Relation of Alpha-Fetoprotein in Acute Hepatitis to Severity and Prognosis

Karvountzis, G.; Redeker, Allan G.

doi:10.7326/0003-4819-80-2-156

Cited by 130 publications

(43 citation statements)

References 11 publications

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“…The degree of increase in the serum AST and ALT levels has been shown to have no prognostic value in fulminant hepatitis (19). Increased serum a-fetoprotein levels have been reported to indicate a favorable prognosis (20,21); however, this parameter did not increase during the acute phase of hepatitis and only increased when the serum AST and ALT levels were declining (21). Therefore the measurement of the hepatic arterial blood flow during the acute phase may be a convenient and reliable way of determining the prognosis of patients with viral hepatitis.…”

Section: Discussionmentioning

confidence: 99%

Increased hepatic arterial blood flow in acute viral hepatitis: Assessment by color doppler sonography

et al. 1993

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To evaluate the effect of acute viral hepatitis on hepatic arterial blood flow, we performed color Doppler sonography with point-spectral analysis in 15 patients with acute viral hepatitis and compared the results with those in 15 normal volunteers. During the acute phase of hepatitis, the peak-systolic and end-diastolic velocity of the hepatic artery were significantly larger than those in normal arteries (p < 0.01). During the recovery phase, these indexes of the hepatic artery decreased significantly to the control levels (p < 0.01). The resistive indexes related to vascular resistance in the hepatic artery during the acute phase were significantly less than those in normal arteries (p < 0.01), and they increased significantly to the control levels during the recovery phase (p < 0.01). No significant correlation was found between these indexes of the hepatic artery and conventional liver function parameters. However, the interval between the acute phase and the recovery phase did correlate negatively with the peak-systolic velocity of the hepatic artery in the acute phase (r = -0.630, p < 0.05) and with the end-diastolic velocity (r = -0.514, p < 0.05). We conclude that color Doppler sonography is useful for imaging increased hepatic arterial blood flow in patients with acute viral hepatitis. We believe that increased hepatic arterial blood flow during the acute phase may provide a marker for earlier recovery from hepatitis-induced damage.

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Section: Discussionmentioning

confidence: 99%

Increased hepatic arterial blood flow in acute viral hepatitis: Assessment by color doppler sonography

et al. 1993

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“…Although others have identified an association between increased AFP values and serum ALT values, 4 ' 7,9 ' 12,16,18 most of the studies that identified an association between AFP and hepatic necrosis or serum aminotransferases are not recent and involved patients with massive or submassive hepatic necrosis. 8,9,15 We are not the first to espouse the opinion that there is no direct relationship between mild hepatic necrosis and elevations in serum AFP values. 21,41 In our opinion, the most plausible model of AFP production revolves around altered hepatocyte-hepatocyte and stroma-hepatocyte interactions as a result of a loss of normal hepatocyte cell plate architecture.…”

Section: Hepatitis C and Ssrum Cc-fetoproteinmentioning

confidence: 99%

Serum α-Fetoprotein Levels in Patients with Chronic Hepatitis C : Relationships With Serum Alanine Aminotransferase Values, Histologic Activity Index, and Hepatocyte MIB-1 Scores

et al. 1999

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Patients with chronic viral hepatitis and cirrhosis often have elevated serum (X-fetoprotein (AFP) values, the causes of which are unclear. We studied 81 patients with chronic hepatitis C and the relationships of serum AFP and alanine aminotransferase (ALT) values Materials and MethodsTwo hundred consecutively evaluated patients with chronic hepatitis C who underwent liver needle biopsy at the time of initial examination and whose serum AFP levels were measured at the time of biopsy were identified by the William

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“…12 In FHF, AFP has been studied predominantly in patients with non-acetaminophen-induced liver failure, and the majority of studies find that an elevation of AFP is associated with a favorable prognosis. 15,[17][18][19][20][21][22][23][24][25] Only a few, older studies have included patients with acetaminophen poisoning. 15,19 Thus, the prognostic value of AFP in acetaminophen-induced hepatotoxicity is widely undetermined.…”

mentioning

confidence: 99%

Alpha-fetoprotein is a predictor of outcome in acetaminophen-induced liver injury

Schmidt¹,

Dalhoff²

2005

Hepatology

162

105

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An increase in alpha-fetoprotein (AFP) following hepatic necrosis is considered indicative of hepatic regeneration. This study evaluated the prognostic value of serial AFP measurements in patients with severe acetaminophen-induced liver injury. Prospectively, serial measurements of AFP were performed in 239 patients with acetaminophen intoxication and a peak alanine aminotransferase (ALT) level above 1,000 U/L. AFP was measured using an enzymelinked immunoassay (EIA) with a detection limit below 0.4 g/L. The optimum threshold of AFP to discriminate nonsurvivors was identified. An increase in AFP above 4 g/L occurred in 158 (79%) of 201 survivors compared with 11 of 33 nonsurvivors (33%; P < .00001). The increase in AFP occurred a mean of 1.0 days (range, ؊2 to ؉6 days) after peak ALT in survivors compared with 4.1 days (range, ؉2 to ؉7 days) in nonsurvivors (P < .00001). Starting on the day of peak ALT, AFP values were significantly higher in survivors than in nonsurvivors. A threshold AFP of 3.9 g/L on day ؉1 after peak ALT to identify nonsurvivors had a sensitivity of 100%, a specificity of 74%, a positive predictive value of 45%, and a negative predictive value of 100%. In conclusion, an increase in AFP was strongly associated with a favorable outcome in patients with acetaminophen-induced liver injury. AFP may be useful as a supplement to existing prognostic criteria. We suggest that the introduction of highly sensitive EIAs for the detection of AFP will require a reevaluation of AFP as a prognostic marker in acute nonneoplastic liver disease. (HEPATOLOGY 2005;41:26 -31.)

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Relation of Alpha-Fetoprotein in Acute Hepatitis to Severity and Prognosis

Cited by 130 publications

References 11 publications

Increased hepatic arterial blood flow in acute viral hepatitis: Assessment by color doppler sonography

Increased hepatic arterial blood flow in acute viral hepatitis: Assessment by color doppler sonography

Serum α-Fetoprotein Levels in Patients with Chronic Hepatitis C : Relationships With Serum Alanine Aminotransferase Values, Histologic Activity Index, and Hepatocyte MIB-1 Scores

Alpha-fetoprotein is a predictor of outcome in acetaminophen-induced liver injury

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