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Novel prognostic biomarkers in decompensated cirrhosis: a systematic review and meta-analysis.

Authors :
Juanola A
Ma AT
de Wit K
Gananandan K
Roux O
Zaccherini G
Jiménez C
Tonon M
Solé C
Villaseca C
Uschner FE
Graupera I
Pose E
Moreta MJ
Campion D
Beuers U
Mookerjee RP
Francoz C
Durand F
Vargas V
Piano S
Alonso S
Trebicka J
Laleman W
Asrani SK
Soriano G
Alessandria C
Serra-Burriel M
Morales-Ruiz M
Torres F
Allegretti AS
Krag A
Caraceni P
Watson H
Abraldes JG
Solà E
Kamath PS
Hernaez R
Ginès P
Source :
Gut [Gut] 2023 Dec 07; Vol. 73 (1), pp. 156-165. Date of Electronic Publication: 2023 Dec 07.
Publication Year :
2023

Abstract

Background: Patients with decompensated cirrhosis experience high mortality rates. Current prognostic scores, including the model for end-stage liver disease (MELD), may underperform in settings other than in those they were initially developed. Novel biomarkers have been proposed to improve prognostication accuracy and even to predict development of complications.<br />Methods: We performed a systematic review and meta-analysis on novel urine and blood biomarkers and their ability to predict 90-day mortality in patients with decompensated cirrhosis. Secondary outcomes included 28-day and 1-year mortality, and development of acute-on-chronic liver failure, acute kidney injury and other complications. To overcome differences in units, temporal changes in assays and reporting heterogeneity, we used the ratio of means (RoM) as measure of association for assessing strength in predicting outcomes. An RoM>1 implies that the mean biomarker level is higher in those that develop the outcome than in those that do not.<br />Results: Of 6629 unique references, 103 were included, reporting on 29 different biomarkers, with a total of 31 362 biomarker patients. Most studies were prospective cohorts of hospitalised patients (median Child-Pugh-Turcotte score of 9 and MELD score of 18). The pooled 90-day mortality rate was 0.27 (95% CI 0.24 to 0.29). The RoM for predicting 90-day mortality was highest for interleukin 6 (IL-6) (2.56, 95% CI 2.39 to 2.74), followed by urinary neutrophil gelatinase-associated lipocalin (uNGAL) (2.42, 95% CI 2.20 to 2.66) and copeptin (2.33, 95% CI 2.17 to 2.50). These RoMs were all higher than for MELD (1.44, 95% CI 1.42 to 1.46).<br />Conclusion: Novel biomarkers, including IL-6, uNGAL and copeptin, can probably improve prognostication of patients with decompensated cirrhosis compared with MELD alone.<br />Competing Interests: Competing interests: FD consults for Biotest. VV consults for Promethera and is on the speakers bureau for Intercept. SP advises Mallinckrodt. HW is employed by Evotec and owns stock in Sanofi. PG consults for and received grants from Gilead, Grifols and Mallinckrodt, and consults for Novartis, Martin and Ferring. JT has received speaking and/or consulting fees from Versantis, Gore, Boehringer-Ingelheim, Falk, Grifols, Genfit and CSL Behring. RH is part of the Editorial Board of the Gut journal.<br /> (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Details

Language :
English
ISSN :
1468-3288
Volume :
73
Issue :
1
Database :
MEDLINE
Journal :
Gut
Publication Type :
Academic Journal
Accession number :
37884354
Full Text :
https://doi.org/10.1136/gutjnl-2023-329923