Alpha-fetoprotein and prognosis in acute liver failure

Frank V. Schiødt, George Ostapowicz, Natalie Murray, Raj Satyanarana, Atif Zaman, Santiago Munoz, William M. Lee, Anne Larson, Jeffery S. Crippin, Timothy J. Davern, Nathan Bass, Sukru Emre, Timothy M. McCashland, J. Eileen Hay, A. Obaid Shakil, Andreas T. Blei, Steven H B Han, Robert J. Fontana, Brendan McGuire, Raymond ChungSteven Lobritto, Robert Brown, Michael Schilsky, M. Edwin Harrison, Adrian Rueben, Rajendar Reddy, R. Todd Stravitz, Lorenzo Rossaro

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Abstract

Serum concentrations of alpha-fetoprotein (AFP), variably elevated during liver injury, have been suggested to be of prognostic importance in acute liver failure (ALF), higher values being associated with improved outcome. Using a nephelometric assay, we measured AFP in sera obtained on admission from 206 patients prospectively enrolled in the US ALF Study, and on day 3 in 162 of these patients. The AFP ratio was defined as the day 3 AFP concentration divided by that observed on day 1. Median (range) admission serum AFP in all patients was 8.1 (1-1,811) ng/mL and increased to 17.6 (1.1-1,162) ng/mL on day 3 (P < 0.001). Higher absolute levels were not associated with improved outcome. In fact, admission AFP levels were lower in survivors not receiving transplants than in those who died or were transplanted (P < 0.001), whereas there was no difference between the 2 groups on day 3 (P = 0.34). However, a rise in AFP values between day 1 and day 3 indicated a better prognosis: the AFP ratio was 2.2 (0.11-22.1) in spontaneous survivors and 0.87 (0.11-16.4) in nonsurvivors (P < 0.001). An increasing AFP level indicated by an AFP ratio ≥1 was observed in 70 of 98 (71%) survivors, whereas a ratio <1 was observed in 51 of 64 (80%) nonsurvivors. In conclusion, AFP values change dynamically during ALF. In this large prospective study, higher absolute values of AFP did not predict a favorable outcome, but a rising level of AFP over the first 3 hospital days frequently indicated survival.

Original languageEnglish (US)
Pages (from-to)1776-1781
Number of pages6
JournalLiver Transplantation
Volume12
Issue number12
DOIs
StatePublished - Dec 2006

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Acute Liver Failure
alpha-Fetoproteins
Survivors
Serum
Patient Admission

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Schiødt, F. V., Ostapowicz, G., Murray, N., Satyanarana, R., Zaman, A., Munoz, S., ... Rossaro, L. (2006). Alpha-fetoprotein and prognosis in acute liver failure. Liver Transplantation, 12(12), 1776-1781. https://doi.org/10.1002/lt.20886

Alpha-fetoprotein and prognosis in acute liver failure. / Schiødt, Frank V.; Ostapowicz, George; Murray, Natalie; Satyanarana, Raj; Zaman, Atif; Munoz, Santiago; Lee, William M.; Larson, Anne; Crippin, Jeffery S.; Davern, Timothy J.; Bass, Nathan; Emre, Sukru; McCashland, Timothy M.; Hay, J. Eileen; Shakil, A. Obaid; Blei, Andreas T.; Han, Steven H B; Fontana, Robert J.; McGuire, Brendan; Chung, Raymond; Lobritto, Steven; Brown, Robert; Schilsky, Michael; Harrison, M. Edwin; Rueben, Adrian; Reddy, Rajendar; Stravitz, R. Todd; Rossaro, Lorenzo.

In: Liver Transplantation, Vol. 12, No. 12, 12.2006, p. 1776-1781.

