Serum bile acids as marker for acute decompensation and ACLF in patients with non-cholestatic cirrhosis

TY - JOUR

T1 - Serum bile acids as marker for acute decompensation and ACLF in patients with non-cholestatic cirrhosis

AU - Horvatits, Thomas

AU - Drolz, Andreas

AU - Roedl, Kevin

AU - Rutter, Karoline

AU - Ferlitsch, Arnulf

AU - Fauler, Günter

AU - Trauner, Michael

AU - Fuhrmann, Valentin

N1 - This article is protected by copyright. All rights reserved.

PY - 2017/2

Y1 - 2017/2

N2 - BACKGROUND & AIMS: Retention of bile acids (BAs) plays a central role in hepatic damage and disturbed BA signalling in liver disease. However, there is lack of data regarding the association of BAs with clinical complications, acute decompensation (AD) and acute-on-chronic liver failure (ACLF). Thus, we aimed to evaluate the impact of circulating serum BAs for complications in patients with cirrhosis.METHODS: Therefore, 143 patients with established cirrhosis were included in this prospective cohort type observational study. Total serum BAs and individual BA composition were assessed in all patients on admission via high performance liquid chromatography. Clinical complications with respect to AD, ACLF as well as 1-year transplant-free survival were recorded.RESULTS: Total BAs and individual serum BAs were significantly higher in patients with bacterial infection, AD and ACLF (p<0.001) and correlated significantly with model of endstage liver disease (MELD) and hepatic venous pressure gradient (p<0.001). Total BAs predicted new onset of AD or ACLF during follow-up (OR 1.025, 95%CI:1.012-1.038, p<0.001). Best cut-off predicting new onset of AD/ACLF and survival during course of time was total BAs ≥36.9 μmol/l.CONCLUSIONS: Serum total and individual BAs are associated with AD and ACLF in patients with cirrhosis. Assessment of total BAs could serve as additional marker for risk stratification in cirrhotic patients with respect to new onset of AD and ACLF. This article is protected by copyright. All rights reserved.

AB - BACKGROUND & AIMS: Retention of bile acids (BAs) plays a central role in hepatic damage and disturbed BA signalling in liver disease. However, there is lack of data regarding the association of BAs with clinical complications, acute decompensation (AD) and acute-on-chronic liver failure (ACLF). Thus, we aimed to evaluate the impact of circulating serum BAs for complications in patients with cirrhosis.METHODS: Therefore, 143 patients with established cirrhosis were included in this prospective cohort type observational study. Total serum BAs and individual BA composition were assessed in all patients on admission via high performance liquid chromatography. Clinical complications with respect to AD, ACLF as well as 1-year transplant-free survival were recorded.RESULTS: Total BAs and individual serum BAs were significantly higher in patients with bacterial infection, AD and ACLF (p<0.001) and correlated significantly with model of endstage liver disease (MELD) and hepatic venous pressure gradient (p<0.001). Total BAs predicted new onset of AD or ACLF during follow-up (OR 1.025, 95%CI:1.012-1.038, p<0.001). Best cut-off predicting new onset of AD/ACLF and survival during course of time was total BAs ≥36.9 μmol/l.CONCLUSIONS: Serum total and individual BAs are associated with AD and ACLF in patients with cirrhosis. Assessment of total BAs could serve as additional marker for risk stratification in cirrhotic patients with respect to new onset of AD and ACLF. This article is protected by copyright. All rights reserved.

U2 - 10.1111/liv.13201

DO - 10.1111/liv.13201

M3 - SCORING: Journal article

C2 - 27416294

VL - 37

SP - 224

EP - 231

JO - LIVER INT

JF - LIVER INT

SN - 1478-3223

IS - 2

ER -