Coagulation factor V levels as a prognostic indicator in fulminant hepatic failure

Area of Science:

• Hepatology
• Transplantation Immunology
• Clinical Biochemistry

Background:

• Fulminant hepatic failure (FHF) poses critical challenges in patient management and prognosis.
• Coagulation factor V has been proposed as a key prognostic indicator for FHF.
• Selection for urgent liver transplantation requires accurate prognostic tools.

Purpose of the Study:

• To evaluate the predictive accuracy of plasma factor V levels in patients with FHF.
• To compare the efficacy of factor V with established prognostic criteria for liver transplantation selection.
• To assess the utility of factor V in acetaminophen-induced FHF versus other etiologies.

Main Methods:

• Plasma factor V levels were measured in 110 FHF patients (grades I-IV coma).
• Eighty-eight patients had acetaminophen overdose as the cause of FHF.
• Statistical analysis included calculating positive predictive values for factor V levels and comparing them with King's criteria.

Main Results:

• Lower factor V levels were observed in non-surviving FHF patients (median 5%) compared to survivors (median 10%).
• Factor V <20% had a positive predictive value of 0.49, and <10% had 0.57 for mortality in acetaminophen-induced FHF.
• King's criteria demonstrated higher predictive accuracy (0.92) than factor V alone (0.73) when combined with coma grade for acetaminophen-induced FHF.

Conclusions:

• Plasma factor V level is less effective than King's criteria for selecting acetaminophen-induced FHF patients for liver grafting.
• Factor V may have utility in predicting outcomes for FHF caused by non-acetaminophen etiologies.
• Established prognostic criteria remain superior for guiding urgent liver transplantation decisions in acetaminophen-induced FHF.