A new parameter using serum lactate dehydrogenase and alanine aminotransferase level is useful for predicting the prognosis of patients at an early stage of acute liver injury: A retrospective study

To confirm this hypothesis, we developed a new parameter with serum alanine aminotransferase (ALT) and LDH: the ALT-LDH index = serum ALT/(serum LDH - median of normal LDH range). We analyzed retrospectively 33 patients suffering acute liver injury (serum ALT more than 1000 U/L or prothrombin time expressed as international normalized ratio over 1.5 at admission) and evaluated the prognostic value of the ALT-LDH index, comparing data from the first 5 days of hospitalization with the Model for End-Stage Liver Disease (MELD) score. Patients whose symptoms had appeared more than 10 days before admission were excluded from this study. Among those included, 17 were conservative survivors, 9 underwent liver transplantation (LT) and 7 died waiting for LT. We found a rapid increase in the ALT-LDH index in conservative survivors but not in fatal patients. While the prognostic sensitivity and specificity of the ALT-LDH index was low on admission, at day 3 they were superior to the results of MELD.ALT-LDH index was useful to predict the prognosis of the patients with acute liver injury and should be helpful to begin preparation for LT soon after admission.Acute liver failure (ALF) or fulminant liver failure is a disease characterized by abrupt onset and high mortality. Liver transplantation (LT) is the only effective treatment for ALF and many patients die before undergoing LT because of rapid progression of the disease [1,2]. Therefore, a prompt decision regarding LT is required following an early determination of prognosis. Among the various clinical selection criteria proposed for LT, the King's College criteria and the Model for End-Stage Liver Disease (MELD) criteria have been applied widely [3,4]. However, those criteria include some factors reflecting multiple or systemic organ failure, which means that many patients fulfilling the criteria are already too unwell for transplantation to be contemplated. The poor prognosis of ALF seems to be attributable to the definition