A22 LIVER TYPE FATTY ACID BINDING PROTEIN (FABP1) LEVELS IMPROVE PERFORMANCE OF PROGNOSTIC MODELS IN ACETAMINOPHEN INDUCED ACUTE LIVER FAILURE

Abstract Background Acetaminophen (APAP) - induced acute liver failure (ALF) is associated with significant mortality. To date, traditional prognostic scores (King’s College Criteria ~ KCC; Acute Liver Failure Study Group (ALFSG) prognostic index) lack discrimination in identifying patients with APAP-ALF who will die without liver transplant (LT), and those who will survive with medical management alone. Liver-type fatty acid binding protein (FABP1) is a 15 kDa cytoplasmic protein abundantly expressed in hepatocytes with potential prognostic value in APAP-ALF patients. Aims Our aims were to a) Determine if elevated serum levels of FABP1 in APAP-ALF are significantly associated with 21-day mortality after adjusting for other significant covariates. b) Determine if the addition of FABP1 improves the performance of previously described prognostic models in APAP-ALF (KCC, ALFSG prognostic index). Methods With serial serum samples (early; day 1 or late; day 3–5) from 198 APAP-ALF patients (99 survivors, 99 non-survivors), FABP1 was measured using solid-phase enzyme-linked immunosorbent assay. No patients in this analysis received LT. With clinical data from the prospectively collected ALFSG registry, model performance (early and late) for KCC, ALFSG index, FABP1, FABP1+KCC, and FABP1+ALFSG index were assessed using AUROC statistics. Comparisons of AUROC statistics between models (e.g. KCC vs. FABP1 + KCC) were made using the Delong method. Results APAP-ALF survivors had significantly lower serum FABP1 levels early (238.6 vs. 690.8 ng/ml, p