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Urinary L-FABP is a promising prognostic biomarker of ACLF and mortality in patients with decompensated cirrhosis
- Source :
- Journal of Hepatology. 76:107-114
- Publication Year :
- 2022
- Publisher :
- Elsevier BV, 2022.
-
Abstract
- 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.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.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.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.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.
- Subjects :
- Male
medicine.medical_specialty
Cirrhosis
Urinary system
Kaplan-Meier Estimate
Urine
Fatty Acid-Binding Proteins
Gastroenterology
Statistics, Nonparametric
L-FABP
Internal medicine
medicine
Risk of mortality
Humans
Nonparametric
Prospective Studies
Mortality
Acute tubular necrosis
Aged
Proportional Hazards Models
Univariate analysis
Hepatology
business.industry
Acute-On-Chronic Liver Failure
Liver
Organ Failure
Biomarkers
Female
Middle Aged
Multivariate Analysis
Prognosis
Statistics
medicine.disease
Cohort
Biomarker (medicine)
lipids (amino acids, peptides, and proteins)
business
Subjects
Details
- ISSN :
- 01688278
- Volume :
- 76
- Database :
- OpenAIRE
- Journal :
- Journal of Hepatology
- Accession number :
- edsair.doi.dedup.....182d63f2d7e875f2924206a3db7599b1