REDUCED SERUM GC-GLOBULIN CONCENTRATIONS IN PATIENTS WITH FULMINANT HEPATIC-FAILURE - ASSOCIATION WITH MULTIPLE ORGAN FAILURE

Objective: To evaluate the association between admission serum concent rations of the actin-scavenger, Gc-globulin, and the subsequent develo pment of multiple organ failure in patients with fulminant hepatic fai lure. Design: Retrospective study. Setting: A hepatologic intensive ca re unit. Patients: Seventy-nine patients with hepatic encephalopathy g rade 3 or 4. Interventions: None. Measurements and Main Results: Serum admission concentrations of both total and nonactin-complexed (free) Gc-globulin were determined, The development of cardiovascular failure , renal failure, pulmonary failure, intracranial hypertension, and inf ections were recorded in each patient. Both total and free Gc-globulin values were significantly lower in the patients, compared with normal controls, The Gc-globulin values were significantly reduced in patien ts who subsequently developed cardiovascular failure (p <.01), intracr anial hypertension (p <.001), and infections (p <.001), compared with those patients who did not, No differences were found between patients with and without pulmonary or renal failure. Patients with total Gc-g lobulin values in the lowest quintile had on average 2.6 organ failure s, whereas patients with Gc-globulin concentrations in the highest qui ntile had 0.9 organ failures, The corresponding figures for the lowest and highest quintiles of free Gc-globulin were 3.0 and 1.1 organ fail ures, respectively, Both total and free Gc-globulin were inversely cor related to the number of organ failures (p <.005 in both cases). Patie nts with multiple organ failure (greater than or equal to 2 organ fail ures) had significantly reduced Gc-globulin values compared with patie nts without multiple organ failure (p < .0001). Conclusions: In patien ts with fulminant hepatic failure, the lowest admission Gc-globulin co ncentrations were associated with the subsequent development of cardio vascular failure, intracranial hypertension, and infections, Lack of G c-globulin correlated significantly with the development of multiple o rgan failure and may be pathogenetically involved in this condition.