Serum Lactate: Creatinine Ratio as a Prognostic Marker for Liver Failure Patients Treated by artificial liver support systems

Abstract

Background: To screen potential serum prognostic markers for patients with liver failure treated by artificial liver support systems (ALSSs).Methods: Serum samples were obtained from 57 liver-failure patients before and after ALSSs therapy and analyzed by proton nuclear magnetic resonance. The diagnostic values were evaluated by calculation of the area under a receiver-operating characteristic curve (AUROC). Two retrospective analyses were further employed.Results: Metabonomics analysis showed that ratios of creatine:creatinine, taurine:creatinine, and lactate:creatinine were significantly altered and restored to normal levels after ALSSs treatment. The ratio of lactate:creatinine showed the highest AUROC value (0.650), which was higher than that of the prothrombin time activity (PTA, 0.562). A total of 105 cases of retrospective analysis showed that serum lactate:creatinine ratios among the liver-failure patients were 0.038 ± 0.002 (survival group, n=48), 0.048 ± 0.005 (three-month death group, n=24), and 0.052 ± 0.005 (one-month death group, n=33), which was significantly negatively correlated with survival (r= - 0.26). Another retrospective cohort analysis (n=81) of the early to middle stage liver-failure patients treated by ALSSs showed that the AUROC of the lactate:creatinine ratio for diagnosis of those who survived for one subsequent month was 0.827, which was higher than that of PTA (0.628) and lactate (0.765).Conclusion: The serum lactate:creatinine ratio may be a more sensitive measure than either the PTA or the lactate to evaluate the prognosis of ALSSs treatment in early to middle stage of liver-failure patients. This finding is worthy of further study in clinical applications.