C-Reactive protein predicts short-term mortality in patients with cirrhosis

Cervoni, Jean–Paul; Thévenot, Thierry; Weil, Delphine; Muel, Emilie; Barbot, Olivier; Sheppard, Frances; Monnet, Élisabeth; Martino, Vincent Di

doi:10.1016/j.jhep.2011.12.030

Cited by 152 publications

(153 citation statements)

References 29 publications

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“…We could show that CRP elevations nonassociated with clinically evident infection were significantly more common in patients with HCC as compared to patients with cirrhosis only. In contrast to Cervoni et al, 20 who studied only advanced cirrhosis (Child-Pugh score 8), this difference was particularly impressive in HCC patients with well-preserved liver function (Child-Pugh stage A), where cirrhosis related infections and complications are usually rare. Furthermore, patients with CRP elevations nonassociated with clinically evident infection had more aggressive tumor characteristics and were more likely to die from tumor progression.…”

Section: Discussionmentioning

confidence: 61%

“…In line with the strong prognostic significance of documented infections for cirrhotic patients, 19 Cervoni et al 20 recently reported a significant prognostic impact of elevated CRP levels on short-term mortality in patients with advanced (Child-Pugh B 8 points) liver cirrhosis and without HCC. Given that all patients in our study were cirrhotic, one may presume that CRP elevations are just a risk factor for cirrhosisrelated death independent from HCC.…”

Section: Discussionmentioning

confidence: 82%

“…One patient received TACE with drug-eluting beads. The patients received a median number of three TACE cycles (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Second-line therapies after TACE included best supportive care (n ¼ 118), local-ablative intervention (radiofrequency ablation: n ¼ 13, percutaneous ethanol injection: n ¼ 1, radiation therapy: n ¼ 1), and medical treatment (sorafenib: n ¼ 7 and other therapies: n ¼ 9).…”

Section: Resultsmentioning

confidence: 99%

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Single determination of C-reactive protein at the time of diagnosis predicts long-term outcome of patients with hepatocellular carcinoma

et al. 2013

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We investigated the prognostic value of C-reactive protein (CRP) in patients with hepatocellular carcinoma (HCC) not amenable to surgery. A total of 615 patients diagnosed with HCC not amenable to surgery between April 1999 and December 2009 at the Department of Gastroenterology of the Medical Universities of Vienna and Innsbruck were included. We assessed the optimal CRP cutoff by regression spline analysis and tested its impact on median overall survival (OS) by the Kaplan-Meier method, univariate analysis (log-rank test), and multivariate analysis (Cox proportional hazard regression model) in a training cohort (n 5 466, Vienna) and an independent validation cohort (n 5 149, Innsbruck). We found a sigmoid-shaped association of CRP and the hazard ratio of death upon regression spline analysis and defined a CRP level <1/1 mg/dL as optimal cutoff for further survival assessments. Elevated CRP (1 mg/dL) at diagnosis was associated with poor OS (CRP-elevated versus CRP-normal; 4 versus 20 months; P < 0.001) and remained a significant negative predictor for OS upon multivariate analysis (hazard ratio, 1.7; P < 0.001), which was independent of age, Child-Pugh class, tumor characteristics, and treatment allocation. Analyses with respect to Barcelona Clinic Liver Cancer (BCLC) stage and Child-Pugh class supported the relevance of CRP (BCLC-stage C and Child-Pugh A: OS for CRP-elevated versus CRP-normal, 6 versus 14; P < 0.001; BCLC-stage C and Child-Pugh B: OS for CRP-elevated versus CRP-normal, 4 versus 15 months; P < 0.001). The prognostic significance of elevated CRP was reproducible at a second CRP determination timepoint and confirmed in the independent validation cohort. Conclusion: Elevated CRP is associated with a dismal prognosis in HCC patients and may become a useful marker for patient selection in HCC management.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

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Single determination of C-reactive protein at the time of diagnosis predicts long-term outcome of patients with hepatocellular carcinoma

et al. 2013

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“…In one study, comparing these models, UKELD and updated MELD were poor in predicting mortality compared to other 4 models. 132 Other factors shown to improve the MELD accuracy are HVPG, 133 von Willebrand factor level at a cut-off level of 315%, 134 persistent CRP levels of $29 mg/L, 135 prealbumin levels of >69 mg/L, 136 apoptosis marker CK-18. 137 Refinements to improve the accuracy of MELD would continue and until we find a better score, livers could continue to be allocated using the current MELD based system.…”

Section: Other Suggested Modificationsmentioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

127

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“…Bota and colleagues reported no significant difference in serum levels of acute phase proteins between cirrhotic and non-cirrhotic critically ill intensive care patients [36]. However Cervoni reported that in patients with decompensated cirrhosis (with or without infection), persistently elevated CRP concentration predicted short-term mortality independent of MELD score, and was superior to the clinicallyassessed SIRS [37]. Also, Papp et al [38] reported that CRP was a reliable marker of bacterial infection in patients with cirrhosis, although its accuracy decreased in advanced cirrhosis or in the presence of ascites.…”

Section: Discussionmentioning

confidence: 99%