肝硬化住院患者血清内脂素水平与器官衰竭之间的关联
Association between serum endocan levels and organ failure in hospitalized patients with cirrhosis.
作者信息
Wejnaruemarn Salisa, Suksawatamnuay Sirinporn, Vanichanan Jakapat, Komolmit Piyawat, Treeprasertsuk Sombat, Thanapirom Kessarin
机构信息
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Center of Excellence in Liver Fibrosis and Cirrhosis, Chulalongkorn University, Bangkok, Thailand.
出版信息
PLoS One. 2024 Dec 26;19(12):e0315619. doi: 10.1371/journal.pone.0315619. eCollection 2024.
BACKGROUND & AIMS: Acute-on-chronic liver failure is a syndrome characterized by organ failure and high short-term mortality. The lack of reliable biomarkers for the early detection of acute-on-chronic liver failure is a significant challenge. Endothelial dysfunction plays a key role in the development of organ failure. Serum endocan is a potential new biomarker for endothelial dysfunction. Therefore, this study aimed to assess the association between endocan and organ failure and 28-day mortality in patients with cirrhosis.
METHODS
Hospitalized patients with cirrhosis with and without organ failure were prospectively enrolled according to the criteria of the European Association for the Study of Liver-Chronic Liver Failure consortium. The comparative performances of serum endocan, procalcitonin, and interleukin-6 for diagnosing organ failure and predicting mortality were studied.
RESULTS
The study included 116 hospitalized patients with cirrhosis, 55 of whom had organ failure on admission. Patients with organ failure had significantly higher endocan, procalcitonin, and interleukin-6 levels than those without it. At a cut-off value of 15.8 ng/mL, endocan showed a sensitivity of 63.6% and specificity of 67.2% for the diagnosis of organ failure, with an area under the receiver operating characteristic curve of 0.65, which is comparable to procalcitonin and interleukin-6. Multivariate analysis identified serum endocan, creatinine, and total bilirubin as independent factors for organ failure in hospitalized patients with cirrhosis. Patients who died within 28 days had significantly higher baseline biomarker levels than those who survived. Liver failure, hospital-acquired infection, mechanical ventilator use, and interleukin-6 ≥37 pg/mL were independent predictors of 28-day mortality.
CONCLUSION
Serum endocan is associated with organ failure and is an independent risk factor of organ failure in hospitalized patients with cirrhosis.
背景与目的
慢加急性肝衰竭是一种以器官功能衰竭和短期高死亡率为特征的综合征。缺乏用于早期检测慢加急性肝衰竭的可靠生物标志物是一项重大挑战。内皮功能障碍在器官功能衰竭的发展中起关键作用。血清内脂素是内皮功能障碍的一种潜在新生物标志物。因此，本研究旨在评估内脂素与肝硬化患者器官功能衰竭及28天死亡率之间的关联。
方法
根据欧洲肝脏研究协会-慢性肝衰竭联盟的标准，前瞻性纳入有或无器官功能衰竭的住院肝硬化患者。研究血清内脂素、降钙素原和白细胞介素-6在诊断器官功能衰竭和预测死亡率方面的比较性能。
结果
该研究纳入了116例住院肝硬化患者，其中55例入院时存在器官功能衰竭。有器官功能衰竭的患者的内脂素、降钙素原和白细胞介素-6水平显著高于无器官功能衰竭的患者。以内脂素截断值15.8 ng/mL诊断器官功能衰竭时，其敏感性为63.6%，特异性为67.2%，受试者工作特征曲线下面积为0.65，与降钙素原和白细胞介素-6相当。多因素分析确定血清内脂素、肌酐和总胆红素是住院肝硬化患者器官功能衰竭的独立因素。28天内死亡的患者基线生物标志物水平显著高于存活患者。肝衰竭、医院获得性感染、机械通气使用和白细胞介素-6≥37 pg/mL是28天死亡率的独立预测因素。
结论
血清内脂素与器官功能衰竭相关，是住院肝硬化患者器官功能衰竭的独立危险因素。
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