Copeptin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival.

Autor: Kerbert AJC; Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands. j.c.kerbert@lumc.nl., Verspaget HW; Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands., Navarro ÀA; Liver Unit/EASL-CLIF Data Center, Hospital Clínic de Barcelona, Barcelona, Spain., Jalan R; Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK., Solà E; Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain., Benten D; Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Durand F; Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France., Ginès P; Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain., van der Reijden JJ; Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands., van Hoek B; Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands., Coenraad MJ; Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2017 Dec 21; Vol. 21 (1), pp. 321. Date of Electronic Publication: 2017 Dec 21.
DOI: 10.1186/s13054-017-1894-8
Abstrakt: Background: Acute-on-chronic liver failure (ACLF) is characterized by the presence of acute decompensation (AD) of cirrhosis, organ failure, and high short-term mortality rates. Hemodynamic dysfunction and activation of endogenous vasoconstrictor systems are thought to contribute to the pathogenesis of ACLF. We explored whether copeptin, a surrogate marker of arginine vasopressin, is a potential marker of outcome in patients admitted for AD or ACLF and whether it might be of additional value to conventional prognostic scoring systems in these patients.
Methods: All 779 patients hospitalized for AD of cirrhosis from the CANONIC database with at least one serum sample available for copeptin measurement were included. Presence of ACLF was defined according to the CLIF-consortium organ failure (CLIF-C OF) score. Serum copeptin was measured in samples collected at days 0-2, 3-7, 8-14, 15-21, and 22-28 when available. Competing-risk regression analysis was applied to evaluate the impact of serum copeptin and laboratory and clinical data on short-term survival.
Results: Serum copeptin concentration was found to be significantly higher in patients with ACLF compared with those without ACLF at days 0-2 (33 (14-64) vs. 11 (4-26) pmol/L; p < 0.001). Serum copeptin at admission was shown to be a predictor of mortality independently of MELD and CLIF-C OF scores. Moreover, baseline serum copeptin was found to be predictive of ACLF development within 28 days of follow-up.
Conclusions: ACLF is associated with significantly higher serum copeptin concentrations at hospital admission compared with those with traditional AD. Copeptin is independently associated with short-term survival and ACLF development in patients admitted for AD or ACLF.
Databáze: MEDLINE
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