There has been a growing interest in identifying prognostic
biomarkers that alone or with available prognostic models (King's College Criteria, KCC; MELD and ALFSG Prognostic Index) would improve prognosis in
acute liver failure (ALF) patients being assessed for
liver transplantation. The
Acute Liver Failure Study Group (ALFSG) has evaluated 15 potential prognostic
biomarkers: serum AFP; apoptosis-associated
proteins; serum actin-free
Gc-globulin; serum
glycodeoxycholic acid; sRAGE/RAGE
ligands; plasma
osteopontin; circulating MBL, M-, L-, H-ficolin and CL-1; plasma
galectin-9; serum FABP1; serum Lct2;
miRNAs;
factor V;
thrombocytopenia, and sCD163. The ALFSG also has reported on 4 susceptibility
biomarkers:
keratins 8 and 18 (K8/
K18) gene variants; polymorphisms of genes encoding putative
APAP-metabolizing
enzymes ( UGT1A1 , UGT 1A0 , UGT 2B15 , SULT1A1 ,
CYP2E1 , and
CYP3A5 ) as well as CD44 and BHMT1 ; single nucleotide polymorphisms (SNPs) of genes associated with human behavior, rs2282018 in the
arginine vasopressin ( AVP ) gene and rs11174811 in the AVP receptor 1A gene. Finally, rs2277680 of the CSCL16 gene in HBV-ALF patients. In conclusion, we have reviewed the prognostic and susceptibility
biomarkers studied by the ALFSG. We suggest that a better approach to predicting the clinical outcome of an ALF patient will require a combination of
biomarkers of pathogenic processes such as cell death, hepatic regeneration, and degree of
inflammation that could be incorporated into prognostic models such as KCC, MELD or ALFSG PI.