Research output: Contribution to journalArticle

Schiødt, FV, Ostapowicz, G, Murray, N, Satyanarana, R, Zaman, A, Munoz, S, Lee, WM, Larson, A, Crippin, JS, Davern, TJ, Bass, N, Emre, S, McCashland, TM, Hay, JE, Shakil, AO, Blei, AT, Han, SHB, Fontana, RJ, McGuire, B, Chung, R, Lobritto, S, Brown, R, Schilsky, M, Harrison, ME, Rueben, A, Reddy, R, Stravitz, RT & Rossaro, L 2006, 'Alpha-fetoprotein and prognosis in acute liver failure', Liver Transplantation, vol. 12, no. 12, pp. 1776-1781. https://doi.org/10.1002/lt.20886
Schiødt FV, Ostapowicz G, Murray N, Satyanarana R, Zaman A, Munoz S et al. Alpha-fetoprotein and prognosis in acute liver failure. Liver Transplantation. 2006 Dec;12(12):1776-1781. https://doi.org/10.1002/lt.20886
Schiødt, Frank V. ; Ostapowicz, George ; Murray, Natalie ; Satyanarana, Raj ; Zaman, Atif ; Munoz, Santiago ; Lee, William M. ; Larson, Anne ; Crippin, Jeffery S. ; Davern, Timothy J. ; Bass, Nathan ; Emre, Sukru ; McCashland, Timothy M. ; Hay, J. Eileen ; Shakil, A. Obaid ; Blei, Andreas T. ; Han, Steven H B ; Fontana, Robert J. ; McGuire, Brendan ; Chung, Raymond ; Lobritto, Steven ; Brown, Robert ; Schilsky, Michael ; Harrison, M. Edwin ; Rueben, Adrian ; Reddy, Rajendar ; Stravitz, R. Todd ; Rossaro, Lorenzo. / Alpha-fetoprotein and prognosis in acute liver failure. In: Liver Transplantation. 2006 ; Vol. 12, No. 12. pp. 1776-1781.
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AU - Ostapowicz, George

AU - Murray, Natalie

AU - Satyanarana, Raj

AU - Zaman, Atif

AU - Munoz, Santiago

AU - Lee, William M.

AU - Larson, Anne

AU - Crippin, Jeffery S.

AU - Davern, Timothy J.

AU - Bass, Nathan

AU - Emre, Sukru

AU - McCashland, Timothy M.

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AU - Shakil, A. Obaid

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AU - Han, Steven H B

AU - Fontana, Robert J.

AU - McGuire, Brendan

AU - Chung, Raymond

AU - Lobritto, Steven

AU - Brown, Robert

AU - Schilsky, Michael

AU - Harrison, M. Edwin

AU - Rueben, Adrian

AU - Reddy, Rajendar

AU - Stravitz, R. Todd

AU - Rossaro, Lorenzo

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N2 - Serum concentrations of alpha-fetoprotein (AFP), variably elevated during liver injury, have been suggested to be of prognostic importance in acute liver failure (ALF), higher values being associated with improved outcome. Using a nephelometric assay, we measured AFP in sera obtained on admission from 206 patients prospectively enrolled in the US ALF Study, and on day 3 in 162 of these patients. The AFP ratio was defined as the day 3 AFP concentration divided by that observed on day 1. Median (range) admission serum AFP in all patients was 8.1 (1-1,811) ng/mL and increased to 17.6 (1.1-1,162) ng/mL on day 3 (P < 0.001). Higher absolute levels were not associated with improved outcome. In fact, admission AFP levels were lower in survivors not receiving transplants than in those who died or were transplanted (P < 0.001), whereas there was no difference between the 2 groups on day 3 (P = 0.34). However, a rise in AFP values between day 1 and day 3 indicated a better prognosis: the AFP ratio was 2.2 (0.11-22.1) in spontaneous survivors and 0.87 (0.11-16.4) in nonsurvivors (P < 0.001). An increasing AFP level indicated by an AFP ratio ≥1 was observed in 70 of 98 (71%) survivors, whereas a ratio <1 was observed in 51 of 64 (80%) nonsurvivors. In conclusion, AFP values change dynamically during ALF. In this large prospective study, higher absolute values of AFP did not predict a favorable outcome, but a rising level of AFP over the first 3 hospital days frequently indicated survival.

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