Biochemical Predictors of Clinical Outcome in Liver Failure Associated with Obstructive Jaundice

The study of predictors of adverse outcomes in liver failure is driven by the rapid increase in patients with obstructive jaundice (OJ) and the lack of standardized diagnostic criteria for assessing liver functional status.

Aim. To investigate the changes of liver injury biomarkers in liver failure associated with OJ.

Materials and Methods. A prospective observational cohort study was conducted on serum biomarkers of liver injury — L-FABP protein, 5'-nucleotidase, liver arginase, and hyaluronic acid — in patients with liver failure due to benign OJ. The study included 53 patients who underwent biliary decompression. Based on the course of disease, patients were divided into two groups: those with favorable outcomes (group 1, N=27) and those with unfavorable outcomes (group 2, N=26). A control group consisted of 25 healthy donors. Serum biomarker levels were assessed on admission and on days 3, 7 and 11 post-decompression. The study used enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using IBM SPSS Statistics 22, including Friedman two-way analysis, Kruskal–Wallis H test, Mann–Whitney U test, and two-sample Kolmogorov–Smirnov test, with significance set at P<0.05.

Results. At hospital admission, median biomarker levels were significantly higher in both patient groups than in the comparison group. Group 1 showed a statistically significant decrease in all biomarkers during treatment (P=0.01 for L-FABP, 5'-nucleotidase, liver arginase; P=0.03 for hyaluronic acid). In group 2, only L-FABP levels decreased significantly (P=0.04). Sensitivity and specificity for predicting disease outcome were 89.2–92.3% and 88.9–96.3% for L-FABP, 53.8–69.2% and 81.5–85.2% for 5'-nucleotidase, 57.7–76.9% and 77.8–88.9% for arginase, and 38.5–46.2% and 74.1–81.5% for hyaluronic acid, respectively.

Conclusion. Among the studied biomarkers, L-FABP showed the highest specificity and sensitivity values for prediction of outcome in liver failure associated with OJ, while other biomarkers demonstrated less significant results.

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