The role of etiology in the hyperamylasemia of acute liver failure
Gregory A Coté, Jeanne H Gottstein, Amna Daud, Andres T Blei, Acute Liver Failure Study Group, William M Lee, Julie Polson, Carla Pezzia, Ezmina Lalani, Corron Sanders, Linda S Hynan, Joan S Reisch, Anne M Larson, Jeffrey S Crippin, Laura Gerstle, Timothy J Davern, Kristine Partovi, Sukru Emre, Timothy M McCashland, Tamara Bernard, J Eileen Hay, Cindy Groettum, Natalie Murray, Sonnya Coultrup, A Obaid Shakil, Diane Morton, Andres T Blei, Jeanne Gottstein, Atif Zaman, Jonathan Schwartz, Ken Ingram, Steven Han, Val Peacock, Robert J Fontana, Suzanne Welch, Brendan McGuire, Linda Avant, Raymond Chung, Deborah Casson, Robert Brown Jr, Michael Schilsky, Lauren Senkbeil, M Edwyn Harrison, Rebecca Rush, Adrian Reuben, Nancy Huntley, Santiago Munroz, Chandra Misra, Todd Stravitz, Jennifer Salvatori, Lorenzo Rossaro, Colette Prosser, Raj Satyanarayana, Wendy Taylor, Raj Reddy, Mical Campbell, Tarek Hassanein, Fatma Barakat, Alistair Smith, Gregory A Coté, Jeanne H Gottstein, Amna Daud, Andres T Blei, Acute Liver Failure Study Group, William M Lee, Julie Polson, Carla Pezzia, Ezmina Lalani, Corron Sanders, Linda S Hynan, Joan S Reisch, Anne M Larson, Jeffrey S Crippin, Laura Gerstle, Timothy J Davern, Kristine Partovi, Sukru Emre, Timothy M McCashland, Tamara Bernard, J Eileen Hay, Cindy Groettum, Natalie Murray, Sonnya Coultrup, A Obaid Shakil, Diane Morton, Andres T Blei, Jeanne Gottstein, Atif Zaman, Jonathan Schwartz, Ken Ingram, Steven Han, Val Peacock, Robert J Fontana, Suzanne Welch, Brendan McGuire, Linda Avant, Raymond Chung, Deborah Casson, Robert Brown Jr, Michael Schilsky, Lauren Senkbeil, M Edwyn Harrison, Rebecca Rush, Adrian Reuben, Nancy Huntley, Santiago Munroz, Chandra Misra, Todd Stravitz, Jennifer Salvatori, Lorenzo Rossaro, Colette Prosser, Raj Satyanarayana, Wendy Taylor, Raj Reddy, Mical Campbell, Tarek Hassanein, Fatma Barakat, Alistair Smith
Abstract
Objectives: Hyperamylasemia (HA) is often reported in patients with acute liver failure (ALF). Direct toxic effects of acetaminophen on the pancreas have been postulated, but the occurrence of HA in other etiologies raises the question of whether multiorgan failure is part of the pathogenesis of HA in this setting. Our main aim was to describe and analyze the incidence, clinical characteristics, and outcomes of HA in ALF of different etiologies.
Methods: Patients enrolled in the Acute Liver Failure Study Group registry with an admission amylase value available were included. For the purpose of this analysis, HA was defined as > or =3x upper limits of normal. Patients were classified as having acetaminophen (APAP)- or non-APAP-induced ALF, and by amylase group: normal (<115), mildly elevated (115-345), or HA (>345). Significant variables identified by univariate analysis were added to a multiple linear regression model. The primary outcome was overall survival.
Results: In total, 622 eligible patients were identified in the database, including 287 (46%) with APAP-induced ALF; 76 (12%) patients met the criteria for HA. Among patients with HA, 7 (9%) had documented clinical pancreatitis. The incidence of HA was similar among APAP (13%) and non-APAP (12%) patients. Although HA was associated with renal failure and greater Model for End-stage Liver Disease scores for both groups, HA was not an independent predictor of mortality in multivariate analysis.
Conclusions: Although not an independent predictor of mortality, HA in ALF was present in all etiologies and was associated with diminished overall survival. HA appeared to be related to renal dysfunction in both groups and multiorgan failure in non-APAP ALF.
Conflict of interest statement
CONFLICT OF INTEREST
Guarantor of the article: Andres Blei, MD.
Specific author contributions: Study concept and design as well as authorship of the paper: Andres Blei and Gregory Coté; data analysis: Jeanne Gottstein and Amna Daud; study concept and database support: William M. Lee. The Acute Liver Failure Study Group approved use of their database for the purposes of this research.
Financial support: Support provided by UO1–123456 and the Stephen B. Tips Fund at Northwestern Memorial Hospital.
Potential competing interests: The authors have no potential competing interests to disclose.
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Source: PubMed