800 Do serum phosphate and lactate levels predict patient outcome in fulminant hepatic failure

HEPATOLOGY, Vol. 34, No. 4, Suppl. 1, 2003

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Disclosures: G u i d o Beldi - N o r e l a t i o n s h i p s to disclose Sonja B i s c h - K n a d e n - N o r e l a t i o n s h i p s to disclose Daniel C a n d i n a s - N o r e l a t i o n s h i p s to disclose Beat Gloor - N o r e l a t i o n s h i p s to disclose Daniel I n d e r b i t z i n - N o r e l a t i o n s h i p s to disclose A d r i a n K e o g h - N o r e l a t i o n s h i p s to disclose D e b o r a h M Stroka - N o r e l a t i o n s h i p s to disclose

800

D O S E R U M P H O S P H A T E A N D L A C T A T E LEVELS P R E D I C T P A T I E N T O U T C O M E IN F U L M I N A N T H E P A T I C FAILURE.

Moataz Seyam, Gerry C MacQuillan, Nick Murphy, James Neuberger, University Hospital Birmingham, Birmingham, UK Background: Previous studies have demonstrated that serum p h o s p h a t e levels (Schmidt, H e p a t o l o g y , 2002) a n d arterial b l o o d lactate (Bernal, Lancet, 2002) c o n c e n t r a t i o n s m e a s u r e d early o n in t h e course of acute h e p a t i c failure m a y p r e d i c t clinical o u t c o m e . F u r t h e r m o r e , m e a s u r e m e n t of s e r u m p h o s p h a t e a n d lactate conc e n t r a t i o n s m a y help identify p a t i e n t s w i t h a p o o r clinical outc o m e earlier t h a n t h e u s e of t h e w i d e l y e s t a b l i s h e d K i n g ' s College H o s p i t a l criteria. M e t h o d : To validate t h e u s e of t h e s e r e a d i l y

547A

m e a s u r a b l e b i o c h e m i c a l p a r a m e t e r s in t h e s e t t i n g of f u l m i n a n t h e p a t i c failure, w e r e t r o s p e c t i v e l y a n a l y s e d a d m i s s i o n s e r u m p h o s p h a t e a n d serial arterial b l o o d lactate e s t i m a t e s in 49 c o n s e c utive p a t i e n t s w i t h f u l m i n a n t h e p a t i c failure ( P a r a c e t a m o l related, n - 38; n o n - p a r a c e t a m o l r e l a t e d n - 11) a d m i t t e d to t h e B i r m i n g h a m Liver I n t e n s i v e Care U n i t b e t w e e n 2000 a n d 2002. Results: O f t h e 49 p a t i e n t s , 41 (84%) w e r e m a n a g e d m e d i c a l l y w i t h 33 p a t i e n t s s u r v i v i n g a n d 8 d e a t h s . Eight p a t i e n t s (16%) u n d e r w e n t liver t r a n s p l a n t a t i o n of w h i c h 6 s u r v i v e d . S e r u m a d m i s s i o n p h o s p h a t e levels t e n d e d to be lower b u t n o t significantly ( M a n n - W h i t n e y U test, p - 0.08) b e t w e e n p a t i e n t s w h o s u r v i v e d w i t h c o n s e r v a t i v e m e d i c a l m a n a g e m e n t ( m e d i a n level 0.83 m m o l / L , lower 95% C.I. 0.65 m m o l / L - u p p e r 95% C.I. 1.02 m m o l / L ; n - 33) a n d t h o s e w h o died w i t h c o n s e r v a t i v e m e d i c a l m a n a g e m e n t or r e q u i r e d liver t r a n s p l a n t a t i o n ( m e d i a n level 1.02 m m o l / L , lower 95% C.I. 0.81 m m o l / L - u p p e r 95% C.I. 1.46 m m o l / L ; n - 16). S e r u m arterial b l o o d lactate c o n c e n t r a t i o n s w e r e n o t significantly different b e t w e e n t h e 2 g r o u p s o n a d m i s s i o n . Following a d e q u a t e fluid r e s u s citation, at 12 h r s p o s t a d m i s s i o n a t r e n d (p - 0.05) h a d d e v e l o p e d for t h e lactate c o n c e n t r a t i o n s in t h e 2 g r o u p s : p a t i e n t s w h o s u r v i v e d w i t h m e d i c a l m a n a g e m e n t alone h a d lower lactate c o n c e n t r a t i o n s ( m e d i a n level 2.07 m m o l / L , l o w e r 95% C.I. 1.88 m m o l / L u p p e r 95% C.I 3.25 m m o l / L ; n - 33) t h a n t h o s e w h o d i e d or r e q u i r e d liver t r a n s p l a n t a t i o n ( m e d i a n level 3.36 m m o l / L , lower 95% C.I. 2.66 m m o l / L - u p p e r 95% C.I 5.62 m m o l / L ; n - 16). A n a l y s i s of p a t i e n t s u n d e r g o i n g m e d i c a l m a n a g e m e n t alone (n 41) r e v e a l e d n o significant d i f f e r e n c e s in a d m i s s i o n p h o s p h a t e levels b e t w e e n s u r v i v o r s a n d n o n - s u r v i v o r s . H o w e v e r , s e r u m lactate c o n c e n t r a t i o n s w e r e significantly different (p - 0.01) b e t w e e n t h e 2 g r o u p s at 12 h r s ( m e d i a n level in s u r v i v o r s 2.1 m m o l / L , lower 95% C.I. 1.9 m m o l / L - u p p e r 95% C.I. 3.3 m m o l / L ; n - 33; m e d i a n level in n o n - s u r v i v o r s 4.3 m m o l / L , lower 95% C.I. 2.7 m m o l / L u p p e r 95% C.I. 6.9 m m o l / L ; n - 8). C o n c l u s i o n : W h i l e s o m e t r e n d s w e r e e v i d e n t b e t w e e n t h e 2 g r o u p s for s e r u m p h o s p h a t e a n d lactate c o n c e n t r a t i o n s , t h e w i d e o v e r l a p p i n g confidence i n t e r v a l s m a y limit t h e clinical utility of t h e s e predictive m a r k e r s . T h e y are u n l i k e l y to r e p l a c e b u t m i g h t e n h a n c e t h e K i n g ' s College H o s p i t a l criteria in t h e f u t u r e . Disclosures: G e r r y C M a c Q u i l l a n - N o r e l a t i o n s h i p s to disclose Nick M u r p h y - N o r e l a t i o n s h i p s to disclose J a m e s N e u b e r g e r - N o r e l a t i o n s h i p s to disclose M o a t a z S e y a m - N o r e l a t i o n s h i p s to disclose