Blood @entity880 as an early predictor of outcome in @entity1443 -induced XXXX : a cohort study.

@entity1 @entity879 @entity1443 @entity880
BACKGROUND: Although the King's College Hospital (KCH) selection criteria for emergency liver transplantation in @entity1443 -induced @entity879 are widely used, strategies to improve sensitivity and facilitate earlier transplantation are required. We investigated the use of arterial blood @entity880 measurement for the identification of transplantation candidates. METHODS: In a single-centre study, we measured arterial blood @entity880 early (median 4 h) and after fluid resuscitation (median 12 h) in @entity1 admitted to a tertiary-referral intensive-care unit. Threshold values that best identified individuals likely to die without transplantation were derived in a retrospective initial sample of 103 @entity1 with @entity1443 -induced @entity879 and applied to a prospective validation sample of 107 @entity1 . Predictive value and speed of identification were compared with those of KCH criteria. FINDINGS: In the initial sample, median @entity880 was significantly higher in non-surviving @entity1 than in survivors both in the early samples (8.5 [range 1.7--21.0] vs 1.4 [0.53--7.9] mmol/L, p<0.0001) and after fluid resuscitation (5.5 [1.3--18.6] vs 1.3 [0.26--3.2], p<0.0001). Applied to the validation sample, a threshold value of 3.5 mmol/L early after admission had sensitivity 67%, specificity 95%, positive likelihood ratio 13, and negative likelihood ratio 0.35; the corresponding values for a threshold of 3.0 mmol/L after fluid resuscitation were 76%, 97%, 30, and 0.24. Combined early and postresuscitation @entity880 concentrations had similar predictive ability to KCH criteria but identified non-surviving @entity1 earlier (4 [3--13] vs 10 [3.5--19.5] h, p=0.01). Addition of postresuscitation @entity880 concentration to KCH criteria increased sensitivity from 76% to 91% and lowered negative likelihood ratio from 0.25 to 0.10. INTERPRETATION: Arterial blood @entity880 measurement rapidly and accurately identifies @entity1 who will die from @entity1443 -induced @entity879 . Its use could improve the speed and accuracy of selection of appropriate candidates for transplantation.
