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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
ARTICLE HIGHLIGHTS
Research background
Systemic inflammation is a hallmark of advanced cirrhosis. Calprotectin is a biomarker of neutrophil activity with high stability in biological fluids. Circulating levels of calprotectin may be an interesting biomarker of systemic inflammation in cirrhosis.
Research motivation
There is a need for inflammatory biomarkers for practical and objective use in cirrhosis. Serum calprotectin has gained relevance in recent years in several other diseases characterized by systemic inflammation.
Research objectives
To investigate factors associated with serum calprotectin levels in acute decompensation of cirrhosis, and to evaluate circulating calprotectin as a prognostic biomarker in patients with complications of cirrhosis.
Research methods
This is a prospective cohort study that included three study groups: 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was collected at hospital admission in the group with acute decompensation. Hospitalized patients were followed for 30 d for survival analysis
Research results
Higher calprotectin was associated with variables related to more advanced liver disease, acute-on-chronic liver failure (ACLF), and infection. Calprotectin was not associated with survival among patients with ACLF. In patients with acute decompensation without ACLF, higher calprotectin was inversely associated with 30-d survival. The combination of calprotectin with the CLIF-C AD score offered a better prognostic discrimination than the variables alone.
Research conclusions
Serum calprotectin are increased in liver cirrhosis and correlated with variables associated with the severity of liver disease. Higher circulating calprotectin is associated with a worse 30-d survival in those hospitalized for complications of cirrhosis without ACLF. The combination of serum calprotectin and CLIF-C AD score is able to better stratify the prognosis than any of the factors alone.
Research perspectives
The routine incorporation of the calprotectin test is a reality. Serum calprotectin may allow early identification of patients with a very low short-term survival, even in the absence of ACLF at admission. Larger, multicentric future studies are recommended to validate these results.
