Prognostic value of serum alpha-fetoprotein kinetics in liver failure on artificial liver support

Liver failure, particularly acute-on-chronic liver failure, is associated with high mortality (50%-90%). The plasma exchange (PE) mode of the artificial liver support system has been shown to improve clinical outcomes, although its efficacy may vary depending on the regenerative capacity of the liver. Alpha-fetoprotein (AFP), an oncofetal glycoprotein, is reactivated during liver regeneration and may serve as a prognostic biomarker. Previous studies have reported significantly higher post-PE AFP levels in survivors than in non-survivors (286.5 ng/mL vs 82.3 ng/mL at day 7). However, the predictive value of baseline AFP stratification and serial AFP kinetics during PE therapy remains unestablished. This study investigated whether serial AFP measurements predict clinical outcomes in liver failure patients receiving PE.

To evaluate the predictive value of serial AFP measurements in liver failure patients receiving PE.

This retrospective study included 194 liver failure patients with complete AFP data, excluding those with tumors, bleeding disorders, allergies, or unstable conditions. Patients were stratified by baseline AFP into low-AFP (< 100 ng/mL, n = 60), medium-AFP (100-200 ng/mL, n = 70), and high-AFP (> 200 ng/mL, n = 64) groups. AFP was measured before PE and on days 1, 10, 20, and 25.

Stratification by baseline AFP revealed significant gradients. The high-AFP group required fewer PE sessions than the low-AFP group (2.8 ± 1.0 vs 4.2 ± 1.5) but exhibited greater post-PE AFP elevation (75.1 ± 20.3 ng/mL vs 33.1 ± 10.2 ng/mL; P < 0.001). The high-AFP group demonstrated optimal values, including the lowest ammonia, bilirubin, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and the highest albumin and prothrombin activity (all post hoc P < 0.05 vs low-AFP). The medium-AFP group showed intermediate values except for prothrombin activity (35.2% ± 8.6%), which was significantly lower than in both other groups (P < 0.001). The high-AFP group had a reduced incidence of spontaneous bacterial peritonitis (9.4% vs 25.0%; P = 0.003), superior three-month survival (90.6% vs 56.7%; P < 0.001), and a higher post-treatment three-month receiver operating characteristic area under the curve (0.8851 vs 0.7051).

AFP dynamics correlate with regenerative capacity and clinical outcomes in liver failure. Serial AFP monitoring may enhance risk stratification and support personalized therapeutic strategies.