Admission levels of serum Gc-globulin: Predictive value in fulminant hepatic failure

Abstract

Gc-globulin scavenges actin released from necrotic he-the central nervous system with hepatic encephalopapatocytes to the extracellular space. In 77 patients with thy. 1 fulminant hepatic failure (FHF) (excluding patients A major problem in the treatment of FHF is the decitreated with liver transplantation), admission levels of sion of orthotopic liver transplantation (OLTx). [2][3][4][5] Early serum Gc-globulin and degree of complexing with mono-identification of patients at risk of dying is essential meric actin (complex ratio) were determined to evaluate to avoid irreversible damages, primarily brain damage their predictive values in relation to survival/nonsur-caused by cerebral edema. Despite a number of studies vival. Gc-globulin levels were significantly reduced in 47 in this area, [6][7][8][9][10][11][12] center to center because of etiological differences or ratio in nonsurvivors did not differ significantly from that of survivors. Gc-globulin levels were significantly differences in the expression of apparent identical dislower in 59 patients with non-acetaminophen-induced eases. FHF, compared with 18 patients with acetaminophen-Gc-globulin is a plasma protein that is synthesized induced FHF (P õ .01). Using a cutoff level of serum Gc-in the liver and abundant in the organism. The most globulin of 100 mg/L, a lesser value correctly predicted important function is to clear actin, released from dying nonsurvival in 79% of patients with non-acetamino-or dead liver cells, from the extracellular space. Gcphen-induced FHF, whereas a higher value predicted globulin binds avidly to the monomeric form of actin, survival in 60%. In patients with acetaminophen-G-actin, and acts in combination with gelsolin in the induced FHF, nonsurvival was correctly predicted in extracellular actin scavenger system. [13][14][15][16] In pathologi-100% of patients and survival in 53%. In comparison, the cal conditions with widespread cell necrosis, the extraKing's College Hospital (KCH) criteria correctly predicted nonsurvival and survival in 69% and 57%, respec-cellular actin scavenger system may be exhausted, and tively, of the same non-acetaminophen-induced FHF free actin-polymers may cause microthrombi in capilpatients and in 60% and 38%, respectively, of the acet-laries and arterioles. 17 In animals and in smaller series aminophen-induced FHF patients. Thus, in our study in man, Gc-globulin levels have been shown to be repopulation, the predictive properties of Gc-globulin duced in FHF. [18][19][20][21][22] In one study with seven patients, were in the same range as the KCH criteria. An advan-nonsurvivors had lower Gc-globulin levels and a higher tage of Gc-globulin is that it gives an estimate of the complex ratio (i.e., degree of complexing with G-actin) outcome already on admission. Acute liver transplanta-than survivors. 21 Recently, a study including 47 FHF tion should be considered in FHF patients with Gc-globpatients with mainly acetaminophen poisoning showed ulin less than 100 mg/L. (HEPATOLOGY 1996;23:713-718.) ...

Increased Turnover of Gc-Globulin in Patients with Hepatic Encephalopathy

“…Our study con rms previous ndings of reduced levels of Gcglobulin and increased complex ratio in severe liver disease, especially in FHF (8)(9)(10)(18)(19)(20)(21).…”

“…In FHF, low Gc-globulin has been demonstrated to be associated with the development of the multiple organ dysfunction syndrome (MODS) (7). Low levels of total and 'free' (non-actin bound) Gc-globulin are indicators of a poor prognosis (8,9). Gc-globulin is also reduced in chronic liver disease (CLD), but to a lesser extent than in FHF (10).…”

Gc-globulin is an acute phase reactant and an indicator of muscle injury after spinal surgery

“…This confirms previous clinical studies in patients sustaining major trauma or fulminant hepatic failure (FHF) [4,5,11,12]. In these situations early serum concentrations of Gc-globulin were reduced combined with increased levels of Gc-globulin-actin complexes.…”

Meta-analysis of performance of Kings’s College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure

“…The search strategy identified 1427 studies potentially relevant of which 138 were retrieved, and 17 studies [11,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were found with enough information to go forward into a meta-analysis ( Fig. 1).…”