Ferritin/alanine aminotransferase ratio as a possible marker for predicting the prognosis of acute liver injury

Abstract

Background and aims: Serum levels of ferritin and heme oxygenase (HO)-1 are both markers of macrophage activation. We evaluated simple markers for predicting the prognosis of severe acute liver injury in which macrophage activation plays an important role.

Methods: Subjects comprised 114 patients with acute liver injury, admitted to the liver unit of Nagasaki Medical Center between January 2001 and September 2010. Subjects included 11 patients with fulminant hepatic failure (FHF), 82 patients with ordinary acute hepatitis (AH), and 21 patients with severe-form AH (AHS). We determined serum levels of ferritin, HO-1 and other biochemical makers, and analyzed relationships between clinical outcomes of patients and each of these parameters alone and in combination.

Results: Median serum ferritin levels were significantly higher in FHF (25900ng/mL) and AHS (3060ng/mL) than in AH (700ng/mL; P<0.01 each). Median HO-1 levels were also significantly higher in FHF (123ng/mL) and AHS (51ng/mL) than in AH (19ng/mL; P<0.01 each). Similarly, median ferritin/alanine aminotransferase (F/A) ratio was significantly higher in FHF (6.7) than in AHS (1.6, P<0.05) or AH (0.5, P<0.01). Among the 11 FHF patients, three recovered, seven died and one underwent liver transplantation. The ability of F/A ratio to distinguish non-survivors from survivors was analyzed using receiver operating characteristics curves. A cut-off level of 3.12 provided high sensitivity (87.5%) and specificity (81.2%).

Conclusion: These results suggest that F/A ratio offer a quick and simple marker for predicting the prognosis of acute liver injury.