It’s estimated that 3,000 people in the United States will be diagnosed with acute liver failure (ALF) each year. While acetaminophen overdose is the most common cause of this condition, prescription drugs, herbal supplements and hepatitis A and B viruses, can also result in such sudden liver injury. Due to a shortage of available livers for transplantation, determining which ALF patients are likely to recover from ALF versus those likely to die is vital.
Recent findings from experts at the University of Michigan Medicine, Rutgers University, the University of Texas Southwestern Medical Center and the Medical University of South Carolina may have uncovered a faster, more accurate method of identifying hospitalized patients who need liver transplants or are likely to recover, according to a Michigan Medicine article.
Published in Clinical Gastroenterology and Hepatology, the study retrospectively analyzed blood samples and medical records from 270 patients admitted to the hospital with ALF. The analysis discovered concentrations of a “short-lived and abundant serum protein” known as carbamoyl phosphate synthetase 1, or CPS1, that helped researchers predict which patients would survive without a liver transplant.
“Any prognostic tool that helps distinguish patients likely to recover from those likely to die from ALF while transplant candidates are still healthy enough to survive surgery is extremely valuable,” said lead study investigator Robert Fontana, MD, professor of internal medicine and transplant hepatology researcher at Michigan Medicine in the article. “That’s why this work is so important.”
This team’s research previously established CPS1’s potential as a prognostic tool by demonstrating that the protein is released into the blood only when acute hepatotoxicants damage CPS1-rich liver cells. Other published works have demonstrated that CPS1 has a short half-life, according to Michigan Medicine. In fact, research has shown that as the liver starts to recover and cell death slows or stops, meaning the patient is likely to survive without a transplant, CPS1 in the blood rapidly decreases within hours.
“In this study, we reviewed records and samples from 103 patients with acetaminophen-induced liver failure and 167 with liver failure from other causes,” Fontana said. “Patients from the first group who received liver transplants or died within 21 days of hospitalization had, on average, about twice as much CPS1 in the blood as those who spontaneously recovered,” while patients from the second group who died or received transplants also CPS1 levels about a third higher than those who spontaneously recovered.
Although additional research is needed, CPS1 levels have the potential to be a highly valuable prognostic tool in cases of acute liver failure, according to senior study author Bishr Omary, MD, PhD, senior vice chancellor for academic affairs and research at Rutgers Biomedical and Health Sciences.