A Study Of Relationship Between The Level Of Vitamin D-binding Protein In The Peripheral Blood And Curative Effect Or Prognosis In Patient With Liver Failure

[Objective]Liver failure is a severe hepatopathy syndrome it primarily involves the liver but often leads to Multiple Organ Dysfunction, including the lungs, the kidneys, the circulatory system, and the central nervous system with hepatic encephalopathy. Early identification of patients at risk of dying is essential to decision of choosing treatment program, but up to now, reliable indicators of outcome in liver failure are still not available. VDBP is a multifunction globulin that is synthesized in the liver and abundant in the organism. The most important function is to clear actin from the extracellular space, released from dying or dead liver cells, and endotoxin in peripheral blood. In pathological conditions with widespread cell necrosis, the extracellular actin scavenger system may be exhausted, and free actin-polymers may cause microthrombi in capillaries and arterioles . There was no investigation to the relation of VDBP level to turnover of liver failure who accepted artificial liver support System therapy, the purpose of the present study was to evaluate the predictive value of VDBP levels in 54 patients with liver failure, and to observe dynamically the level of vitamin D-binding protein (VDBP) in the peripheral blood in patients with liver failure received artificial liver support system and/or medical treatment and to investigate the relationship between the level of VDBP and curative effect and prognosis.[Methods]1. Study PopulationFifty-four patients with liver failure, 23 patients accepted artificial liver support system treatment (ALSS group) and 31 patients accepted medical treatment group (medical group), were divided into 4 groups according to the treatment protocol and indicators such as liver function and clinical symptoms etc, there were 12 effective cases and 11 ineffective cases in the ALSS group while 16 effective cases and 15 ineffective cases in the medical group. At the same time, 30 healthy volunteer serum were collected as normal group and the level of VDBP and other indexes in the peripheral blood was measured.2. VDBP AnalysisIn this study, the total VDBP level in serum was determined using a new, rapid ELISA method.3. Data AnalysisAll the patients were assessed and scored according to the MELD score system, and to compare the VDBP level with scores. Pretherapy VDBP levels in 54 patients with liver failure were determined to evaluate their predictive values in relation to improve and unfavourable turnover. By using a receiver operating characteristic curve analysis show cut-off level provide the best discrimination between improve patients and unfavourable turnover patients, then evaluation the prognosis efficiency. The relationship between the level of VDBP and curative was analyzed accordingly.[Results]1. The level of VDBP was significantly lower in the group of patients with liver failure compared to the group of healthy volunteers, with significant difference between the two groups (P < 0.001). There was significant difference among group A (5≤MELD score < 15),group B (15≤MELD score < 25),group C (25≤MELD score < 35) and group of healthy volunteer (P=0.001) .There was no significant difference between group A and group of healthy volunteer (P > 0.05). But contrasting to the group of healthy volunteer ,the level of VDBP in peripheral blood were lower, in patients of group B (P < 0.001) and group C (P < 0.001), and the differences were significant (P < 0.050). 2. There was no significant correlation between pretherapy level of VDBP with other indexes (Alb,ALT,AST,TB,TBA,CHE) in the peripheral blood (r<0.5) .3. To contrast the level of VDBP in the peripheral blood in the normal control group, for those effective groups, there was no significant difference (P > 0.050). It was no statistically significant and statistically significant for ALSS group and medical group respectively when both compared to the normal control group(P > 0.050) , and there was also no significant difference between ALSS group and medical group(P > 0.050)..4. After treatment, the VDBP in the effective groups was 567±268. 5mg/L, it showed significant difference before and after the treatment (P < 0.050) . There was no statistical significant was found when compared effective group with the normal control group (P > 0.050), and no significant difference between ALSS group with medical group (P > 0.050) .5. As to the ineffective groups, the VDBP level was lower before treatment compared to the normal control (P < 0.050) . There was no significant difference between ineffective ALSS group and ineffective medical group (P > 0.050) . The differences were statistical significant when ALSS group and medical group compared to the normal control group respectively (P< 0.050) .6. After treatment, the VDBP level in the ineffective groups is lower than normal control group (P < 0.050) , contrast to the VDBP level before treatment, there was no significant difference (P > 0.050) . There were no significant difference before and after the treatment in ineffective ALSS group and ineffective medical group (P > 0.050) .7. The change of VDBP level appears to be "rise" curve in the effective groups and the trend seems more obviously in the medical group compared to the ALSS group. In the ineffective treatment groups, the VDBP level is always below to the normal level, although the concentration of VDBP will improve after treatment in medical group, it is difficult to sustain in long period. As to the medical treatment group, the VDBP level appeared no change in very low level.8. Using a cut-off level of admission serum VDBP of 215mg/L, the Positive Predict Value (PPV) and Negative Predict Value (NPV) was 87.0% and 80.6% respectively; Youden' s index was 0.662; Positive Likelihood Ratio(LR+) and Negative Likelihood Ratio(LR-) was 7.179 and 0.258 respectively. [Conclusion]1. An advantage of VDBP is that it gives an estimate of the outcome already on admission, because of its correlation with turnover of patients with live failure.2. VDBP has the best efficiency of prognosis, when take 215mg/L as cut-off value to judge the turnover of patients with liver failure.3. The level of VDBP was correlated with the curative effect and it may be used as a potential indicator for curative effect in patients with liver failure.