@article{666c57a0dd1a445493c420da8359961b,
title = "Changes in alpha-foetoprotein and Gc-globulin in relation to outcomes in non-acetaminophen acute liver failure",
abstract = "Background: Changes in Gc-globulin (Gc) and in alpha-foetoprotein (AFP) have been shown to be related to outcome in patients with acute liver failure (ALF). Gc is a serum protein that complexes with intravascular actin released during cellular necrosis. AFP, also made by hepatocytes, is associated with hepatocellular growth and regeneration. Previously, low absolute levels or decreases over time in either AFP or Gc portended to be a poor outcome. Methods: In a retrospective analysis of the double-blind trial of intravenous N-acetylcysteine (NAC) for ALF not because of acetaminophen, sera on days 1 and 3 or days 2 and 4 following admission were available to measure AFP in 70 patients and Gc in 66 patients. Mann-Whitney U tests were performed on the admission values, the absolute change and the fractional change of AFP and Gc to compare TFS (transplant-free survival) and non-TFS (death or transplantation). Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the markers in comparison and in addition to King's College Criteria (KCC). Results: Transplant-free survival patients were characterized by increases in AFP, whereas non-TFS had significantly different (negative) absolute and fractional changes (P <.01). The addition of declining AFP levels to KCC improved the area under the curve in predicting non-TFS (AUC >70%). Gc globulin values did not differ between TFS and non-TFS in the 2-day intervals studied (P>.2). Conclusion: In this comparison of two prognostic markers in patients with non-acetaminophen-induced ALF, rising AFP but not rising Gc levels was associated with TFS. Trial Registration: ClinicalTrials.gov number NCT00004467.",
keywords = "AFP, Gc-globulin, acute liver failure",
author = "Sundeep Singh and Hynan, {Linda S.} and Rule, {Jody A.} and Lee, {William M.}",
note = "Funding Information: The US Acute Liver Failure Study Group has been supported by R‐01‐DK58369 and U‐01‐DK58369 from the National Institute of Diabetes, Digestive and Kidney Diseases, and by FD‐R‐001661 from the Orphan Products Division, United States Food and Drug Administration. Additional funding from the Southwestern Medical Foundation, Dallas TX. Funding Information: Funding information The US Acute Liver Failure Study Group has been supported by R-01-DK58369 and U-01-DK58369 from the National Institute of Diabetes, Digestive and Kidney Diseases, and by FD-R-001661 from the Orphan Products Division, United States Food and Drug Administration. Additional funding from the Southwestern Medical Foundation, Dallas TX. We acknowledge the members and institutions participating in the Acute Liver Failure Study Group 1998-2009 as follows: WM Lee, MD (Principal Investigator); Anne M. Larson, MD, Iris Liou, MD, University of Washington, Seattle, WA; Oren Fix, MD, Swedish Medical Center, Seattle, WA; Michael Schilsky, MD, Yale University, New Haven, CT; Timothy McCashland, MD, University of Nebraska, Omaha, NE; J. Eileen Hay, MBBS, Mayo Clinic, Rochester, MN; Natalie Murray, MD, Baylor University Medical Center, Dallas, TX; A. Obaid S. Shaikh, MD, University of Pittsburgh, Pittsburgh, PA; Andres Blei, MD, Northwestern University, Chicago, IL (deceased), Daniel Ganger, MD, Northwestern University, Chicago, IL; Atif Zaman, MD, University of Oregon, Portland, OR; Steven HB Han, MD, University of California, Los Angeles, CA; Robert Fontana, MD, University of Michigan, Ann Arbor, MI; Brendan McGuire, MD, University of Alabama, Birmingham, AL; Raymond T. Chung, MD, Massachusetts General Hospital, Boston, MA; Alastair Smith, MB, Ch.B., Duke University Medical Center, Durham, NC; Robert Brown, MD, Cornell/Columbia University, New York, NY; Jeffrey Crippin, MD, Washington University, St Louis, MO; Edwin Harrison, Mayo Clinic, Scottsdale, AZ; Adrian Reuben, MBBS, Medical University of South Carolina, Charleston, SC; Santiago Munoz, MD, Albert Einstein Medical Center, Philadelphia, PA; Rajender Reddy, MD, University of Pennsylvania, Philadelphia, PA; R. Todd Stravitz, MD, Virginia Commonwealth University, Richmond, VA; Lorenzo Rossaro, MD, University of California Davis, Sacramento, CA; Raj Satyanarayana, MD, Mayo Clinic, Jacksonville, FL; and Tarek Hassanein, MD, University of California, San Diego, CA. The University of Texas Southwestern Administrative Group included Grace Samuel, Ezmina Lalani, Carla Pezzia and Corron Sanders, PhD, Nahid Attar, Linda S. Hynan, PhD, and the Medical University of South Carolina Data Coordination Unit included Valerie Durkalski, PhD, Wenle Zhao, PhD, Jaime Speiser, Catherine Dillon, Holly Battenhouse and Michelle Gottfried and the coordinators, patients and families who made this study possible. Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",
year = "2019",
month = dec,
day = "1",
doi = "10.1111/liv.14216",
language = "English (US)",
volume = "39",
pages = "2368--2373",
journal = "Liver International",
issn = "1478-3223",
publisher = "Wiley-Blackwell",
number = "12",
}