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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis
Camila Matiollo, Elayne Cristina de Morais Rateke, Emerita Quintina de Andrade Moura, Michelle Andrigueti, Fernanda Cristina de Augustinho, Tamara Liana Zocche, Telma Erotides Silva, Lenyta Oliveira Gomes, Mareni Rocha Farias, Janaina Luz Narciso-Schiavon, Leonardo Lucca Schiavon
Camila Matiollo, Elayne Cristina de Morais Rateke, Emerita Quintina de Andrade Moura, Michelle Andrigueti, Clinical Analysis Laboratory Unit, University Hospital, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
Fernanda Cristina de Augustinho, Tamara Liana Zocche, Telma Erotides Silva, Division of Gastroenterology, University Hospital, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
Lenyta Oliveira Gomes, Mareni Rocha Farias, Department of Pharmaceutical Sciences Health Sciences Center, Federal University of Santa Catarina, Florianópolis 88040-370, Brazil
Janaina Luz Narciso-Schiavon, Leonardo Lucca Schiavon, Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil
Author contributions: Schiavon LL and Narciso-Schiavon JL designed the research; Rateke ECM and Matiollo C contributed to sample handling and general laboratory analysis; De Augustinho FC, Zocche TL, Silva TE, Macalli C, and Narciso-Schiavon JL collected the clinical data; Moura EQA Andrigueti M, Gomes LO, and Farias MR contributed to specific laboratory analysis; Schiavon LL and Matiollo C analyzed the data and wrote the paper; Farias MR and Narciso-Schiavon JL reviewed the manuscript.
Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico.
Institutional review board statement: The study protocol complies with the ethical principles of the Declaration of Helsinki and was approved by the Ethics Committee on Human Research of the Federal University of Santa Catarina.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest regarding this manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author upon request at
leo-jf@uol.com.br. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Leonardo Lucca Schiavon, PhD, Associate Professor, Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Brazil.
leo-jf@uol.com.br
Received: October 2, 2022
Peer-review started: October 2, 2022
First decision: October 11, 2022
Revised: October 18, 2022
Accepted: November 2, 2022
Article in press: November 2, 2022
Published online: November 27, 2022
Processing time: 52 Days and 16.8 Hours
BACKGROUND
Acute decompensation (AD) of cirrhosis is related to systemic inflammation and elevated circulating cytokines. In this context, biomarkers of inflammation, such as calprotectin, may be of prognostic value.
AIM
To evaluate serum calprotectin levels in patients hospitalized for complications of cirrhosis.
METHODS
This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was measured by enzyme-linked immunosorbant assay.
RESULTS
Calprotectin levels were higher among groups with cirrhosis when compared to healthy controls. Higher median calprotectin was related to Child-Pugh C, ascites, and hepatic encephalopathy. Higher calprotectin was related to acute-on-chronic liver failure (ACLF) and infection in the bivariate, but not in multivariate analysis. Calprotectin was not associated with survival among patients with ACLF; however, in patients with AD without ACLF, higher calprotectin was associated with a lower 30-d survival, even after adjustment for chronic liver failure-consortium (CLIF-C) AD score. A high-risk group (CLIF-C AD score ≥ 60 and calprotectin ≥ 580 ng/mL) was identified, which had a 30-d survival (27.3%) similar to that of patients with grade 3 ACLF (23.3%).
CONCLUSION
Serum calprotectin is associated with prognosis in patients with AD without ACLF and may be useful in clinical practice to early identify patients with a very low short-term survival.
Core Tip: Acute decompensation (AD) of cirrhosis is associated with systemic inflammation and increased circulating cytokines. In this context, inflammatory markers, such as calprotectin, may be of prognostic value. This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was associated with prognosis in patients with AD without acute-on-chronic liver failure and may be useful in clinical practice to early identify patients with a very low short-term survival.
