Association Between Plasma Level of Galectin-9 and Survival of Patients With Drug-Induced Acute Liver Failure.
Clin Gastroenterol Hepatol. 2015 Oct 20;
Authors: Rosen HR, Biggins SW, Niki T, Gralla J, Hillman H, Hirashima M, Schilsky M, Lee WM, Acute Liver Failure Study Group (ALFSG)
BACKGROUND & AIMS: Fewer than 50% of patients with acute liver failure (ALF) recover spontaneously, and ALF has high mortality without liver transplantation. Kupffer cells have been reported to mediate liver inflammation during drug-induced injury. Galectin-9 is produced by Kupffer cells and has diverse roles in regulating immunity. We investigated whether plasma levels of galectin-9 are associated with outcomes of patients with ALF.
METHODS: We analyzed plasma samples (collected at time of hospital admission) and clinical data from149 patients included in the Acute Liver Failure Study Group from July 2006 through November 2010 (110 had acetaminophen-induced hepatotoxicity and 39 had non-acetaminophen drug-induced liver injury [DILI]). We compared data with those from all patients enrolled in the study (from July 1, 2006 through October 30, 2013), as well as from healthy individuals of similar ages with no evidence of liver disease (controls). Plasma levels of galectin-9 were measured using a polyclonal antibody and colorimetric assay.
RESULTS: Patients with ALF had statistically higher plasma levels of galectin-9 than controls, but levels did not differ significantly between patients with acetaminophen-induced liver injury vs DILI. A level of galectin-9 above 690 pg/mL was associated with a statistically significant increase in risk for mortality or liver transplantation due to ALF. Competing risk analyses associated level of galectin-9 with transplant-free survival, independently of model for end-stage liver disease (MELD) score or systemic inflammatory response syndrome.
CONCLUSIONS: A one-time measurement of plasma galectin-9 level can be used to assign patients with ALF to high-, intermediate-, and low-risk groups. The combination of galectin-9 level and MELD score was more closely associated with patient outcome than either value alone. This system might be used to determine patient prognoses and prioritize patients for liver transplantation. ClinicalTrials.gov no: NCT00518440.
PMID: 26499927 [PubMed - as supplied by publisher]