Supplementary Material for: Performance of the LiMAx test, fibrinogen, and transient elastography in patients with acute liver injury

Background Acute liver failure (ALF) occurs as a rare, sudden, extensive loss of liver function in a previously healthy liver. In advanced cases, ALF may require liver transplantation (LT). Available prognostic parameters have limited accuracy to decide, which patient to consider for LT. The liver maximum function capacity test (LiMax) can accurately determine liver function and was assessed as predictor of survival, along with coagulation parameters and liver stiffness in non-acetaminophen-induced ALF. Methods Various liver function tests, including LiMAx measurements, coagulation factors, and transient elastography (TE) were analyzed retrospectively for associations with clinical outcome in 34 patients with ALF or acute hepatitis (AH). Data were compared between patients with spontaneous recovery (SR) and non-spontaneous recovery (3-month mortality/LT;NSR) Results The analysis included 34 patients (22 ALF, 12 AH; 19 male, 15 female; age 36.7±14.6y) with various causes of liver failure. Thirty-one patients recovered spontaneously, two patients died, and one patient underwent LT. The LiMax was 197.6 for SR vs. 92.33 for NSR (p = 0.0157). Fibrinogen was significantly lower in patients with NSR than in SR patients (209.0 vs. 106.3; p = 0.02). Mean liver stiffness measured by TE was 39.3 for NSR and 17.3 for SR (p = 0.26). KCC were fulfilled in only four patients (3 SR, 1 NSR). LiMAx results correlated positively with serum fibrinogen and antithrombin III concentrations and correlated negatively with liver stiffness. No other analyzed factor could differentiate between SR and NSR. Conclusion Decision-making in ALF remains challenging. LiMAx and fibrinogen might predict the prognosis in patients with non-acetaminophen-induced ALF and in combination could be feasible tools to decide if LT is necessary.背景 急性肝衰竭（Acute liver failure, ALF）是指既往肝功能正常者罕见突发的广泛肝功能丧失。病情进展至晚期时，急性肝衰竭患者可能需要接受肝移植（liver transplantation, LT）。现有预后参数在判断哪些患者需考虑肝移植时，准确性有限。肝脏最大功能储备试验（liver maximum function capacity test, LiMax）可精准评估肝功能，在非对乙酰氨基酚诱导的急性肝衰竭患者中，其与凝血参数、肝脏硬度一同被用作生存预测指标。 方法 本研究回顾性分析了34例急性肝衰竭或急性肝炎（acute hepatitis, AH）患者的多项肝功能检测指标，包括LiMax检测值、凝血因子及瞬时弹性成像（transient elastography, TE）结果，以探究其与临床结局的关联。研究将患者分为自发恢复组（spontaneous recovery, SR）与非自发恢复组（3个月内死亡/接受肝移植，non-spontaneous recovery, NSR），并对两组数据进行对比。 结果 本研究共纳入34例因不同病因导致肝衰竭的患者（22例急性肝衰竭、12例急性肝炎；男性19例，女性15例；年龄36.7±14.6岁）。其中31例患者实现自发恢复，2例死亡，1例接受了肝移植。自发恢复组的LiMax值为197.6，非自发恢复组为92.33（p=0.0157）。非自发恢复组的纤维蛋白原水平显著低于自发恢复组（209.0 vs 106.3；p=0.02）。经瞬时弹性成像检测的肝脏平均硬度在非自发恢复组为39.3，自发恢复组为17.3（p=0.26）。仅4例患者符合KCC标准（3例来自自发恢复组，1例来自非自发恢复组）。LiMax检测结果与血清纤维蛋白原、抗凝血酶Ⅲ浓度呈正相关，与肝脏硬度呈负相关。其余所有分析指标均无法区分自发恢复组与非自发恢复组患者。 结论 急性肝衰竭的临床决策仍颇具挑战。LiMax与纤维蛋白原或可预测非对乙酰氨基酚诱导的急性肝衰竭患者的预后，二者联合应用或可成为判断是否需实施肝移植的可行工具。