Elevated serum liver-type fatty acid binding protein levels in non-acetaminophen acute liver failure patients with organ dysfunction.
Liver-type fatty acid binding protein (FABP1) has previously been        demonstrated to improve prognostic discrimination in acetaminophen (APAP)-induced        ALF but has not been investigated in other etiologies of ALF. AIM: To determine        whether FABP1 levels (early: admission or late: days 3-5) are associated with 21-day        transplant-free survival in non-APAP ALF. METHODS: FABP1 was measured in serum        samples from 384 ALF patients (n = 88 transplant-free survivors (TFS), n = 296        died/LT-NTFS) using solid-phase enzyme-linked immunosorbent assay and analyzed with        US ALFSG registry data. RESULTS: Of 384 ALF patients (autoimmune hepatitis n = 125,        drug-induced liver injury n = 141, Hepatitis B n = 118), 177 (46%) patients received        LT. Early FABP1 levels were significantly higher in ALF patients requiring        vasopressor support (203.4 vs. 76.3 ng/mL) and renal replacement therapy (203.4 vs.        78.8 ng/mL; p < 0.001 for both). Late FABP1 levels were significantly higher in        patients requiring mechanical ventilation (77.5 vs. 53.3 ng/mL), vasopressor support        (116.4 vs. 53.3 ng/mL) and in patients with grade 3/4 hepatic encephalopathy (71.4        vs. 51.4 ng/mL; p = 0.03 for all). Late FABP1 levels were significantly lower in TFS        patients (TFS 54 vs. NTFS 66 ng/mL; p = 0.049) but not admission (TFS 96 vs. NTFS        87 ng/mL; p = 0.67). After adjusting for significant covariates, serum FABP1 did not        discriminate significantly between TFS and patients who died/received LT at day 21        either on admission (p = 0.29) or late (days 3-5, p = 0.087) time points.        CONCLUSION: In this first report of FABP1 in non-APAP ALF, FABP1 levels at late time        points (days 3-5) were significantly lower in ALF patients who were alive without        transplant at day 21 but not after adjusting for covariates reflecting severity of        illness. Higher FABP1 levels were associated with the presence of increased organ        failure.
Acute liver failure Liver-type fatty acid binding protein Multiorgan failure Prognosis ALFSG index