Volume 2 Supplement 1

18th International Symposium on Intensive Care and Emergency Medicine

Open Access

Circulating markers of endothelial activation in acetaminophen induced acute liver failure

  • W Bernal1,
  • P Langley1 and
  • J Wendon1
Critical Care19982(Suppl 1):P009

DOI: 10.1186/cc139

Published: 1 March 1998

Background

Once defined clinical criteria are fulfilled, survival following acetaminophen overdose is very poor without emergency liver transplantation. The early identification of patients developing multiple organ failure (MOF) is important for prompt listing for transplantation. MOF is associated with early elevations of the circulating markers of endothelial activation E-Selectin, VCAM-1 and ICAM-1 and Von Willebrand Factor (VWF). We determined their levels and those of Interleukin-6 (IL-6) on admission in acetaminophen overdose patients, to evaluate their use in the identification of those who would require transplantation.

Patients

Nine healthy controls and 20 patients were studied. Eleven patients became encephalopathic and seven patients either died or required emergency liver transplantation.

Methods

E-selectin, VCAM, ICAM, IL-6 and VWF were determined on admission using commercial ELISA. Statistical testing used Mann-Whitney U tests and Spearmans Rank correlation. Results were corrected for multiple testing.

Results

All molecules assayed were significantly higher in patients than controls (Pc < 10-4). IL-6 alone was higher in non survivors than survivors [158 pg/ml (range 22–440) vs 32 pg/ml (3.5–177), Pc < 0.05]. Adhesion molecule levels were consistent with multiple organ failure of a non-septic aetiology. VWF was elevated in those patients who became encephalopathic : 371 U/dl (149–658) vs 178 U/dl (65–340), P < 0.04 and correlated strongly with mean arterial pressure (r = 0.664, P < 0.005).

Conclusions

ICAM, VCAM and E-selectin are poorly predictive of outcome in ALF, but suggest a non-septic aetiology of MOF. The pathogenesis of encephalopathy may involve endothelial activation and cardiovascular dysfunction. IL-6 appears the most useful early marker of a poor outcome in ALF.

Authors’ Affiliations

(1)
Institute of Liver Studies, Kings College Hospital

Copyright

© Current Science Ltd 1998

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