Transjugular diagnostics in fulminant hepatitis including measurements of hepato-central venous biomarker gradients

Background & Aims:

Fulminant hepatitis (FH) and acute liver failure (ALF) are the clinical conditions representative of severe liver injury and associated with a significant risk of death. As high urgency liver transplantation may be required, early outcome prediction is essential in these patients. Prognosis scores like the model for end-stage liver disease and the King's College criteria are helpful, but further possibilities to increase accuracy would be of great value.

Methods:

We examined 30 patients with FH or ALF who underwent transjugular liver biopsy (TJLB) and investigated the clinical relevance of histology for correct diagnosis and etiology. We also assessed the suitability of the extent of necrosis, HVPGs and hepato-central venous gradients of serum biomarkers for outcome prediction. For this purpose, we calculated the difference of biomarker levels between blood samples from the hepatic vein (HV) and superior vena cava (SVC).

Results:

Histological evaluation of TJLB specimens contributed to finding the underlying etiology in 83%. Necrosis (%) and HVPGs were not significantly different between outcome groups. In gradient measurements, caspase 3/7-activity and total cytokeratin-18 (CK-18 M65) had significant and relevant levels different from zero. Although they were not accurate for outcome prediction, differences between outcome groups were detected in caspase activation: Levels of caspase 3/7-activity in the HV and caspase-cleaved CK-18 (M30) in the SVC were significantly higher in spontaneously recovered patients.

Conclusions:

Our results underline the role of caspase activation in spontaneous recovery of FH/ALF. Furthermore, the calculation of hepato-central venous biomarker gradients could depict a new diagnostic tool whose clinical potential needs to be further investigated in future studies, also for other liver diseases.