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sTREM-1 as promising prognostic biomarker for acute-on-chronic liver failure and mortality in patients with acute decompensation of cirrhosis

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World Journal of Gastroenterology 2024年第9期30卷 1177-1188页

作者： Song-Man Yu Hai Li Guo-Hong Deng Xian-Bo Wang Xin Zheng Jin-Jun Chen Zhong-Ji Meng Yu-Bao Zheng Yan-Hang Gao Zhi-Ping Qian Feng Liu Xiao-Bo Lu Yu Shi Jia Shang Ruo-Chan Chen Yan Huang Department of Infectious Diseases Xiangya HospitalCentral South UniversityChangsha 410000Hunan ProvinceChina Department of Gastroenterology Renji HospitalShanghai Jiao Tong University School of MedicineShanghai 200127China Department of Infectious Diseases Southwest HospitalThird Military Medical University(Army Medical University)Chongqing 400038China Center of Integrative Medicine Beijing Ditan HospitalCapital Medical UniversityBeijing 100020China Department of Infectious Diseases Institute of Infection and ImmunologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430020Hubei ProvinceChina Department of Infectious Diseases Nanfang HospitalSouthern Medical UniversityGuangzhou 510515Guangdong ProvinceChina Department of Infectious Disease Taihe HospitalHubei University of MedicineShiyan 442009Hubei ProvinceChina Department of Infectious Diseases The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510630Guangdong ProvinceChina Department of Hepatology The First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina Department of Liver Intensive Care Unit Shanghai Public Health Clinical CentreFudan UniversityShanghai 200093China Tianjin Institute of Hepatology Nankai University Second People's HospitalTianjin 300192China Infectious Disease Center The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054Xinjiang Uygur Autonomous RegionChina The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The First Affiliated Hospital of School of MedicineZhejiang UniversityHangzhou 310003Zhejiang ProvineChina Department of Infectious Diseases Henan Provincial People's HospitalZhengzhou 463599Henan ProvineChina Department of Infectious Diseases Hunan Key Laboratory of Viral HepatitisXiangya HospitalCentral South UniversityChangsha 110051Hunan ProvineChina

BACKGROUND acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accurate identification of AD patients with high risk of development of ACLF and *** triggering receptor expressed on myeloid cells-1(sTREM-1)is released from activated innate immune cells and correlated with various inflammatory *** To explore the prognostic value of sTREM-1 in patients with AD of *** A multicenter prospective cohort of 442 patients with cirrhosis hospitalized for AD was divided into a study cohort(n=309)and validation cohort(n=133).Demographic and clinical data were collected,and serum sTREM-1 was measured at *** enrolled patients were followed-up for at least 1 *** In patients with AD and cirrhosis,serum sTREM-1 was an independent prognosis predictor for 1-year survival and correlated with liver,coagulation,cerebral and kidney failure.A new prognostic model of AD(P-AD)incorporating sTREM-1,blood urea nitrogen(BUN),total bilirubin(TBil),international normalized ratio(INR)and hepatic encephalopathy grades was established and performed better than the model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-consortium(CLIF-C)ACLF and CLIF-C AD ***,sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d *** ACLF risk score incorporating serum sTREM-1,BUN,INR,TBil and aspartate aminotransferase levels was established and significantly superior to MELD,MELD-Na,CLIF-C ACLF,CLIF-C AD and P-AD in predicting risk of ACLF *** Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.

关键词： Soluble triggering receptor expressed on myeloid cell-1 acute decompensation Cirrhosis acute-on-chronic liver failure Prognostic biomarker

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Therapeutic possibilities of gut microbiota modulation in acute decompensation of liver cirrhosis

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World Journal of Hepatology 2023年第4期15卷 525-537页

作者： Dmitry Victorovich Garbuzenko Department of Faculty Surgery South Ural State Medical UniversityChelyabinsk 454080Russia

