Serial monitoring of serum alpha-fetoprotein (AFP) can give insights into the prognosis of a patient with acute liver failure (ALF). Production of AFP correlates with liver regeneration.
Patient selection: acute liver failure
Measurement: serial levels from admission, daily or every-other-day for 5 to 7 days
If the serum AFP concentrations show an upward trend, then the better the survival and lower the risk of requiring a liver transplant.
If the serum AFP concentration is decreasing, then the prognosis is worse and the need for liver transplantation increases.
Other factors associated with a worse prognosis:
(1) older age
(2) rising serum total bilirubin (with increasing jaundice)
(3) higher INR
Differential diagnosis:
(1) elevated serum alpha-fetoprotein concentrations associated with hepatocellular carcinoma
(2) elevated serum alpha-fetoprotein concentrations associated with pregnancy
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