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

当肝脏衰竭时，几乎所有的身体器官都会受到影响，并且它们的功能不足。在存在肝脏疾病的患者中，相对较小的事件如并发感染或出血可导致灾难性的肝功能衰竭。这种情况被称为急性慢性肝功能衰竭。我们过去5年的研究表明，目前用于确定肝硬化患者是否会发展为全面肝衰竭的常规检查是不够的。一个好的测试，可以准确地识别患者在高风险的进展到肝衰竭和死亡率将允许早期积极的治疗方法，转移到专科中心和肝移植上市。迫切需要进行这样的测试。在确定为什么肝衰竭时几个器官不能正常工作的研究中，我们发现了两种血液测试可以预测哪一种？有风险吗患者将继续发展为晚期肝衰竭并死亡。当这两种测试结合成一个单一的评分系统时，它们被证明可以正确预测52名患者中约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科中心，以验证我们开发的测试是否确实有用。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，那么这种测试可能会很快到达患者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.