Indication of liver transplantation in acute liver failure following amatoxin intoxication is still uncertain.
Dr Ganzer and colleagues from Munich in Germany studied a total of 198 patients retrospectively.
The research team analyzed laboratory parameters alanine aminotransferase, serum bilirubin, serum creatinine and prothrombin index over time.
The researchers determined predictors of fatal outcome and survival by receiver-operating-characteristic and sensitivity–specificity analysis.
23 patients died in the median 6.1 days (range, 2.7–13.9 days) after ingestion.
| Median time period between the first occurrence of this predictor in non-survivors and death was 63h|
|Journal of Hepatology|
The research team used a single parameter as predictor of fatal outcome.
The researchers found that the area under the receiver-operating-characteristic curve of prothrombin index and serum creatinine were both significantly greater compared with serum bilirubin and alanineaminotransferase.
The research team noted that the prediction of fatal outcome had an optimum if a prothrombin index less than 25% was combined with a serum creatinine greater than 106μmol/l from day 3 after ingestion onwards (sensitivity 100%).
The median time period between the first occurrence of this predictor in non-survivors and death was 63h (range, 3–230h).
Dr Ganzert commented, "A decision model of liver transplantation following amatoxin intoxication using prothrombin index in combination with serum creatinine from day 3 to 10 after ingestion enables an early and reliable assessment of outcome."