The formation of liver cirrhosis(LC) is an unfavorable event in the natural history of chronic liver diseases and with the development of portal hypertension and/or impaired liver function can cause a fatal outcome. decompensation of LC is considered the most important stratification variable for the risk of death. It is currently postulated that decompensation of LC occurs through an acute(including acute-on-chronic liver failure) and non-acute pathway. acute decompensation of LC is accompanied by the development of life-threatening complications, characterized by an unfavorable prognosis and high *** in understanding the underlying molecular mechanisms has led to the search for new interventions, drugs, and biological substances that can affect key links in the pathogenesis of acute decompensation in LC, for example the impaired gut-liver axis and associated systemic inflammation. Given that particular alterations in the composition and function of gut microbiota play a crucial role here, the study of the therapeutic possibilities of its modulation has emerged as one of the top concerns in modern hepatology. This review summarized the investigations that describe the theoretical foundations and therapeutic potential of gut microbiota modulation in acute decompensation of LC. Despite the encouraging preliminary data, the majority of the suggested strategies have only been tested in animal models or in preliminary clinical trials;additional multicenter randomized controlled trials must demonstrate their efficacy in larger patient populations.

关键词： Liver cirrhosis acute decompensation Pathogenesis Therapy Gut microbiota Modulation

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Fecal cytolysin does not predict disease severity in acutely decompensated cirrhosis and acute-on-chronic liver failure

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Hepatobiliary & Pancreatic Diseases International 2023年第5期22卷 474-481页

作者： Phillipp Hartmann Sonja Lang Robert Schierwagen Sabine Klein Michael Praktiknjo Jonel Trebicka Bernd Schnabl Department of Pediatrics University of California San DiegoLa JollaCAUSA Division of Gastroenterology Hepatology&NutritionRady Children’s Hospital San DiegoSan DiegoCAUSA Department of Medicine University of California San DiegoLa JollaCAUSA Department of Gastroenterology and Hepatology Faculty of MedicineUniversity of CologneUniversity Hospital CologneCologneGermany Department of Internal Medicine B University of MünsterMünsterGermany European Foundation for the Study of Chronic Liver Failure BarcelonaSpain Department of Medicine VA San Diego Healthcare SystemSan DiegoCAUSA

Background:Cirrhosis with acute decompensation(AD)and acute-on-chronic liver failure(ACLF)are characterized by high morbidity and ***,a toxin from Enterococcus faecalis(***),is associated with mortality in alcohol-associated hepatitis(AH).It is unclear whether cytolysin also contributes to disease severity in AD and ***:We studied the role of fecal cytolysin in 78 cirrhotic patients with AD/*** DNA from fecal samples was extracted and real-time quantitative polymerase chain reaction(PCR)was *** association between fecal cytolysin and liver disease severity in cirrhosis with AD or ACLF was ***:Fecal cytolysin and *** abundance did not predict chronic liver failure(CLIF-C)AD and ACLF *** of fecal cytolysin was not associated with other liver disease markers,including Fibrosis-4(FIB-4)index,‘Age,serum Bilirubin,INR,and serum Creatinine(ABIC)’score,Child-Pugh score,model for end-stage liver disease(MELD)nor MELD-Na scores in AD or ACLF ***:Fecal cytolysin does not predict disease severity in AD and ACLF *** predictive value of fecal cytolysin positivity for mortality appears to be restricted to AH.

关键词： Liver disease acute decompensation acute-on-chronic liver failure Microbiome Model for end-stage liver disease

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Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome

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World Journal of Gastroenterology 2014年第40期20卷 14934-14941页

作者： Radha K Dhiman Swastik Agrawal Tarana Gupta Ajay Duseja Yogesh Chawla Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh 160012 India

AIM: To compare the utility of the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) and Asia-Pacific Association for the Study of Liver (APASL) definitions of acute-on-chronic liver failure (ACLF)... 详细信息

关键词： Cirrhosis acute decompensation Mortality Prognosis acute on chronic liver failure

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Definition and classification of acute-on-chronic liver diseases

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World Journal of Clinical Cases 2022年第15期10卷 4717-4725页

