HDL-related biomarkers are robust predictors of survival in patients with chronic liver failure.
Abstract | BACKGROUND & AIMS:
High-density lipoprotein cholesterol (HDL-C) levels are reduced in patients with chronic liver disease and inversely correlate with disease severity. During acute conditions such as sepsis, HDL-C levels decrease rapidly and HDL particles undergo profound changes in their composition and function. We aimed to determine whether indices of HDL quantity and quality associate with progression and survival in patients with advanced liver disease. METHODS: RESULTS: Baseline levels of HDL-C and apoA-I were significantly lower in patients with stable cirrhosis compared to controls and were further decreased in patients with acute decompensation (AD) and ACLF. In stable cirrhosis (n = 228), both HDL-C and apoA-I predicted the development of liver-related complications independently of model for end-stage liver disease (MELD) score. In patients with AD, with or without ACLF (n = 280), both HDL-C and apoA-I were MELD-independent predictors of 90-day mortality. On ROC analysis, both HDL-C and apoA-I had high diagnostic accuracy for 90-day mortality in patients with AD (AUROCs of 0.79 and 0.80, respectively, similar to that of MELD 0.81). On Kaplan-Meier analysis, HDL-C <17 mg/dl and apoA-I <50 mg/dl indicated poor short-term survival. The prognostic accuracy of HDL-C was validated in a large external validation cohort of 985 patients with portal hypertension due to advanced chronic liver disease (AUROCs HDL-C: 0.81 vs. MELD: 0.77). CONCLUSION: LAY SUMMARY:
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Authors | Markus Trieb, Florian Rainer, Vanessa Stadlbauer, Philipp Douschan, Angela Horvath, Lukas Binder, Athina Trakaki, Eva Knuplez, Hubert Scharnagl, Tatjana Stojakovic, Ákos Heinemann, Mattias Mandorfer, Rafael Paternostro, Thomas Reiberger, Carla Pitarch, Alex Amorós, Alexander Gerbes, Paolo Caraceni, Carlo Alessandria, Richard Moreau, Joan Clària, Gunther Marsche, Rudolf E Stauber |
Journal | Journal of hepatology
(J Hepatol)
Vol. 73
Issue 1
Pg. 113-120
(07 2020)
ISSN: 1600-0641 [Electronic] Netherlands |
PMID | 32061870
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. |
Chemical References |
- Apolipoprotein A-I
- Biomarkers
- Cholesterol, HDL
- Lipoproteins, HDL2
- Lipoproteins, HDL3
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Topics |
- Acute-On-Chronic Liver Failure
(blood, diagnosis, epidemiology, metabolism)
- Apolipoprotein A-I
(blood, metabolism)
- Biomarkers
- Cholesterol, HDL
(blood, metabolism)
- Cross-Sectional Studies
- Disease Progression
- Europe
(epidemiology)
- Female
- Humans
- Lipoproteins, HDL2
(blood, metabolism)
- Lipoproteins, HDL3
(blood, metabolism)
- Liver Cirrhosis
(blood, diagnosis, epidemiology)
- Male
- Middle Aged
- Organ Dysfunction Scores
- Predictive Value of Tests
- Prognosis
- Severity of Illness Index
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