Interleukin-1 receptor antagonist correlates with hepatic venous pressure gradient and predicts occurrence of overall complications and bacterial infections in patients with cirrhosis

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

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.

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.

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).

CONCLUSION

Novel biomarkers, including IL-6, uNGAL and copeptin, can probably improve prognostication of patients with decompensated cirrhosis compared with MELD alone.

Inflammation and autonomic balance in cirrhosis: Association between sympathetic nervous system and osteopontin, interleukin‐22, interleukin‐6 and interleukin‐1Ra concentrations according to portal hypertension and disease severity

Background

The autonomic nervous system is linked to hyperdynamic circulation in cirrhosis and several studies have highlighted the crucial role that systemic inflammation elicits in altering sympathovagal equilibrium with the consequent reduction in heart rate variability (HRV).

To investigate the correlation between time‐domain HRV parameters, serum cytokines concentrations and portal hypertension, we studied a cohort of patients with cirrhosis, accounting for etiology and treatments.

Methods

In this cross‐sectional, observational cohort study, 107 outpatients with non‐alcoholic cirrhosis were assessed consecutively by abdominal ultrasound and by upper gastrointestinal endoscopy to search for esophagogastric varices. 24‐h electrocardiogram Holter monitoring with time‐domain HRV measurement (square root of the mean of successive differences of Normal‐to‐Normal [NN] [RMSSD], standard deviation or the square root of variance [SDNN] and standard deviation of the means of the NN intervals calculated over a 5‐min period [SDANN]) was performed and serum concentrations of osteopontin (OPN), interleukin (IL)‐22, IL‐6, IL‐1Ra and IL‐17 were obtained in all patients.

Results

IL‐6, OPN, IL‐22 and IL‐1Ra concentrations in cirrhotic patients were associated with disease severity expressed by Child‐Pugh and MELD score, to some portal hypertension's indirect signs and some of its complications. A significant increase in systemic concentrations of OPN in patients with hepatocellular carcinoma was encountered. SDANN and SDNN values were indirectly related to serum levels of IL‐6, OPN, IL‐1Ra and IL‐22.

Conclusions

This study underlines the interaction between the alteration of the ANS and the activation of inflammatory pathways that characterize cirrhosis taking into account clinical characteristics and treatments.

Mac-2 binding protein glycosylation isomer is a potential biomarker to predict portal hypertension and bacterial infection in cirrhotic patients

Objectives

Mac-2-binding protein glycosylation isomer (M2BPGi) is a novel plasma biomarker for liver fibrosis, but less is known about its role in portal hypertension. We aimed to evaluate the association between M2BPGi and hepatic venous pressure gradient (HVPG) and to investigate its predictive value on prognosis of cirrhotic patients.

Methods

Forty-eight cirrhotic patients who underwent HVPG measurement in Taipei Veterans General hospital were retrospectively enrolled. The Spearman’s correlation test was used to analyze the correlation between plasma M2BPGi levels and HVPG and other parameters. Cox proportional hazards regression models were used to identify predictors for clinical outcomes.

Results

Plasma M2BPGi levels were higher in cirrhotic patients than healthy subjects and significantly correlated with HVPG levels (r_s = 0.45, p = 0.001). On multivariate Cox regression analysis, higher plasma M2BPGi levels [≥ 6 cut-off index (C.O.I)] did not predict mortality within five years for cirrhotic patients and the result was similar in patients without hepatocellular carcinoma. Interestingly, M2BPGi ≥ 6 C.O.I was a potential predictor of bacterial infection within five years [Hazar ratio (HR) = 4.51, p = 0.003]. However, M2BPGi failed to predict occurrence of other cirrhosis-related complications, including variceal bleeding, ascites formation, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatic encephalopathy.

Conclusion

Plasma M2BPGi levels positively correlated with HVPG and higher serum M2BPGi levels might have a potential role in predicting development of bacterial infection for cirrhotic patients with portal hypertension.

Short-term effect of carvedilol vs propranolol in reduction of hepatic venous pressure gradient in patients with cirrhotic portal hypertension

AIM: To compare the short-term effect of carvedilol and propranolol in the reduction of hepatic venous pressure gradient (HVPG) in patients with cirrhotic portal hypertension.

METHODS: Ninety-six patients with cirrhotic portal hypertension were randomly divided into either an experiment group or a control group. The experiment group was treated with carvedilol, and the control group was treated with propranolol. The levels of wedged hepatic venous pressure (WHVP), free hepatic venous pressure (FHVP), HVPG, mean arterial pressure (MAP), heart rate (HR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), serum creatinine (SCr), blood urea nitrogen (BUN) and adverse drug reactions were compared between the two groups.

RESULTS: The levels of WHVP, HVPG, MAP and HR in the experiment group were significantly lower after treatment than prior treatment (16.26 mmHg ± 5.28 mmHg vs 18.42 mmHg ± 6.83 mmHg, 10.01 mmHg ± 3.77 mmHg vs 13.42 mmHg ± 5.68 mmHg, 85.58 mmHg ± 10.42 mmHg vs 95.16 mmHg ± 12.03 mmHg, 62.99/min ± 5.24/min vs 75.39/min ± 7.78/min, P < 0.05). The levels of HVPG, MAP and HR in the control group were significantly lower after treatment than prior treatment (12.03 mmHg ± 4.63 mmHg vs 13.54 mmHg ± 5.78 mmHg, 89.52 mmHg ± 12.55 mmHg vs 95.29 mmHg ± 13.25 mmHg, 61.08/min ± 7.66/min vs 73.98/min ± 6.46/min, P < 0.05). There was no significant difference in the percentage of HVPG responders between the two groups (56.25% vs 41.67%, P > 0.05). The decreases in HVPG and MAP in the experiment group were more significant than those in the control group (28.30% ± 22.19% vs 12.38% ± 24.09%, 10.67% ± 6.77% vs 6.06% ± 5.79%, P < 0.05). The levels of SCr in the control group were significantly lower post treatment than prior treatment (70.82 mg/d ± 11.60 mg/d vs 76.57 mg/d ± 15.22 mg/d, P < 0.05). There were no significant differences for the experiment group in the levels of liver and kidney function indicators (36.79 IU/L ± 19.62 IU/L vs 48.84 IU/L ± 31.66 IU/L, 44.55 IU/L ± 21.41 IU/L vs 46.42 IU/L ± 24.81 IU/L, 26.56 μmol/L ± 16.43 μmol/L vs 25.94 μmol/L ± 18.30 μmol/L, 74.97 mg/d ± 15.33 mg/d vs 75.71 mg/d ± 12.33 mg/d, 5.02 mg/d ± 2.47 mg/d vs 5.26 mg/d ± 1.69 mg/d, P > 0.05). No obvious adverse reactions or exacerbation occurred.

CONCLUSION: Both carvedilol and propranolol have good clinical effects in patients with cirrhotic portal hypertension in terms of reduction of HVPG, reducing the risk of esophagogastric varices bleeding, no obvious effects on liver and kidney function, and no adverse reactions, and carvedilol has better clinical effects.