PREDICTING SURVIVAL IN FULMINANT HEPATIC-FAILURE USING SERUM GC PROTEIN CONCENTRATIONS

Plasma Gc protein sequesters actin released into the circulation after massive hepatocyte necrosis, but is greatly depleted in the process. In fulminant hepatic failure (FHF), Gc is present in serum both as a c omplex with actin and as unbound protein, the latter becoming complete ly exhausted in those patients with the most severe FHF. In the presen t study, 47 consecutive patients with FHF, 39 of whom were the result of acetaminophen (AC) overdose, were evaluated to determine whether me asurement of Gc protein levels could be used to predict survival. Usin g serum samples obtained shortly after admission as well as later samp les, levels for total Gc protein, percentage of Gc complexed with acti n, and calculated unbound Gc remaining in serum were compared for surv ivors and those who died of their illness. The most marked changes wer e present in unbound Gc levels in nonsurvivors, the mean of which for follow-up samples was 10% of normal mean values, as compared with 23% of normal mean values in those who survived (P < .01). Using a cutoff value for unbound Gc protein of greater than or equal to 34 mu g/mL, t o predict survival, outcome was correctly predicted in 32 of 47 (68%) patients using early samples, and in 24 of 27 (89%) patients using lat er sera No differences were observed between values and/or outcome in AC and non-AC cases. Measurement of Gc protein level correctly predict ed all patients dying of hepatic failure. This single measurement comp ares favorably with multifactorial predictive models, such as the King 's College model, and might be a useful test far patients being consid ered for transplantation.