Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain.
Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Eur J Clin Invest. 2024 Feb;54(2):e14111. doi: 10.1111/eci.14111. Epub 2023 Oct 17.
Calprotectin is a calcium-binding-S100-protein synthetized mainly in neutrophils which has been demonstrated to be an accurate biomarker of the presence of these cells. Gut barrier dysfunction in patients with advanced chronic liver disease (ACLD), in addition to the lack of noninvasive tools for diagnosis and prognosis of cirrhosis decompensations, has raised interest in this biomarker.
Our aim is to summarize the current evidence regarding the role of calprotectin in terms of its diagnostic and prognostic utility in ACLD.
We performed a systematic search (PROSPERO registration no. CRD42023389069) of original articles published without any restrictions on the publication date until January 2023 providing information about calprotectin for the prognosis or diagnosis of ACLD and its decompensations in adult patients.
A total 227 articles were identified, and 26 observational studies finally met the inclusion criteria. In 14 studies, calprotectin was measured in ascitic fluid, all of which reported higher calprotectin values in spontaneous bacterial peritonitis, while cut-off points for its diagnosis were proposed in nine studies. Three studies reported higher faecal calprotectin levels in patients with hepatic encephalopathy and portal hypertension. Four studies evaluated faecal calprotectin and one plasma calprotectin as biomarkers for gut barrier integrity and bacterial translocation.
Calprotectin is emerging as a promising biomarker in ACLD, particularly for the management of bacterial infections and alcohol-related liver disease. Further research with better study designs should help to determine the feasibility of calprotectin measurement in routine clinical practice.
钙卫蛋白是一种主要在中性粒细胞中合成的钙结合 S100 蛋白，已被证明是这些细胞存在的准确生物标志物。在晚期慢性肝病（ACLD）患者中，肠道屏障功能障碍以及缺乏用于诊断和预测肝硬化失代偿的非侵入性工具，引起了对这种生物标志物的兴趣。
我们旨在总结钙卫蛋白在 ACLD 中的诊断和预后效用方面的现有证据。
我们对截至 2023 年 1 月发表的无任何出版日期限制的原始文章进行了系统检索（PROSPERO 注册编号 CRD42023389069），这些文章提供了有关钙卫蛋白在成人 ACLD 及其失代偿中的预后或诊断的信息。
共确定了 227 篇文章，最终有 26 项观察性研究符合纳入标准。在 14 项研究中，钙卫蛋白在腹水进行了测量，所有这些研究均报告自发性细菌性腹膜炎时钙卫蛋白值更高，而在 9 项研究中提出了其诊断的截断值。三项研究报告肝性脑病和门静脉高压患者的粪便钙卫蛋白水平较高。四项研究评估了粪便钙卫蛋白和一项血浆钙卫蛋白作为肠道屏障完整性和细菌易位的生物标志物。
钙卫蛋白作为 ACLD 的一种有前途的生物标志物正在出现，特别是在管理细菌感染和酒精性肝病方面。进一步设计更好的研究应有助于确定在常规临床实践中测量钙卫蛋白的可行性。
