McGill Leads Study That Discovers Key Element to Predicting Outcome for Acute Liver Failure Patients

By Kev' Moye

It’s a discovery that can play a big role in predicting a patient’s potential outcome.

The project — published by The Journal of Applied Laboratory Medicine and highlighted by Clinical Laboratory News — was a cross-disciplinary endeavor comprised of researchers and clinicians from the College of Public Health, the UAMS College of Medicine and health professionals from across the nation.

The group, which included College of Medicine faculty members Sam Mackintosh, Ph.D.; Hoda Hagrass, M.D., Ph.D.; and Ari Filip, M.D., examined serum samples from 58 acute liver failure patients. There were nearly 1,700 proteins measured in a subset of the samples. Additionally, the team conducted a retrospective review of medical charts from 238 acute liver failure patients admitted to UAMS over a 12-year period.

The final review confirmed that lactate dehydrogenase is a useful predictive biomarker in acute liver failure.

According to the National Library of Medicine, lactate dehydrogenase is a protein, found in several body tissues, that plays a role in creating energy for the body. When damaged, the tissues release lactate dehydrogenase into the bloodstream or other body fluids.

The protein is regularly measured in clinical laboratories. However, it’s typically not tested as a prognostic marker for acute liver failure. Discovering that heightened levels of lactate dehydrogenase can provide clues to the potential outcome for a person with acute liver failure, surprised the researchers.

“It’s been hiding in plain sight all this time — literally right under our noses every time we look at a patient’s chart,” McGill said. “Logistic regression and other metrics further revealed how elevated lactate dehydrogenase levels are a good indicator of who needs a liver transplant in order to survive.

“I think lactate dehydrogenase is usually overlooked because it’s elevated in other conditions as well, like hemolysis and cancer. As a result, most researchers have assumed that it would not be specific enough for liver injury to be useful in acute liver failure. However, the very large increases in serum lactate dehydrogenase that occur in acute liver failure patients are unique. You just don’t get those numbers very often with other conditions.”

McGill noted that the research sheds additional light on the severity of the ailment.

“Approximately 30% of acute liver failure patients die,” he said. “The typical time from onset to death is just a few days. Currently, the only life-saving treatment, in the most severe cases, is a new liver. Unfortunately, healthy donor organs are typically in short supply. Therefore, it’s critical to have biomarkers — like lactate dehydrogenase — that can help clinicians quickly determine who needs a liver transplant and who can survive without one.

“Clinicians in Arkansas, and elsewhere, may be able to add lactate dehydrogenase to their prognostic arsenal in an effort to improve treatment and outcomes for acute liver failure patients.”

Overall, the study is vital to improving the survival rates for all people — especially women and African Americans, who are most affected by acute liver failure with the ailment being most common among women. Nationally, women comprise about 60 to 70% of acute liver failure patients.

“Lactate dehydrogenase is already routinely measured in hospital laboratories,” McGill said. “But doctors can now explore its use in acute liver failure prognosis immediately. It may help them save lives.

“We also hope that at some point there’s an improvement in donor organ allocation — which is a fundamental public health issue.”