Early‐phase prothrombin time‐international normalized ratio in acute liver injury indicates the timing of therapeutic intervention and predicts prognostic improvement. Issue 2 (10th November 2022) - Kumagai, Kotaro
Abstract: Aim: We investigated whether an early‐phase prothrombin time‐international normalized ratio (PT‐INR) is an interventional prognostic indicator for patients with acute liver injury, including acute liver failure. Methods: This was a multicenter retrospective observational study. We included 595 patients with alanine aminotransferase levels ≥300 U/L due to acute liver injury who were admitted to Kagoshima University Hospital or other collaborative investigation organizations between January 1, 2010, and December 31, 2015. Patients with alanine aminotransferase levels ≥300 U/L and no previous liver disease were defined as having an acute liver injury. Acute liver failure was defined by PT‐INR ≥1.5 with or without hepatic encephalopathy in acute liver injury patients. Data were obtained retrospectively from case reports and analyzed. Results: The PT‐INR on day 1 was the most accurate independent prognosis predictor in patients with acute liver injury and acute liver failure. On day 1, the transplant‐free survival rates were significantly lower in patients with PT‐INR ≥1.3. The transplant‐free survival rates were also significantly higher in patients with acute liver injury and acute liver failure, in whom the PT‐INR had recovered from ≥1.3 on day 1 to <1.3 by day 8. Conclusion: Early‐phase changes in the PT‐INR can predict the prognosis of patients with acute liver injury and acute liver failure. Furthermore, PT‐INR ≥1.3 could be an interventional marker, whereas PT‐INR <1.3 after 1 week could reflect prognostic improvement.