Jothimani Dinesh, Paramasivam Ramya, Manoharan Mullaiezhili, Ramachandran Hemalatha, Muthusamy Subha, Simon Evangeline, Ravichandran Jinesh, Rela Mohamed
Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, No 7, CLC Works Road, Chrompet, Chennai, 600 044, India.
Indian J Gastroenterol. 2023 Dec;42(6):818-823. doi: 10.1007/s12664-023-01450-9. Epub 2023 Oct 12.
Sepsis is the most challenging complication in patients with liver cirrhosis. It destabilizes patients leading to worsening of liver dysfunction and increased mortality. Intestinal bacterial dysbiosis, release of endotoxins, increased gut permeability and associated immune dysregulation have been described in cirrhotic patients with septic complications. Calprotectin is a major cytosolic protein secreted by the inflammatory cells and has been widely studied in patients with inflammatory bowel disease. We aimed at evaluating the role of fecal calprotectin (FCAL) in patients with liver cirrhosis.
A prospective, observational study on the utility of FCAL test was conducted in patients with liver cirrhosis. Fifteen milligrams of fecal specimen was collected and analyzed within 48 hours of hospitalization from patients with end-stage liver disease (ESLD), acute-on-chronic liver failure (ACLF) and at the time of outpatient visit for stable cirrhotics. Five healthy volunteers underwent FCAL test as control population.
The mean FCAL (µg/g) level in healthy control (n = 5), stable cirrhotics (n = 10), ESLD (n = 10) and ACLF (n = 10) patients was 109.2 (95% CI: - 53.39 to 271.79), 143.3 (95% CI: 50.5-236.45), 176.9 (95% CI: 122.93-230.87) and 543.5 (95% CI: 207.09-879.91) (p = 0.005), respectively. Sepsis was identified in 13 (43.3%) patients. Area under the receiver-operating characteristics curve (AUROC) of FCAL was 0.80 (p = 0.005) and FCAL ≥ 200 µg/g (OR = 10.8, p = 0.006) was associated with sepsis. Nine (25.7%) patients expired. FCAL level was significantly higher in dead patients compared to survivors (mean, 493.67 (95% CI: 142.20-845.14) vs. 199.71 (95% CI: 99.84-299.59) μg/g,p = 0.005.
FCAL levels are increased in patients with chronic liver disease, with highest level in ACLF. An FCAL level of ≥ 200 µg/g was associated with sepsis and mortality in cirrhotic patients. Larger studies are required to identify the role of FCAL in these patients. Early identification and initiation of anti-microbials may mitigate sepsis and reduce mortality.
脓毒症是肝硬化患者最具挑战性的并发症。它会使患者病情不稳定，导致肝功能恶化和死亡率增加。肝硬化合并脓毒症并发症的患者存在肠道细菌失调、内毒素释放、肠道通透性增加及相关免疫失调的情况。钙卫蛋白是炎症细胞分泌的一种主要胞质蛋白，在炎症性肠病患者中已得到广泛研究。我们旨在评估粪便钙卫蛋白（FCAL）在肝硬化患者中的作用。
对肝硬化患者进行了一项关于FCAL检测效用的前瞻性观察性研究。收集了15毫克粪便标本，并在晚期肝病（ESLD）、慢加急性肝衰竭（ACLF）患者住院48小时内以及稳定期肝硬化患者门诊就诊时进行分析。5名健康志愿者作为对照人群进行了FCAL检测。
健康对照（n = 5）、稳定期肝硬化患者（n = 10）、ESLD患者（n = 10）和ACLF患者（n = 10）的平均FCAL（μg/g）水平分别为109.2（95%CI：-53.39至271.79）、143.3（95%CI：50.5 - 236.45）、176.9（95%CI：122.93 - 230.87）和543.5（95%CI：207.09 - 879.91）（p = 0.005）。13名（43.3%）患者被确诊为脓毒症。FCAL的受试者工作特征曲线下面积（AUROC）为0.80（p = 0.005），FCAL≥200 μg/g（OR = 10.8，p = 0.006）与脓毒症相关。9名（25.7%）患者死亡。死亡患者的FCAL水平显著高于存活患者（平均，493.67（95%CI：142.20 - 845.14）对199.71（95%CI：从99.84 - 299.59）μg/g，p = 0.005）。
慢性肝病患者的FCAL水平升高，ACLF患者中水平最高。FCAL水平≥200 μg/g与肝硬化患者的脓毒症和死亡率相关。需要开展更大规模的研究来确定FCAL在这些患者中的作用。早期识别并开始使用抗菌药物可能减轻脓毒症并降低死亡率。
