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Cardiac and proinflammatory markers predict prognosis in cirrhosis

Authors

  • Signe Wiese,

    Corresponding author
    1. Department of Clinical Physiology and Nuclear Medicine, Center of Functional and Diagnostic Imaging and Research, Copenhagen, Denmark
    2. Gastro Unit, Medical Department, Hvidovre Hospital, Hvidovre, Denmark
    • Correspondence

      Signe Wiese, MD, Department of Clinical Physiology and Nuclear Medicine, 239, Center of Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Kettegaard Alle 30, DK-2650 Hvidovre, Copenhagen, Denmark

      Tel: +45 3862 2275

      Fax: +45 3862 3750

      e-mail: signe.skovgaard.wiese@regionh.dk

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  • Christian Mortensen,

    1. Gastro Unit, Medical Department, Hvidovre Hospital, Hvidovre, Denmark
    2. Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Jens P. Gøtze,

    1. Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
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  • Erik Christensen,

    1. Department of Medicine I, Bispebjerg Hospital, Copenhagen, Denmark
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  • Ove Andersen,

    1. Clinical Research Centre, Hvidovre Hospital, Copenhagen, Denmark
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  • Flemming Bendtsen,

    1. Gastro Unit, Medical Department, Hvidovre Hospital, Hvidovre, Denmark
    2. Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Søren Møller

    1. Department of Clinical Physiology and Nuclear Medicine, Center of Functional and Diagnostic Imaging and Research, Copenhagen, Denmark
    2. Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract

Background & Aims

Inflammation and cardiac dysfunction plays an important role in the development of complications leading to increased mortality in patients with cirrhosis. Novel cardiac markers such as prohormone of ANP (proANP), copeptin and high-sensitivity troponin T (hs-TnT) and proinflammatory markers including soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitive C-reactive protein (hs-CRP) are related to these complications. We aimed to investigate if cardiac and proinflammatory markers are related to severity of liver disease, cardiac and haemodynamic changes, and long-term survival.

Methods

One hundred and ninety-three stable cirrhotic patients (Child class: A = 46; B = 97; C = 50) had a full haemodynamic investigation performed with measurement of splanchnic and systemic haemodynamics and measurement of circulating levels of proBNP, proANP, copeptin, hs-TnT, LBP, IL 6, IL 8, IP 10, VEGF, hs-CRP and suPAR.

Results

Soluble urokinase-type plasminogen activator receptor soluble urokinase-type plasminogen activator receptor, hs-CRP, and hs-TnT were significantly different throughout the Child classes (P < 0.01; P < 0.01; P < 0.02). All markers except copeptin correlated with indicators of disease severity in cirrhosis; ProANP and suPAR correlated with hepatic venous pressure gradient (r = 0.24 and r = 0.34; P < 0.001) and systemic vascular resistance (r = −0.24 and r = −0.33; P < 0.001). Cardiac (proANP, hs-TnT; P < 0.01) and proinflammatory (hs-CRP, suPAR; P < 0.05) markers were associated with mortality in a univariate Cox analysis, however, the strongest predictors of mortality in a multivariate Cox analysis were hs-TnT, ascites and hepatic venous pressure gradient (reg.coeff.: 0.34, P < 0.001; 0.16, < 0.001; 0.06, P = 0.04).

Conclusion

Markers of cardiac dysfunction and inflammation are significantly associated with disease severity, degree of portal hypertension and survival in cirrhosis. In particular, hs-TnT and suPAR seem to contain prognostic information.

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