Cardiac and proinflammatory markers predict prognosis in cirrhosis

Liver International - Tập 34 Số 6 - 2014
Signe Wiese1,2, Christian Mortensen3,2, Jens Peter Gøtze4, Erik Christensen5, Ove Andersen6, Flemming Bendtsen3,2, Søren Møller1,3
1Department of Clinical Physiology and Nuclear Medicine, Center of Functional and Diagnostic Imaging and Research, Copenhagen, Denmark
2Gastro Unit, Medical Department, Hvidovre Hospital, Hvidovre, Denmark
3Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
4Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
5Department of Medicine I, Bispebjerg Hospital, Copenhagen, Denmark
6Clinical Research Centre, Hvidovre Hospital, Copenhagen, Denmark

Tóm tắt

AbstractBackground & AimsInflammation and cardiac dysfunction plays an important role in the development of complications leading to increased mortality in patients with cirrhosis. Novel cardiac markers such as prohormone of ANP (proANP), copeptin and high‐sensitivity troponin T (hs‐TnT) and proinflammatory markers including soluble urokinase‐type plasminogen activator receptor (suPAR) and high‐sensitive C‐reactive protein (hs‐CRP) are related to these complications. We aimed to investigate if cardiac and proinflammatory markers are related to severity of liver disease, cardiac and haemodynamic changes, and long‐term survival.MethodsOne hundred and ninety‐three stable cirrhotic patients (Child class: A = 46; B = 97; C = 50) had a full haemodynamic investigation performed with measurement of splanchnic and systemic haemodynamics and measurement of circulating levels of proBNP, proANP, copeptin, hs‐TnT, LBP, IL 6, IL 8, IP 10, VEGF, hs‐CRP and suPAR.ResultsSoluble urokinase‐type plasminogen activator receptor soluble urokinase‐type plasminogen activator receptor, hs‐CRP, and hs‐TnT were significantly different throughout the Child classes (P < 0.01; P < 0.01; P < 0.02). All markers except copeptin correlated with indicators of disease severity in cirrhosis; ProANP and suPAR correlated with hepatic venous pressure gradient (r = 0.24 and r = 0.34; P < 0.001) and systemic vascular resistance (r = −0.24 and r = −0.33; P < 0.001). Cardiac (proANP, hs‐TnT; P < 0.01) and proinflammatory (hs‐CRP, suPAR; P < 0.05) markers were associated with mortality in a univariate Cox analysis, however, the strongest predictors of mortality in a multivariate Cox analysis were hs‐TnT, ascites and hepatic venous pressure gradient (reg.coeff.: 0.34, P < 0.001; 0.16, P < 0.001; 0.06, P = 0.04).ConclusionMarkers of cardiac dysfunction and inflammation are significantly associated with disease severity, degree of portal hypertension and survival in cirrhosis. In particular, hs‐TnT and suPAR seem to contain prognostic information.

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Liver International

Tập 34 Số 6

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