Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1394
Peer-review started: February 28, 2021
First decision: May 2, 2021
Revised: May 12, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: October 27, 2021
Processing time: 235 Days and 17 Hours
Increased gut permeability and bacterial translocation play an important role in liver cirrhosis. Zonulin is a recently recognized protein involved in the disintegration of the intestinal barrier.
To investigate possible differences in serum zonulin levels among patients with different cirrhosis stages and their potential prognostic implications.
Consecutive cirrhotic patients who attended our liver clinic were included in the study. Serum zonulin levels, clinical, radiological and biochemical data were collected at baseline. Patients who accepted participation in a regular surveillance program were followed-up for at least 12 mo.
We enrolled 116 cirrhotics [mean Child-Turcotte-Pugh (CTP) score: 6.2 ± 1.6; model for end-stage liver disease score: 11 ± 3.9]. The causes of cirrhosis were viral hepatitis (39%), alcohol (30%), non-alcoholic fatty liver disease (17%), and other (14%). At baseline, 53% had decompensated cirrhosis, 48% had ascites, and 32% had history of hepatic encephalopathy. Mean zonulin levels were significantly higher in patients with CTP-B class than CTP-A class (4.2 ± 2.4 ng/dL vs 3.5 ± 0.9 ng/dL, P = 0.038), with than without ascites (P = 0.006), and with than without history of encephalopathy (P = 0.011). Baseline serum zonulin levels were independently associated with the probability of decompensation at 1 year (P = 0.039), with an area under the receiving operating characteristic of 0.723 for predicting hepatic decompensation. Higher CTP score (P = 0.021) and portal vein diameter (P = 0.022) were independent predictors of mortality.
Serum zonulin levels are higher in patients with more advanced chronic liver disease and have significant prognostic value in identifying patients who will develop decompensation.
Core Tip: Zonulin is a protein that appears to play a significant role in gut barrier integrity. Increased zonulin levels and deregulation of intestinal permeability have been demonstrated in patients suffering from celiac disease or type 2 diabetes. However, the role of zonulin as a promoting factor of intestinal barrier disruption in patients with liver cirrhosis has not been studiedadequately. We evaluated serum zonulin levels in patients with different stages of advanced liver disease. According to our findings, serum zonulin levels are increased in patients with more advanced liver disease and are independently associated with progression to decompensation.