Fulminant Hepatic Failure | Serum ALT to LDH Index for Evaluating Risk

Patient selection: severe acute hepatitis (serum ALT > 1,000 IU/L or PT/INR > 1.5 on admission)

Patient selection:

(1) serum ALT in IU/L

(2) serum LDH in IU/L

(3) mean of the normal reference range for serum LDH

ALT to LDH index =

= (serum ALT) / ((serum LDH) - (mean of the normal reference range for LDH))

where:

• The paper uses the median of the normal reference range. Since the normal reference range should follow a normal Gaussian distribution then the mean can be substituted.

Interpretation:

• A patient with an index > 3 on day 3 after admission can usually be managed conservatively.

• The index tends to increase between admission and day 3 of hospitalization in patients who can be managed conservatively.

• The index does not increase or only slightly in a patient who develops fulminant disease requiring liver transplantation.

Performance:

• An index > 3 had a sensitivity of 75% and specificity of 100% for predicting conservative management.

Limitations:

• The methods used to measure the serum ALT and LDH were not stated.