作者： Yuan-Yao Zhang Zhong-Ji Meng Postgraduate Training Basement of Jinzhou Medical University Taihe HospitalHubei University of MedicineShiyan 442000Hubei ProvinceChina Institute of Biomedical Research Hubei Key Laboratory of Embryonic Stem Cell ResearchTaihe HospitalHubei University of MedicineShiyan 442000Hubei ProvinceChina Department of Infectious Diseases Hubei Clinical Research Center for Precise Diagnosis and Therapy of Liver CancerTaihe HospitalHubei University of MedicineShiyan 442000Hubei ProvinceChina

Patients with chronic liver diseases(CLDs)develop acute liver injury and/or acute decompensation under the attack of various precipitants and present with significantly elevated alanine aminotransferase and/or total bilirubin levels,liver failure,or acute decompensation of liver cirrhosis,which is called acute-on-CLD(AoCLD).AoCLD accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious *** is complicated by various clinical types,the severity of the disease,and may pose a high risk of *** date,the definition of AoCLD is still vague,and a consensus concept of the clinical classification is *** review aimed to define the concept and clinical types of AoCLD based on related studies and the literature.

关键词： Chronic liver disease acute-on-chronic liver disease acute liver injury acute decompensation acute-on-chronic liver failure

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Circulating insulin-like growth factor-binding protein 3 as prognostic biomarker in liver cirrhosis

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World Journal of Hepatology 2016年第17期8卷 739-748页

作者： Carina Gabriela Correa Bruno da Silveira Colombo Marcelo Fernando Ronsoni Pedro Eduardo Soares e Silva Leonardo Fayad Telma Erotides Silva Letícia Muraro Wildner Maria Luiza Bazzo Esther Buzaglo Dantas-Correa Janaína Luz Narciso-Schiavon Leonardo de Lucca Schiavon Division of Gastroenterology Federal University of Santa Catarina Department of Clinical Analysis Federal University of Santa Catarina

AIM: To investigate the prognostic significance of insulin-like growth factor-binding protein 3(IGFBP-3) in patients with ***: Prospective study that included two cohorts: outpatients with stable cirrhosis(n = 138) and patients hospitalized for acute decompensation(n = 189). Development of complications, mortality or liver transplantation was assessed by periodical phone calls and during outpatient visits. The cohort of stable cirrhosis also underwent clinical and laboratory evaluation yearly(2013 and 2014) in predefined study visits. In patients with stable cirrhosis, IGFBP-3 levels were measured at baseline(2012) and at second re-evaluation(2014). In hospitalized subjects, IGFBP-3 levels were measured in serum samples collected in the first and in the third day after admission and stored at-80 ℃. IGFBP-3 levels were measured by ***: IGFBP-3 levels were lower in hospitalized patients as compared to outpatients(0.94 mcg/mL vs 1.69 mcg/m L, P < 0.001) and increased after liver transplantation(3.81 mcg/m L vs 1.33 mcg/mL, P = 0.008). During the follow-up of the stable cohort, 17 patients died and 11 received liver transplantation. Bivariate analysis showed that death or transplant was associated with lower IGFBP-3 levels(1.44 mcg/mL vs 1.74 mcg/m L, P = 0.027). The Kaplan-Meier transplant-free survival probability was 88.6% in patients with IGFBP-3 ≥ 1.67 mcg/mL and 72.1% for those with IGFBP3 < 1.67 mcg/mL(P = 0.015). In the hospitalized cohort, 30-d mortality was 24.3% and was independently associated with creatinine, INR, SpO_2/FiO_2 ratio and IGFBP-3 levels in the logistic regression. The 90-d transplant-free survival probability was 80.4% in patients with IGFBP-3 ≥ 0.86 mcg/mL and 56.1% for those with IGFBP3 < 0.86 mcg/mL(P < 0.001). CONCLUSION: Lower IGFBP-3 levels were associated with worse outcomes in patients with cirrhosis, and might represent a promising prognostic tool that can be incorporated in clinical practice.

关键词： Liver cirrhosis acute decompensation Insulin-like growth factor binding protein 3 acute-onchronic liver failure Prognosis

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