eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
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1/2024
vol. 10
 
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abstract:
Original paper

Assessing the predictive value of serum phosphate for short-term mortality in acute-on-chronic liver failure patients: An observational study at a non-transplant tertiary care centre

Rohit S. Wagh
1
,
Shamshersingh Chauhan
1
,
Mit Shah
1
,
Yogesh Bairwa
1
,
Motij Dalai
1
,
Meghraj Ingle
1

  1. Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
Clin Exp HEPATOL 2024; 10, 1: 20–29
DOI: https://doi.org/10.5114/ceh.2024.136290
Online publish date: 2024/03/17
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Aim of the study:
The gradual clinical worsening of acute-on-chronic liver failure (ACLF) leads to a high 28-day mortality rate. There are several prognostication scores for predicting early mortality in ACLF. Serum phosphate, which is the main component of adenosine tri-phosphate (ATP) synthesis, is utilized for liver synthetic functions, leading to subnormal or decreased serum phosphate levels. Hence more than normal levels of serum phosphate can be used as a marker of decreased liver cell reserve. Hence, we aimed to compare serum phosphate levels with available prognostic scores to assess mortality among ACLF patients.

Material and methods:
100 consecutive ACLF patients according to the Asia Pacific Association for Study of the Liver (APASL) definition were studied. The baseline blood workups and determination of viral bio-markers, serum phosphate, and lactate levels on days 1, 3, and 7 were carried out and prospectively followed up, and the baseline serum phosphate levels were compared with the usual scores to predict the 28-day mortality.

Results:
CLIF-SOFA (accuracy 76-91%) followed by CLIF-C score (accuracy 73-84%) and AARC score (accuracy 70-85%) had the statistically significantly highest accuracy as compared with CTP, MELD, and MELD-Na on all three days. Serum phosphate values (accuracy 69-86%) on all three days were not better than the CLIF-SOFA score but better than all other prognostic scores on days 3 and 7.

Conclusions:
The high serum phosphate levels on day 3 with a value of more than 6.4 mg/dl showed almost comparable accuracy with CLIF-SOFA for screening short-term mortality. Hence serum phosphate measurement can be used as a simple bedside laboratory investigation to predict mortality in ACLF patients and early interventions in low-resource settings.

keywords:

ACLF, acute-on-chronic liver failure, serum phosphate, mortality
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