BACKGROUND Liver-type fatty acid binding protein (FABP1) has previously been demonstrated to improve prognostic discrimination in acetaminophen (APAP)-induced ALF but has not been investigated in other etiologies of ALF. AIM To determine whether FABP1 levels (early: admission or late: days 3-5) are associated with 21-day transplant-free survival in non-APAP ALF. METHODS FABP1 was measured in serum samples from 384 ALF patients (n = 88 transplant-free survivors (TFS), n = 296 died/LT-NTFS) using solid-phase enzyme-linked immunosorbent assay and analyzed with US ALFSG registry data. RESULTS Of 384 ALF patients (autoimmune hepatitis n = 125, drug-induced liver injury n = 141, Hepatitis B n = 118), 177 (46%) patients received LT. Early FABP1 levels were significantly higher in ALF patients requiring vasopressor support (203.4 vs. 76.3 ng/mL) and renal replacement therapy (203.4 vs. 78.8 ng/mL; p < 0.001 for both). Late FABP1 levels were significantly higher in patients requiring mechanical ventilation (77.5 vs. 53.3 ng/mL), vasopressor support (116.4 vs. 53.3 ng/mL) and in patients with grade 3/4 hepatic encephalopathy (71.4 vs. 51.4 ng/mL; p = 0.03 for all). Late FABP1 levels were significantly lower in TFS patients (TFS 54 vs. NTFS 66 ng/mL; p = 0.049) but not admission (TFS 96 vs. NTFS 87 ng/mL; p = 0.67). After adjusting for significant covariates, serum FABP1 did not discriminate significantly between TFS and patients who died/received LT at day 21 either on admission (p = 0.29) or late (days 3-5, p = 0.087) time points. CONCLUSION In this first report of FABP1 in non-APAP ALF, FABP1 levels at late time points (days 3-5) were significantly lower in ALF patients who were alive without transplant at day 21 but not after adjusting for covariates reflecting severity of illness. Higher FABP1 levels were associated with the presence of increased organ failure.

中文翻译：

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非对乙酰氨基酚急性肝功能不全患者的血清肝型脂肪酸结合蛋白水平升高。

背景技术先前已证明肝型脂肪酸结合蛋白（FABP1）可改善对乙酰氨基酚（APAP）诱导的ALF的预后判别，但尚未在ALF的其他病因中进行研究。目的确定FABP1水平（早期：入院或晚期：3-5天）是否与非APAP ALF的21天无移植生存期相关。方法采用固相酶联免疫吸附法测定384例ALF患者（n = 88例无移植存活者（TFS），n = 296例死亡/ LT-NTFS）的血清样本中的FABP1，并用美国ALFSG注册数据进行分析。结果384例ALF患者（自身免疫性肝炎n = 125，药物性肝损伤n = 141，乙型肝炎n = 118）中，有177（46％）患者接受了LT。需要血管加压药支持的ALF患者的早期FABP1水平显着升高（203.4 vs. 76。3 ng / mL）和肾脏替代疗法（203.4 vs. 78.8 ng / mL；两者均p <0.001）。需要机械通气的患者（77.5 vs. 53.3 ng / mL），血管加压药支持（116.4 vs. 53.3 ng / mL）和3/4级肝性脑病患者（71.4 vs. 51.4 ng / mL）的晚期FABP1水平明显更高；对于所有参数，p = 0.03）。TFS患者的晚期FABP1水平显着降低（TFS 54 vs. NTFS 66 ng / mL； p = 0.049），但未入院（TFS 96 vs. NTFS 87 ng / mL； p = 0.67）。在校正了显着的协变量后，在入院（p = 0.29）或晚（3-5天，p = 0.087）时间点，TFS与在第21天死亡/接受LT的患者之间没有明显区分血清FABP1。结论在非APAP ALF中FABP1的第一份报告中，在ALF患者中，在第21天仍未存活但在未调整反映疾病严重程度的协变量之后，FABP1在晚期时间点（第3-5天）显着降低。较高的FABP1水平与器官衰竭增加相关。