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PTU-024 Do iron studies on admission predict outcome in patients with acute liver failure?

Introduction Acute liver failure (ALF) has a high short term mortality. Current prognostic models lack sensitivity. This study aimed to investigate the prognostic potential of iron metabolism in ALF. Methods 528 patients admitted to a liver transplant unit with ALF were selected. Aetiology, outcome (spontaneously survived vs. death/transplant) and hepatic encephalopathy (HE) were recorded. Patients without the relevant iron indices recorded were excluded. Results Paracetamol overdose (POD) patients (n=236) had a significantly higher transferrin if they survived (n=168) compared to those that died or were transplanted (n=68) (1.585 (1.363–1.918) vs. 1.285 (1.000–1.730) (p<0.001)) In non-POD patients (n=88) the median transferrin was also significantly higher in those patients that survived (n=48) compared to those that died or were transplanted (n=40) (1.965 (1.435–2.375) vs. 1.455 (1.078–1.803) (p=0.001)) In POD patients (n=246) the median ferritin was significantly higher in those who died or were transplanted (n=70) compared with survivors (n=176) (36,822(13,054–64,358) vs. 17,641 (5,120–42,895) (p=0.002)). There was no statistical difference in the non-POD group. Transferrin was significantly lower in POD patients with HE (n=143) compared to those that never developed HE (n=93) (1.420 (1.100–1.720) vs. 1.670 (1.400–1.990) (p<0.001)). Levels were also significantly lower in the non-POD group (1.500 (1.085–1.945) vs. 1.985 (1.445–2.365) (p=0.007)). Ferritin was significantly higher in POD patients with HE (n=146) compared to those who never developed HE (n=99). (24,828 (9,267–61,214) vs. 17,149 (3,153–37,994) (p=0.009)). There was no difference in the non-POD group. No significant results were found when comparing circulating iron levels and transferrin saturations. ROC curve analysis, however, showed that iron studies are poor at predicting survival in ALF. For example the area under the curve for transferrin to predict survival in POD patients was 0.662. To predict encephalopathy free course of disease in the same group of patients was 0.666. Conclusions Iron indices, specifically ferritin and transferrin, are significantly different in patients with ALF and relate to aetiology and outcome. However they are poor at predicting survival.