G.M. and M.S. contributed equally to the writing of this article and are considered joint first authors.
Article first published online: 25 AUG 2005
Copyright © 2005 American Association for the Study of Liver Diseases
Volume 11, Issue 9, pages 1073–1079, September 2005
How to Cite
MacQuillan, G. C., Seyam, M. S., Nightingale, P., Neuberger, J. M. and Murphy, N. (2005), Blood lactate but not serum phosphate levels can predict patient outcome in fulminant hepatic failure. Liver Transpl, 11: 1073–1079. doi: 10.1002/lt.20427
See Editorial on Page 1028
Presented in part as a poster at the AASLD annual meeting, Boston, MA, 2003.
- Issue published online: 25 AUG 2005
- Article first published online: 25 AUG 2005
- Manuscript Accepted: 14 FEB 2005
- Manuscript Received: 8 FEB 2005
Early identification of those patients with fulminant hepatic liver failure (FHF) who need a transplant greatly helps in their management. A number of prognostic criteria have recently been proposed, including arterial blood lactate and serum phosphate concentrations. To validate their use, we retrospectively studied 83 consecutive patients with FHF admitted to our intensive treatment unit between August 2000 and March 2003. A total of 48 patients (58%) survived with medical management only (group I) and 35 patients (42%) failed to survive spontaneously (group II). This group included 19 patients (23%) who underwent orthotopic liver transplantation (LT), and 16 patients (19%) who died without undergoing LT (group IIa). A total of 5 patients (6%) who underwent liver transplantation died. Within paracetamol overdose (POD) and non-POD subgroups, phosphate concentrations were not significantly higher in group II patients (P = 0.08 and P = 0.27, respectively), when compared to group I patients. In multivariate analysis, post admission 12-hour lactate level was the only predictor of survival for the POD subgroup, whereas in non-POD patients, 12-hour lactate and admission bilirubin levels were significant in predicting patients' outcome. In conclusion, we found that while serum phosphate concentrations have limited clinical utility as prognostic markers, persistently elevated arterial blood lactate levels despite adequate fluid resuscitation are indicators of a poor prognosis in FHF. (Liver Transpl 2005;11:1073–1079.)