| COAGULATION FACTORS V AND VIII IN RELATION TO SEVERITY AND OUTCOME IN ACUTE ALCOHOLIC HEPATITIS (1992) | |||||||||||||
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| The relationship between levels of coagulation Factors V and VIII and disease severity was evaluated in 33 patients with alcoholic liver disease, and related to outcome in the 23 with severe acute alcoholic hepatitis. Factor V levels in acute alcoholic hepatitis were significantly lower than in inactive alcoholic liver disease (median 28% vs 74%), and both results were lower than values in 10 control subjects (median 101%; P < 0.001 and P < 0.002, respectively). Plasma Factor VIII concentrations were not significantly higher in alcoholic hepatitis than in inactive alcoholic liver disease, although both results significantly exceeded control values (median 163% and 151% vs 104%; P < 0.005 and P < 0.05, respectively). In the 18 in-patients with alcoholic hepatitis who survived, admission factor V (median 32%) was higher, and admission serum bilirubin (65 μmol/l) and discriminant function score (derived from prothrombin time and bilirubin: median 31) were lower than in the four who died and one who received a liver transplant (median 16%, 527 μmol/l and 113; P < 0.005, P < 0.005, P < 0.05, respectively). An admission Factor V level < 15% correctly predicted outcome in a greater number (87%) of cases than admission discriminant function > 100 (83%), bilirubin > 300 μmol/l (83%) or prothrombin ratio > 1.5 (78%). This predictive accuracy increased to 100% for minimum Factor V < 15% and was again superior to maximum discriminant function > 100 or bilirubin > 300 μmol/l (both 83%) or maximum prothrombin ratio > 1.5 (78%). The finding that the admission Factor V level was the best predictor of outcome in this small series of patients with acute alcoholic hepatitis suggests that the test may be of considerable value in identifying patients requiring liver transplantation. | |||||||||||||
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