Plasma disappearance rate of indocyanine green is a prognostic indicator in acute liver failure

Background and aim: In patients presenting with acute liver failure (ALF) prediction of prognosis is vital to determine the need of transplantation. Based on the evidence that plasma disappearance rate of indocyanine green (ICG-PDR) correlates with liver cell function, we evaluated the ability of ICG-PDR measured by pulse dye densitometry to predict outcome in patients with acute liver failure.

Methods: Prospectively markers of hepatocellular injury, synthesis and excretion, including ICG-PDR were measured daily until liver transplantation, death, discharge from intensive care unit, or up to 7 days in 25 patients with acute liver failure. Receiver operating curve (ROC) analysis was performed to assess the value of ICG-PDR to predict outcome in ALF.

Results: The 25 patients analyzed included 18 that recovered spontaneously and 7 that underwent liver transplantation (n=6) or died (n=1). Causes of ALF included viral hepatitis (n=4), toxic liver injury (n=15), ischemic liver injury (n=2), and cryptogenic liver failure (n=4). King's college criteria were fulfilled in 85.7% of patients not recovering spontaneously and in 16.7% of patients recovering spontaneously. The mean ICG-PDR measured on day 1 in patients recovering spontaneously was 12.0±7.8%/min and in patients not recovering spontaneously 4.3±2.0%/min (P=0.002). By ROC analysis the sensitivity and specificity of an ICG-PDR value ≤6.3%/min on study day 1 were 85.7% and 88.9%, respectively, for predicting a non spontaneous outcome in ALF.

Conclusions: ICG-PDR allows early and sensitive bedside assessment of liver dysfunction in ALF. Measurement of ICG-PDR might be helpful in predicting the outcome in acute liver failure.