Urinary L-FABP is a promising prognostic biomarker of ACLF and mortality in patients with decompensated cirrhosis

Background & aims: Decompensated cirrhosis (DC) is associated with high mortality, mainly owing to the development of acute-on-chronic liver failure (ACLF). Identifying the patients with DC who are at high risk of mortality and ACLF development is an unmet clinical need. Liver fatty acid-binding...

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Detalles Bibliográficos
Autores: Juanola Mayos, Adrià, Graupera, Isabel, Elia, Chiara, Piano, Salvatore, Solé, Cristina, Carol, Marta, Pérez-Guasch, Martina, Bassegoda, Octavi, Escudé, Laia, Rubio, Ana Belén, Cervera, Marta, Napoleone, Laura, Avitabile, Emma, Ma, Ann T., Fabrellas i Padrès, Núria, Pose Méndez, Elisa, Morales Ruiz, Manuel, Jiménez Povedano, Wladimiro, Torres, Ferran, Crespo Conde, Gonzalo, Solà, Elsa, Ginès i Gibert, Pere
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/216456
Acceso en línea:https://hdl.handle.net/2445/216456
Access Level:acceso abierto
Palabra clave:Anàlisi d'orina
Àcids grassos
Fetge
Cirrosi hepàtica
Marcadors bioquímics
Urine analysis
Fatty acids
Liver
Hepatic cirrhosis
Biochemical markers
Descripción
Sumario:Background & aims: Decompensated cirrhosis (DC) is associated with high mortality, mainly owing to the development of acute-on-chronic liver failure (ACLF). Identifying the patients with DC who are at high risk of mortality and ACLF development is an unmet clinical need. Liver fatty acid-binding protein (L-FABP) is expressed in several organs and correlates with liver and systemic inflammation. Herein, we aimed to assess the prognostic value of L-FABP in patients with DC. Methods: A prospective series of 444 patients hospitalized for DC was divided into 2 cohorts: study cohort (305 patients) and validation cohort (139 patients). L-FABP was measured in urine and plasma samples collected at admission. Neutrophil gelatinase-associated lipocalin (NGAL) was also measured in urine samples for comparison. Results: Urine but not plasma L-FABP correlated with 3-month survival on univariate analysis. On multivariate analysis, urine L-FABP and model for end-stage liver disease (MELD)-Na were the only independent predictors of prognosis. Urine L-FABP levels were higher in patients with ACLF than in those without and also predicted the development of ACLF, together with MELD-Na, during follow-up. In patients with ACLF, urine L-FABP correlated with liver, coagulation, and circulatory failure. Urine L-FABP levels were also increased in patients with acute kidney injury, particularly in those with acute tubular necrosis. The ability of urinary L-FABP to predict survival and ACLF development was confirmed in the validation cohort. Urine NGAL predicted outcome on univariate but not multivariate analysis. Conclusions: Urinary L-FABP levels are independently associated with the 3-month clinical course in patients with DC, in terms of mortality and ACLF development. Urinary L-FABP is a promising prognostic biomarker for patients with DC.

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