期刊
JOURNAL OF HEPATOLOGY
卷 76, 期 1, 页码 107-114出版社
ELSEVIER
DOI: 10.1016/j.jhep.2021.08.031
关键词
Liver; Cirrhosis; Acute-On-Chronic Liver Failure; Organ Failure; Mortality; L-FABP; Fatty Acid-Binding Proteins
资金
- Contratos Rio Hortega - Instituto de Salud Carlos III [CM19/00044]
- Award 'Emili Letang' - Hospital Clinic de Barcelona
- Ajut per a la Iniciacio a la Recerca - Societat Catalana de Digestologia
- Plan Nacional Investigacion cientifica, Desar-rollo e Innovacion Tecnologica (I+D+I) [PI16/00043, PI20/00579]
- Instituto Carlos III (ISCIII) -Subdireccion General de Evaluacion
- European Regional Development Fund
- Plan Nacional Investigacion cientifica, Desarrollo e Innovacion Tecnologica (I+D+I)
- European Regional Development Fund [PI18/00727, PI18/0862]
- Plan Nacional Investigacion cientifica, Desarrollo e Innovacion Tec-nologica (I+D+I)
- European H2020 Program
- LIV-ERHOPE PROJECT [731875]
This study found that in patients with decompensated cirrhosis, urinary L-FABP levels are independently associated with the 3-month clinical course and can predict mortality and ACLF development.
Background & Aims: Decompensated cirrhosis (DC) is associated with high mortality, mainly owing to the development of acute-on-chronic liver failure (ACLF). Identifying the patients with DC who are at high risk of mortality and ACLF development is an unmet clinical need. Liver fatty acid-binding protein (L-FABP) is expressed in several organs and correlates with liver and systemic inflammation. Herein, we aimed to assess the prognostic value of L-FABP in patients with DC. Methods: A prospective series of 444 patients hospitalized for DC was divided into 2 cohorts: study cohort (305 patients) and validation cohort (139 patients). L-FABP was measured in urine and plasma samples collected at admission. Neutrophil gelatinase-associated lipocalin (NGAL) was also measured in urine samples for comparison. Results: Urine but not plasma L-FABP correlated with 3-month survival on univariate analysis. On multivariate analysis, urine L-FABP and model for end-stage liver disease (MELD)-Na were the only independent predictors of prognosis. Urine L-FABP levels were higher in patients with ACLF than in those without and also predicted the development of ACLF, together with MELD-Na, during follow-up. In patients with ACLF, urine L-FABP correlated with liver, coagulation, and circulatory failure. Urine L-FABP levels were also increased in patients with acute kidney injury, particularly in those with acute tubular necrosis. The ability of urinary L-FABP to predict survival and ACLF development was confirmed in the validation cohort. Urine NGAL predicted outcome on univariate but not multivariate analysis. Conclusions: Urinary L-FABP levels are independently associated with the 3-month clinical course in patients with DC, in terms of mortality and ACLF development. Urinary L-FABP is a promising prognostic biomarker for patients with DC. Lay summary: Increased levels of liver fatty acid-binding protein (L-FABP), a protein related to lipid metabolism, have been associated with liver-related diseases. The present study analyzed urinary L-FABP levels in 2 independent groups of patients with decompensated cirrhosis and showed that higher urinary L-FABP levels correlated with increased mortality and risk of acute-on- chronic liver failure development. Therefore, urinary L-FABP levels could be useful as a new tool to predict complications in patients with decompensated cirrhosis. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.
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