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• W2000314205 abstract "There are considerable variations among patients, particularly when a large number of variables are assessed; for example, patients with ALF due to acute viral hepatitis usually have higher serum bilirubin than patients with acetaminophen-related ALF. Several relevant variables, such as serum lactate, phosphates, α-fetoprotein, are not included; variables reflecting multiorgan dysfunction have significantly higher discriminative ability (area under the curve = 0.79).1 Because of the heterogeneity of data, precise prediction of outcome in an individual patient may not be possible by the application of a predictive model. The dynamic nature of the disease process matters; changes in variables (for example, a change in lactate) or in score (for example, a change in the Model for End-Stage Liver Disease score) may be more useful than the initial set of values, or a subsequent value may be more predictive.2 How early is “early”? The concept of “early” may not be the same in each study. Is it the time at which a patient comes to the hospital, or is it a mild early disease regardless of presentation to the hospital? As emphasized by Professor O'Grady in the accompanying editorial,3 it is important to recognize this fundamental difference when various studies on this issue are compared. However, several patients have fast deterioration within hours and days, thus having a higher grade of encephalopathy and cerebral edema on presentation to the hospital. We agree with the authors that further studies are needed to assess the prognostic accuracy of any new marker or a set of markers or a model both early in the course of ALF and serially in the subsequent course. We are prospectively examining the discriminative ability of clinical prognostic indicators and the Model for End-Stage Liver Disease on admission as well as a subsequent change at a different time interval. Radha K. Dhiman M.D., D.M., F.A.C.G.*, Ajay Duseja M.D., D.M., F.A.C.G.*, Yogesh K. Chawla M.D., D.M., F.A.C.G.*, * Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh, India." @default.
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• W2000314205 date "2007-01-01" @default.
• W2000314205 modified "2023-09-25" @default.
• W2000314205 title "Reply: Prognostic impact of lactate in acute liver failure" @default.
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• W2000314205 doi "https://doi.org/10.1002/lt.21402" @default.
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