Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis

Abstract

BACKGROUND Acute decompensation (AD) of cirrhosis is related to systemic inflammation and elevated circulating cytokines. In this context, biomarkers of inflammation, such as calprotectin, may be of prognostic value. AIM To evaluate serum calprotectin levels in patients hospitalized for complications of cirrhosis. METHODS This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was measured by enzyme-linked immunosorbant assay. RESULTS Calprotectin levels were higher among groups with cirrhosis when compared to healthy controls. Higher median calprotectin was related to Child-Pugh C, ascites, and hepatic encephalopathy. Higher calprotectin was related to acute-on-chronic liver failure (ACLF) and infection in the bivariate, but not in multivariate analysis. Calprotectin was not associated with survival among patients with ACLF; however, in patients with AD without ACLF, higher calprotectin was associated with a lower 30-d survival, even after adjustment for chronic liver failure-consortium (CLIF-C) AD score. A high-risk group (CLIF-C AD score ≥ 60 and calprotectin ≥ 580 ng/mL) was identified, which had a 30-d survival (27.3%) similar to that of patients with grade 3 ACLF (23.3%). CONCLUSION Serum calprotectin is associated with prognosis in patients with AD without ACLF and may be useful in clinical practice to early identify patients with a very low short-term survival.

G-CSF increases calprotectin expression, liver damage and neuroinflammation in a murine model of alcohol-induced ACLF

“…Increased calprotectin levels, have been shown in ACLF patients ( Matiollo et al, 2022 ), further validating our ACLF model. Calprotectin (S100a8/9 heterodimer) signaling can be mediated by the activation of TLR4, RAGE or CD33 receptors, inducing NF-kB nuclear translocation, activation of ROS, and translation of chemokine/cytokine genes, which contribute to sustained inflammation ( Garcia et al, 2022 ).…”

Systematic review of the role of calprotectin in cirrhosis

“…Recently, Matiollo et al 33 . reported the results of a prospective study evaluating serum calprotectin in 200 subjects hospitalized for complications of cirrhosis, including 20 outpatients with stable cirrhosis and 20 healthy controls.…”

“…5 Calprotectin seems to be a predictive marker of survival particularly in alcohol-related cirrhosis regardless of liver function. 33 One of the mechanisms that would explain the magnitude of systemic inflammation in alcohol-related liver disease is that alcohol consumption increases gut permeability. This favours BT and allows pathogens to interact with liver cells and circulating immune cells, increasing inflammation biomarkers.…”

“…Only one study 33 discuss the potential role of serum calprotectin in ACLF. Although some aspects of the physiopathology of ACLF still unknown systemic inflammation play a crucial role, it seems reasonable that calprotectin may be higher in patients with this condition.…”

“…Recently, Matiollo et al 33 reported the results of a prospective study evaluating serum calprotectin in 200 subjects hospitalized for complications of cirrhosis, including 20 outpatients with stable cirrhosis 20 healthy controls. They reported higher calprotectin levels among patients who developed acute on chronic liver failure (ACLF) compared with those with acute decompensation (577.75 vs. 453.05 ng/mL, p = .047).…”