Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2024; 30(9): 1177-1188
Published online Mar 7, 2024. doi: 10.3748/wjg.v30.i9.1177
sTREM-1 as promising prognostic biomarker for acute-on-chronic liver failure and mortality in patients with acute decompensation of cirrhosis
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
Song-Man Yu, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410000, Hunan Province, China
Hai Li, Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Guo-Hong Deng, Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
Xian-Bo Wang, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100020, China
Xin Zheng, Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430020, Hubei Province, China
Jin-Jun Chen, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Zhong-Ji Meng, Department of Infectious Disease, Taihe Hospital, Hubei University of Medicine, Shiyan 442009, Hubei Province, China
Yu-Bao Zheng, Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Yan-Hang Gao, Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Zhi-Ping Qian, Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai 200093, China
Feng Liu, Tianjin Institute of Hepatology, Nankai University Second People's Hospital, Tianjin 300192, China
Xiao-Bo Lu, Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Yu Shi, The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Provine, China
Jia Shang, Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou 463599, Henan Provine, China
Ruo-Chan Chen, Yan Huang, Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha 110051, Hunan Provine, China
Co-corresponding authors: Ruo-Chan Chen and Yan Huang.
Author contributions: The authors have all contributed to this manuscript and approved the version of this submission; Yu SM, Li H, Deng GH, Wang XB, Zheng X and Chen JJ contributed equally to this work. Yu SM contributed to Data collection, statistical analysis and original drafting of the manuscript; Li H, Deng GH, Wang XB, Zheng X and Chen JJ contributed to obtained administrative, technical, or material support; acquisition, analysis or interpretation of data; Meng ZJ, Zheng YB, Gao YH, Qian ZP, Liu F, Lu XB, Shi Y and Shang J contributed to acquisition of data. Chen RC contributed to supervision, reviewing and editing the draft for important intellectual content; Huang Y conceptualization, reviewing and editing the draft for important intellectual content; obtained funding and administrative, technical, or material support. Chen RC and Huang Y share the co-corresponding authors.
Supported by National Natural Science Foundation of China, No. 81970550, No. 82070613 and No. 82370638; Natural Science Foundation of Hunan Province, China, No. 2021JJ31067 and No. 2021JJ41048; Hunan innovative province construction project, No. 2023JJ10095; and Innovative Talented Project of Hunan province, China, No. 2022RC1212.
Institutional review board statement: The study design was approved by the Renji Hospital Ethics Committee of Shanghai Jiao tong University School of Medicine, No. (2014)148k.
Informed consent statement: All of the patients signed written informed consent before the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original datasets generated in the study are included in the article/supplementary material, and further inquiries can be directed to the corresponding author at drhyan@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Huang, PhD, Professor, Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Kaifu District, Changsha 110051, Hunan Provine, China. drhyan@csu.edu.cn
Received: November 29, 2023
Peer-review started: November 29, 2023
First decision: December 14, 2023
Revised: December 22, 2023
Accepted: January 30, 2024
Article in press: January 30, 2024
Published online: March 7, 2024
Processing time: 97 Days and 9.6 Hours
Abstract
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 mortality. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is released from activated innate immune cells and correlated with various inflammatory processes.

AIM

To explore the prognostic value of sTREM-1 in patients with AD of cirrhosis.

METHODS

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 admission. All enrolled patients were followed-up for at least 1 year.

RESULTS

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 scores. Additionally, sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d follow-up. The 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 development.

CONCLUSION

Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.

Keywords: Soluble triggering receptor expressed on myeloid cell-1; Acute decompensation; Cirrhosis; Acute-on-chronic liver failure; Prognostic biomarker

Core Tip: Acute decompensation (AD) of cirrhosis is associated with high short-term mortality, mainly due to development of acute-on-chronic liver failure (ACLF). serum Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is an independent risk factor for development of ACLF and mortality in patients with AD of cirrhosis. The new prognostic model of AD (P-AD) and the ACLF risk score (ACLF-R) were established and performed better than currently available prognostic models in predicting 1-year mortality and 28-d ACLF development in patients with AD of cirrhosis. Serum sTREM-1 Level, P-AD and ACLF-R score will facilitate clinical decision-making in the management of AD of cirrhosis.