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Gc‐globulin and prognosis in acute liver failure

Serum concentrations of the actin scavenger Gc‐globulin are reduced in acute liver failure (ALF). Prospectively, we tested Gc‐globulin's value to predict outcome following ALF using sera from 182 patients with ALF from the U.S. ALF Study Group. Admission serum levels of Gc‐globulin (normal range: 350‐500 mg/L) were studied by an immunonephelometric method. The median (range) serum Gc‐globulin level on admission for the entire group was 91 (5‐307) mg/L. Gc‐globulin levels were significantly higher in spontaneous survivors than in patients who died or underwent transplantation (113 [5‐301] mg/L vs. 73 [5‐307] mg/L, P < 0.001). Those surviving non‐acetaminophen (paracetamol)‐induced ALF without transplantation had higher Gc‐globulin levels than nonsurvivors (102 [5‐301] mg/L vs. 61 [5‐232] mg/L, P = 0.002), whereas there was no significant difference in levels between the groups in patients with acetaminophen‐induced ALF. A cutoff level of 80 mg/L in the non‐acetaminophen group yielded positive and negative predictive values of 85% and 43%, respectively. The corresponding figures for the King's College criteria were 90% and 49%, respectively. In conclusion, we found that Gc‐globulin levels were markedly decreased in patients with ALF; the lowest levels were observed in patients who died or were transplanted. In contrast to previous studies, this study demonstrated that Gc‐globulin has prognostic value in patients with non‐acetaminophen‐induced ALF, in the same range as the King's College criteria. Further refinements of the assay would be necessary to make it more accurate and of practical utility. (Liver Transpl 2005;11:1223–1227.)