Publication

Abstract : Background and Aim: Acute liver failure is associated with high mortality and only about 40% patients survive without liver transplantation. The available prognostic models failed to predict the outcome correctly. Here, we aimed to determine if alpha-fetoprotein (AFP) can be used as a prognostic marker in acute liver failure. Materials and Methods: For this prospective observational study, sixty patients with the diagnosis of acute liver failure were allocated and serum AFP ratio was measured on days 1 and 3 of admission. AFP ratio was calculated as day 3 AFP/day 1 AFP value. Other laboratory parameters and various etiological factors of acute liver failure were also studied. Results: The average AFP ratio among survivors was 1.77 ± 0.94 and among patients who died, the average ratio was 0.68 ± 0.58. Hence, AFP ratio is an important prognostic tool in predicting mortality with a P < 0.001. Majority of patients (80.6%) of patients whose AFP ratio was <0.7 died while majority of patients whose AFP ratio was >0.7 survived (70.4%). Hence, we concluded that AFP values change dynamically during the course of acute liver failure and AFP ratio can be used as a prognostic marker in acute liver failure. AFP ratio showed statistically significant negative correlation with prothrombin time and international normalized ratio, serum globulin, and the levels of indirect bilirubin, especially on the third day after admission and the variables were significantly elevated in the patients who died. Conclusions: AFP ratio can be used as a predictor of mortality in acute liver failure patients. Higher the ratio more are the chances of survival.