PROSPECTIVE-STUDY OF PLASMA FIBRONECTIN IN FULMINANT-HEPATITIS - ASSOCIATION WITH INFECTION AND MORTALITY

Background/Aims: Plasma fibronectin is an opsonic glycoprotein, normal ly synthesized by the liver, which decreases subsequent to severe live r damage and low levels of which may contribute to reticuloendothelial system dysfunction by compromising opsonic activity, This may result in an increased frequency of infection and death. The present study wa s conducted to evaluate the association of plasma fibronectin activity with infection and mortality in patients with fulminant hepatic failu re. Methods: Plasma fibronectin was estimated serially in 69 consecuti ve patients with fulminant hepatic failure, nine patients with uncompl icated acute viral hepatitis and 32 normal, volunteers. Results: Plasm a fibronectin levels in patients w ith fulminant hepatic failure (85.6 +/-75.8 pg/ml) were significantly lower than in patients with uncompli cated acute viral hepatitis (295,5+/-88.5 mu g/ml) and healthy volunte ers (362.6+/-69.2 mu g/ml). Forty-nine (72%) patients with fulminant h epatic failure died. The initial values of fibronectin in fulminant he patic failure did not correlate with mortality Patients with fulminant hepatic failure who survived showed a progressive rise in the fibrone ctin levels compared to the absence of an increase in fibronectin leve ls in the non-survivors. The mortality in patients with fulminant hepa tic failure with infection (24/27) was significantly higher (p<0.05) c ompared to those without infection (25/42), Initial fibronectin levels in patients with infection (70.3+/-54.2 mu g/ml) were significantly l ower (p<0.05) than in those without infection (92.3+/-64.4 pg/ml). We conclude that plasma fibronectin levels in patients with fulminant hep atic failure are decreased compared to healthy subjects and the absenc e of an increase in levels indicates a poor prognosis, Low levels of f ibronectin are associated with an increased incidence of infection, wh ich increases the mortality in these patients. (C) Journal of Hepatolo gy.