Liver Fatty Acid Binding Protein. a marker for traumatic liver injury.

Brouwers, M.L.E.J. (2014) Liver Fatty Acid Binding Protein. a marker for traumatic liver injury. thesis, Medicine.

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Abstract

Introduction Currently, there is no laboratory test available which predicts the extent of traumatic liver injury. By many, a computed tomography (CT) scan is considered the golden standard for evaluating the presence and extent of such injury. However, a CT scan is not without risk, as it makes use of ionizing radiation and transport to and from the CT room takes time and endangers the patient. Aim of this study was to test if the plasma concentration of the protein Liver Fatty Acid Binding Protein (L-FABP) is an accurate diagnostic marker for the presence or absence of liver injury in a poly trauma patient during the initial admission and during the first two days after trauma. Secondary aim is to analyze whether plasma and urine L-FABP levels correlate with commonly used liver function tests and grade of injury on CT scan or preoperatively during the initial admission and/or during the first 48 hours after trauma. Methods This study is part of a large prospective cohort study on markers for gut wall integrity in trauma. Inclusion criteria were: age > 18 years, A-trauma, free abdominal fluid as seen on FAST-echo or CT-scan on admission at the shock room and injury seen in damage control surgery i.e. laparotomy. Plasma samples were obtained upon arrival at the shock room, three hours post trauma, and after 24 and 48 hours. CT-scans of all patients were (re)scored by a radiologist according to the Organ Injury Scale (OIS) of the AAST. ELISA technique was used to analyze plasma samples. Medians of L-FABP were compared between patients with or without liver injury, using Mann-Whitney test. L-FABP was correlated to liver function tests and OIS grades of liver injury, by using Pearsons or Spearmans test, depending on normal distribution or not. The optimal cut-off point for L-FABP as marker for the presence of liver injury was defined with help of ROC curves. Results We included 62 patients. There were 48 (77.4%) males and 14 (22.6%) females. The mean age was 39 years (SD±16.7). Overall mortality rate was 22.6% (n=14). The injury mechanism was blunt force trauma in 56 patients (90.3) and penetrating trauma in 6 patients (9.7%). L-FABP was significantly raised in patients with liver injury compared to patients without liver injury upon arrival at the shock room: 244.5 ng/ml in patients with and 75.6 ng/ml in patients without liver injury, (p = 0.03). Correlation of L-FABP with the OIS liver injury classes was (0.320, p = 0.05) upon admission. The strongest correlation of ALT and AST to L-FABP was found three hours after trauma, 0.786 (p < 0.01) and 0.807 (p < 0.01) respectively. At the chosen cut-off point (418.34 ng/ml), the sensitivity of L-FABP was 44% specificity was 90%, NPV was 77% and PPV was 70% Conclusion L-FABP is a relatively good test to rule out traumatic liver injury. L-FABP was unable to discriminate between the different grades of liver injury during initial admission to the shockroom and 48 hours afterwards.

Item Type:	Thesis (Thesis)
Supervisor name:	Hulscher, J.B.F. MD/PhD
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:58
Last Modified:	25 Jun 2020 10:58
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1830

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