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In the United States, acute liver failure (ALF) affects an estimated 2,000 people per year and accounts for 6% of all liver transplants. Without transplantation, however, less than 50% of patients survive with medical management alone. Early identification of patients with survivable AFL is important to guiding their management and early referral to transplantation.

Studies have shown that the current prognostic scoring systems used for FHF, including the King’s College Criteria (KCC) and the Model for End- Stage Liver Disease (MELD), have poor sensitivity and negative predictive value for predicting outcome, highlighting a need for more accurate predictive models.

Ki-67 is a well-established marker of cellular proliferation but its expression in FHF as a surrogate marker of liver regeneration has not been studied as a tool to predict outcome in these patients.

In this pilot study, we sought to determine the predictive value of Ki-67 expression in patients with FHF and its potential for improving the accuracy of current predictive models.