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Fibrinogen as a prognostic indicator in hepatic failure

Introduction

Fibrinogen as a prognostic test of mortality in acute hepatic failure has not been reported. Two hundred and sixty patients admitted to the liver intensive therapy unit (LITU) with hepatic failure (that is, subacute, acute and fulminant) between 1 January 2004 and 30 September 2006 were identified from the LITU database (I-Care, UK). Twelve patients without fibrinogen testing on admission were excluded from the analysis.

Methods

The mean (± SD) age was 38.1 (14) years. Ninety-seven patients were male and 151 female; 116 had taken a paracetamol overdose (POD). The mean (± SD) fibrinogen on admission was 1.88 (1.24) g/l. Overall ICU mortality was 30.2% (POD 43.4%; non-POD 26.1%). Forty-nine patients received a transplant (14 POD and 35 non-POD).

Results

Fibrinogen levels (all in g/l) in survivors were higher than in nonsurvivors (1.98 ± 1.26 vs 1.63 ± 1.15; P = 0.033). Fibrinogen was higher in survivors of POD (1.81 ± 1.0 vs 1.41 ± 0.94; P = 0.039) and not significantly different between groups in non-POD hepatic failure (2.13 ± 1.43 vs 1.85 ± 1.31; P = 0.28). Fibrinogen was higher in those who survived after transplant (1.49 ± 0.83 vs 1.23 ± 0.23; P = 0.27). A cutoff value of fibrinogen of ≤1 g/l has sensitivity 0.47 and specificity 0.74 (positive predictive value (PPV) 0.44) for prediction of death in acute hepatic failure. In POD the sensitivity is 0.51, specificity 0.81 and PPV 0.59; in non-POD hepatic failure the values are 0.29, 0.73 and 0.31 respectively. In those POD who did not receive a transplant, fibrinogen ≤1 g/l has sensitivity 0.61, specificity 0.78 and PPV of 0.57 for death. Fibrinogen is higher in survivors of hepatic failure after POD.

Conclusion

Fibrinogen ≤1 g/l performs better than INR > 6.5 in predicting mortality after POD (sensitivity 0.69, specificity 0.61), but not as well as the combined King's College Criteria (sensitivity 0.69, specificity 0.96). Fibrinogen of ≤1 g/l in POD not meeting King's College Criteria for transplantation may identify a group with poor prognosis. A low fibrinogen level on admission may predict death after transplant (more data required).

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Thomas, M., Duffy, M., Auzinger, G. et al. Fibrinogen as a prognostic indicator in hepatic failure. Crit Care 11, P395 (2007). https://doi.org/10.1186/cc5555

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Keywords

  • Public Health
  • Poor Prognosis
  • Emergency Medicine
  • Fibrinogen
  • Paracetamol