) of blood sampling, [28][29][30] whether whole blood or plasma was used, 29,30 and the mixing of ALF and AOCLD patients. 31 But in general, the ammonia levels in our study compared well with those reported by others in ALF [28][29][30] and in AOCLD.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, comparison of our ammonia levels to those of other studies is limited by missing information about the site (arterial or venous) of blood sampling, [28][29][30] whether whole blood or plasma was used, 29,30 and the mixing of ALF and AOCLD patients. 31 But in general, the ammonia levels in our study compared well with those reported by others in ALF [28][29][30] and in AOCLD. 17,31 In the analysis of all patients with ALF (Groups A ϩ B), high arterial ammonia was associated with later death by CH (Fig.…”

Section: Discussionmentioning

confidence: 99%

Cerebral herniation in patients with acute E liver failure is correlated with arterial ammonia concentration

et al. 1999

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Cerebral edema leading to cerebral herniation (CH) is a common cause of death in acute liver failure (ALF). Animal studies have related ammonia with this complication. During liver failure, hepatic ammonia removal can be expected to determine the arterial ammonia level. In patients with ALF, we examined the hypotheses that high arterial ammonia is related to later death by CH, and that impaired removal in the hepatic circulation is related to high arterial ammonia. Twenty-two patients with ALF were studied retrospectively. In addition, prospective studies with liver vein catheterization were performed after development of hepatic encephalopathy (HE) in 22 patients with ALF and 9 with acute on chronic liver disease (AOCLD). Cerebral arterial-venous ammonia difference was studied in 13 patients with ALF. In all patients with ALF (n ‫؍‬ 44), those who developed CH (n ‫؍‬ 14) had higher arterial plasma ammonia than the non-CH (n ‫؍‬ 30) patients (230 ؎ 58 vs. 118 ؎ 48 mol/L; P F .001). In contrast, galactose elimination capacity, bilirubin, creatinine, and prothrombin time were not different (NS). Cerebral arterial-venous differences increased with increasing arterial ammonia (P F .001). Arterial plasma ammonia was lower than hepatic venous in ALF (148 ؎ 73 vs. 203 ؎ 108 mol/L; P F .001). In contrast, arterial plasma ammonia was higher than hepatic venous in patients with AOCLD (91 ؎ 26 vs. 66 ؎ 18 mol/L; P F .05). Net ammonia release from the hepatic-splanchnic region was 6.5 ؎ 6.4 mmol/h in ALF, and arterial ammonia increased with increasing release. In contrast, there was a net hepatic-splanchnic removal of ammonia (2.8 ؎ 3.3 mmol/h) in patients with AOCLD. We interpret these data that in ALF in humans, vast amounts of ammonia escape hepatic metabolism, leading to high arterial ammonia concentrations, which in turn is associated with increased cerebral ammonia uptake and CH. (HEPATOL-OGY 1999;29:648-653.)

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“…Galactose elimination capacity has been shown to have a predictive value for fulminant hepatic failure, 13 primary biliary cirrhosis, 14 and chronic active hepatitis. 15 Further, it provides additional prognostic information in cirrhotic patients when compared with the Child-Pugh classification.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Galactose Elimination Capacity Predicts Complications and Survival After Hepatic Resection

Redaelli¹,

Dufour²,

Wagner³

et al. 2002

Annals of Surgery

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ObjectiveTo analyze a single center's 6-year experience with 258 consecutive patients undergoing major hepatic resection for primary or secondary malignancy of the liver, and to examine the predictive value of preoperative liver function assessment. Summary Background DataDespite the substantial improvements in diagnostic and surgical techniques that have made liver surgery a safer procedure, careful patient selection remains mandatory to achieve good results in patients with hepatic tumors. MethodsIn this prospective study, 258 patients undergoing hepatic resection were enrolled: 111 for metastases, 78 for hepatocellular carcinoma (HCC), 21 for cholangiocellular carcinoma, and 48 for other primary hepatic tumors. One hundred fiftyeight patients underwent segment-oriented liver resection, including hemihepatectomies, and 100 had subsegmental resections. Thirty-two clinical and biochemical parameters were analyzed, including liver function assessment by the galactose elimination capacity (GEC) test, a measure of hepatic functional reserve, to predict postoperative (60-day) rates of death and complications and long-term survival. All variables were determined within 5 days before surgery. Data were subjected to univariate and multivariate analysis for two patient subgroups (HCC and non-HCC). The cutoffs for GEC in both groups were predefined. Long-term survival (Ͼ60 days) was subjected to Kaplan-Meier analysis and the Cox proportional hazard model. ResultsIn the entire group of 258 patients, a GEC less than 6 mg/ min/kg was the only preoperative biochemical parameter that predicted postoperative complications and death by univariate and stepwise regression analysis. A GEC of more than 6 mg/min/kg was also significantly associated with longer survival. This predictive value could also be shown in the subgroup of 180 patients with tumors other than HCC. In the subgroup of 78 patients with HCC, a GEC less than 4 mg/min/kg predicted postoperative complications and death by univariate and stepwise regression analysis. Further, a GEC of more than 4 mg/ min/kg was also associated with longer survival. ConclusionsThis prospective study establishes the preoperative determination of the hepatic reserve by GEC as a strong independent and valuable predictor for short-and long-term outcome in patients with primary and secondary hepatic tumors undergoing resection.

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Galactose elimination capacity as a prognostic index in patients with fulminant liver failure.

Cited by 90 publications

References 10 publications

Systematic review: acute liver failure – one disease, more than 40 definitions

Systematic review: acute liver failure – one disease, more than 40 definitions

Cerebral herniation in patients with acute E liver failure is correlated with arterial ammonia concentration

Preoperative Galactose Elimination Capacity Predicts Complications and Survival After Hepatic Resection

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