Predictive utility of the dimethylarginines and ischemia modified albumin as prognostic markers in liver failure

当肝脏衰竭时，身体几乎所有的器官都会受到影响，它们的功能不充分。在存在肝病的患者中，相对较小的事件，如并发感染或出血，可能会导致灾难性的肝功能衰竭。这种情况在慢性肝功能衰竭时被称为急性。我们在过去5年的研究表明，目前用于确定并发问题的肝硬变患者是否会进展为全面肝功能衰竭的常规测试是不够的。一项可以准确识别进展为肝功能衰竭和死亡的高风险患者的良好测试将允许及早采取积极的方法进行治疗，转移到专家中心并列出肝移植的名单。这样的测试是迫切需要的。在确定为什么几个器官在肝功能衰竭期间不能发挥作用的研究中，我们发现了两项血液测试，可以预测哪一项？处于危险之中？患者会继续发展为晚期肝功能衰竭并死亡。当这两个测试结合成一个单一的评分系统时，它们被证明能够正确预测52名被研究患者中约90%的结果。我们建议进行一项大型研究，涉及英国几个重要的专家中心，以验证我们开发的测试是否真的有用。伦敦大学学院已经为这项测试申请了专利，一家开发体外肝脏支持设备的公司将共同资助该项目。如果数据与试点实验的数据一致，这项测试可能会很快到达患者手中，并开始对他们的结果产生影响。

When the liver fails, almost all the organs of the body are affected and they function inadequately. In patients that have existent liver disease, a relatively minor event such as intercurrent infection or bleeding can lead to catastrophic liver failure. This condition is referred to as acute on chronic liver failure. Our studies over the past 5 years have revealed that the current conventional tests that are performed to determine whether a patient with cirrhosis, who develop intercurrent problems, will progress to full blown liver failure are inadequate. A good test that could accurately identify patients at high risk of progressing to liver failure and mortality would allow early aggressive approach to treatment, transfer to specialist centres and listing for liver transplantation. Such a test is urgently needed. During studies determining why several organs fail to function during liver failure, we discovered two blood tests that may predict which ?at risk? patients would proceed to develop advanced liver failure and die. When these two tests were combined into a single scoring system, they were shown to correctly predict the outcome of about 90% of the 52 patients that were studied. We propose to perform a large study involving several important specialist centres in the UK to validate whether the test that we have developed is indeed useful. UCL has patented the test and a company developing an extracorporeal liver support device will co-fund the project. If the data are in keeping with those of the pilot experiments, it is possible that this test could reach the patients quickly and start to make a difference to their outcome.