Graupera Isabel, Solà Elsa, Fabrellas Núria, Moreira Rebeca, Solé Cristina, Huelin Patricia, de la Prada Gloria, Pose Elisa, Ariza Xavier, Risso Alessandro, Albertos Sonia, Morales-Ruiz Manuel, Jiménez Wladimiro, Ginès Pere
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
PLoS One. 2016 Jun 30;11(6):e0157371. doi: 10.1371/journal.pone.0157371. eCollection 2016.
MCP-1 (monocyte chemoattractant protein-1) is a proinflammatory cytokine involved in chemotaxis of monocytes. In several diseases, such as acute coronary syndromes and heart failure, elevated MCP-1 levels have been associated with poor outcomes. Little is known about MCP-1 in cirrhosis.
To investigate the relationship between MCP-1 and outcome in decompensated cirrhosis.
Prospective study of 218 patients discharged from hospital after an admission for complications of cirrhosis. Urine and plasma levels of MCP-1 and other urine proinflammatroy biomarkers: osteopontin(OPN), trefoil-factor3 and liver-fatty-acid-binding protein were measured at admission. Urine non-inflammatory mediators cystatin-C, β2microglobulin and albumin were measured as control biomarkers. The relationship between these biomarkers and the 3-month hospital readmission, complications of cirrhosis, and mortality were assessed.
69 patients(32%) had at least one readmission during the 3-month period of follow-up and 30 patients died(14%). Urine MCP-1 and OPN levels, were associated with 3-month probability of readmission (0.85 (0.27-2.1) and 2003 (705-4586) ug/g creat vs 0.47 (0.2-1.1) and 1188 (512-2958) ug/g creat, in patients with and without readmission, respectively; p<0.05; median (IQR)). Furthermore, urine levels of MCP-1 were significantly associated with mortality (1.01 (1-3.6) vs 0.5 (0.2-1.1) μg/g creat, in dead and alive patients at 3 months; p<0.05). Patients with higher levels of urine MCP-1 (above percentile 75th) had higher probability of development of hepatic encephalopathy, bacterial infections or AKI. Urine MCP-1 was an independent predictive factor of hospital readmission and combined end-point of readmission or dead at 3 months. Plasma levels of MCP-1 did not correlated with outcomes.
Urine, but not plasma, MCP-1 levels are associated with hospital readmission, development of complications of cirrhosis, and mortality. These results suggest that in cirrhosis there is an inflammatory response that is associated with poor outcomes.
单核细胞趋化蛋白-1（MCP-1）是一种参与单核细胞趋化作用的促炎细胞因子。在急性冠脉综合征和心力衰竭等多种疾病中，MCP-1水平升高与不良预后相关。关于肝硬化中MCP-1的情况知之甚少。
探讨MCP-1与失代偿期肝硬化预后的关系。
对218例因肝硬化并发症入院后出院的患者进行前瞻性研究。入院时检测尿和血浆中MCP-1以及其他尿促炎生物标志物：骨桥蛋白（OPN）、三叶因子3和肝脂肪酸结合蛋白的水平。检测尿非炎症介质胱抑素-C、β2微球蛋白和白蛋白作为对照生物标志物。评估这些生物标志物与3个月内再次入院、肝硬化并发症及死亡率之间的关系。
69例患者（32%）在3个月的随访期内至少有一次再次入院，30例患者死亡（14%）。尿MCP-1和OPN水平与3个月内再次入院的概率相关（再次入院患者与未再次入院患者分别为0.85（0.27 - 2.1）和2003（705 - 4586）μg/g肌酐 vs 0.47（0.2 - 1.1）和1188（512 - 2958）μg/g肌酐；p<0.05；中位数（四分位间距））。此外，尿MCP-1水平与死亡率显著相关（3个月时死亡患者与存活患者分别为1.01（1 - 3.6）和0.5（0.2 - 1.1）μg/g肌酐；p<0.05）。尿MCP-1水平较高（高于第75百分位数）的患者发生肝性脑病、细菌感染或急性肾损伤的可能性更高。尿MCP-1是医院再次入院以及3个月内再次入院或死亡联合终点的独立预测因素。血浆MCP-1水平与预后无关。
尿而非血浆中的MCP-1水平与医院再次入院、肝硬化并发症的发生及死亡率相关。这些结果表明，在肝硬化中存在一种与不良预后相关的炎症反应。
