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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2020; 26(1): 97-108
Published online Jan 7, 2020. doi: 10.3748/wjg.v26.i1.97
Usefulness of autotaxin for the complications of liver cirrhosis
Xue Shao, Haruki Uojima, Toru Setsu, Tomomi Okubo, Masanori Atsukawa, Yoshihiro Furuichi, Yoshitaka Arase, Hisashi Hidaka, Yoshiaki Tanaka, Takahide Nakazawa, Makoto Kako, Tatehiro Kagawa, Katsuhiko Iwakiri, Shuji Terai, Wasaburo Koizumi
Xue Shao, Haruki Uojima, Hisashi Hidaka, Yoshiaki Tanaka, Takahide Nakazawa, Wasaburo Koizumi, Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0375, Japan
Xue Shao, Department of Hepatopancreatobiliary Medicine, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Haruki Uojima, Makoto Kako, Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, Japan
Toru Setsu, Shuji Terai, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
Tomomi Okubo, Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
Masanori Atsukawa, Katsuhiko Iwakiri, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo 113-8603, Japan
Yoshihiro Furuichi, Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Shinjuku, Tokyo 113-8510, Japan
Yoshitaka Arase, Tatehiro Kagawa, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa 259-1193, Japan
Author contributions: Shao X, Uojima H, Setsu T, Okubo T, Atsukawa M, Furuichi Y, Arase Y, Hidaka H, Tanaka Y, Nakazawa T, Kako M, Kagawa T, Iwakiri K, Terai S and Koizumi W contributed equally to this work; Hidaka H, Shao X, Setsu T, Okubo T and Tanaka Y collected and analyzed the data; Uojima H drafted the manuscript; Hidaka H and Nakazawa T designed and supervised the study; Atsukawa M, Tanaka Y, Arase Y, Kagawa T, Iwakiri K and Koizumi W offered technical or material support. Kako M and Terai S were general supervising of the study group. All authors read and approved the final manuscript
Institutional review board statement: This study was approved by the Institutional Review Board Ethics Committee of the Tokushukai Medical Group, and the protocol for this study conforms to the provisions of the Declaration of Helsinki.
Informed consent statement: This study is a retrospective observational study. Informed consent was obtained from all individual participants included in the study by the opt-out method of our hospital website.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at kiruha@kitasato-u.ac.jp. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Haruki Uojima, MD, Doctor, Department of Gastroenterology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan.
kiruha@kitasato-u.ac.jp
Received: October 31, 2019
Peer-review started: October 31, 2019
First decision: November 22, 2019
Revised: December 4, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: January 7, 2020
Processing time: 67 Days and 21.5 Hours
BACKGROUND
Autotaxin (ATX) has been reported as a direct biomarker for estimating the evaluation of liver fibrosis. But available data on ATX as a useful biomarker for the complications of liver cirrhosis (LC) are scant.
AIM
To assess the clinical usefulness of ATX for assessing the complications of LC.
METHODS
This multicenter, retrospective study was conducted at six locations in Japan. We include patients with LC, n = 400. The ATX level was evaluated separately in men and women because of its high level in female patients. To assess the clinical usefulness of ATX for the complications of LC, the area under the curve (AUC) of ATX assessing for the severe complications was analyzed in comparison with the model for end-stage liver disease score, albumin-bilirubin (ALBI) score, fibrosis-4 index, and aspartate aminotransferase-to-platelet ratio index.
RESULTS
The mean age was 68.4 ± 11.4 years, 240 patients (60.0%) were male. A total of 213 (53.3%) and 187 (46.8%) patients were compensated and decompensated, respectively. The numbers of patients with varix rupture, hepatic ascites, and hepatic encephalopathy were 35 (8.8%), 131 (32.8%), and 103 (25.8%), respectively. The AUCs of ATX in men for hepatic encephalopathy, hepatic ascites, and varix ruptures were 0.853, 0.816, and 0.706, respectively. The AUCs of ATX in women for hepatic encephalopathy, hepatic ascites, and varix rupture were 0.759, 0.717, and 0.697, respectively. The AUCs of ATX in men were higher than those in women, as were all the other biomarkers used to detect encephalopathy and varix ruptures. However, for detecting ascites, the AUC of ALBI in men was more effective than using ATX.
CONCLUSION
ATX in men was more effective than any other biomarkers for detecting hepatic encephalopathy and varix ruptures.
Core tip: Autotaxin (ATX) has been reported as a novel biomarker for estimating liver fibrosis stages, and researchers have reported that this fibrosis marker correlated closely with more advanced fibrosis. Especially, the assessment for the complications of liver cirrhosis (LC) is valuable in helping to make treatment decisions. However, data on the clinical usefulness of novel fibrosis markers in assessing the complications of LC are scant. This study showed that ATX is a useful biomarker for assessing the complications of LC. Especially, the use of ATX in men was more effective than any other biomarker for detecting hepatic encephalopathy and varix ruptures.
