Prognostic markers

A variety of markers are related to outcome and are used clinically to direct treatment strategies. Both serum creatinine levels and prothrombin time have been shown to correlate with survival. A serum creatinine concentration of less than 100 ^mol/l (1.13 mg/dl) is associated with a survival rate of 65 per cent, but this falls to just 23 per cent when the serum creatinine is greater than 300 ^mol/l (3.39 mg/dl). A peak prothrombin time of less than 90 s correlates with 80 per cent survival, but a peak prothrombin time of greater than 180 s is associated with a survival of less than 10 per cent. The presence of metabolic acidosis which does not correct with fluid resuscitation is a particularly poor prognostic sign, with a survival rate of less than 10 per cent. The degree of encephalopathy is also related to outcome, with a grade I or II encephalopathy associated with 95 per cent survival, but this falls to less than 22 per cent if the patient develops grade IV encephalopathy or cerebral edema. Patients who become hypotensive and require vasopressors are also at very high risk, with less than 10 per cent survival. Referral to a specialist liver unit for discussion and subsequent transfer should be made if any of the complications in T,ab]e,1 develop (MakiDl. „aodl. „^^^ll.iam.s lm1996).

Uft£ofc»4»& tfiwpw** lo liri rttust'iloi < 7£>. table 1 Guidelines for referral to a specialized liver unit

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