Buechter Matthias, Gerken Guido, Hoyer Dieter P, Bertram Stefanie, Theysohn Jens M, Thodou Viktoria, Kahraman Alisan
Department of Gastroenterology and Hepatology, University Clinic of Essen, Hufelandstr. 55, 45147, Essen, Germany.
Department of General, Visceral, and Transplantation Surgery, University Clinic of Essen, Hufelandstr. 55, 45147, Essen, Germany.
BMC Anesthesiol. 2018 Jun 20;18(1):71. doi: 10.1186/s12871-018-0538-0.
Acute liver failure (ALF) is a life-threatening entity particularly when infectious complications worsen the clinical course. Urgent liver transplantation (LT) is frequently the only curative treatment. However, in some cases, recovery is observed under conservative treatment. Therefore, prognostic tools for estimating course of the disease are of great clinical interest. Since laboratory parameters sometimes lack sensitivity and specificity, enzymatic liver function measured by liver maximum capacity (LiMAx) test may offer novel and valuable additional information in this setting.
We here report the case of a formerly healthy 20-year old male caucasian patient who was admitted to our clinic for ALF of unknown origin in December 2017. Laboratory parameters confirmed the diagnosis with an initial MELD score of 28 points. Likewise, enzymatic liver function was significantly impaired with a value of 147 [> 315] μg/h/kg. Clinical and biochemical analyses for viral-, autoimmune-, or drug-induced hepatitis were negative. Liver synthesis parameters further deteriorated reaching a MELD score of 40 points whilst clinical course was complicated by septic pneumonia leading to severe hepatic encephalopathy grade III-IV, finally resulting in mechanical ventilation of the patient. Interestingly, although clinical course and laboratory data suggested poor outcome, serial LiMAx test revealed improvement of the enzymatic liver function at this time point increasing to 169 μg/h/kg. Clinical condition and laboratory data slowly improved likewise, however with significant time delay of 11 days. Finally, the patient could be dismissed from our clinic after 37 days.
Estimating prognosis in patients with ALF is challenging by use of the established scores. In our case, improvement of enzymatic liver function measured by the LiMAx test was the first parameter predicting beneficial outcome in a patient with ALF complicated by sepsis.
急性肝衰竭（ALF）是一种危及生命的病症，尤其是当感染性并发症使临床病程恶化时。紧急肝移植（LT）常常是唯一的治愈性治疗方法。然而，在某些情况下，保守治疗可观察到病情恢复。因此，用于评估疾病进程的预后工具具有重大临床意义。由于实验室参数有时缺乏敏感性和特异性，通过肝脏最大能力（LiMAx）测试测量的酶促肝功能可能在此情况下提供新的有价值的补充信息。
我们在此报告一例病例，一名既往健康的20岁白种男性患者，于2017年12月因不明原因的急性肝衰竭入住我院。实验室参数确诊了该诊断，初始终末期肝病模型（MELD）评分为28分。同样，酶促肝功能显著受损，值为147[>315]μg/h/kg。针对病毒、自身免疫或药物性肝炎的临床和生化分析均为阴性。肝脏合成参数进一步恶化，MELD评分达到40分，同时临床病程因脓毒症肺炎而复杂化，导致严重的III - IV级肝性脑病，最终患者需要机械通气。有趣的是，尽管临床病程和实验室数据提示预后不良，但连续的LiMAx测试显示此时酶促肝功能有所改善，升至169μg/h/kg。临床状况和实验室数据同样缓慢改善，但有11天的显著时间延迟。最终，患者在37天后从我院出院。
使用既定评分评估急性肝衰竭患者的预后具有挑战性。在我们的病例中，通过LiMAx测试测量的酶促肝功能改善是预测一名合并脓毒症的急性肝衰竭患者良好预后的首个参数。
