Plasma calprotectin: A new prognostic marker of survival in alcohol-induced cirrhosis

Abstract

Plasma levels of calprotectin were determined in 84 patients with alcohol-induced cirrhosis. Calprotectin is released from disintegrating neutrophils, and plasma levels seem to reflect activation and turnover of such cells. The purpose of the study was to investigate the degree of activation of neutrophils, which has been indicated to be increased and a cause of neutrophil exhaustion in these patients. Additionally, on follow-up after a median observation period of 559 days, we investigated the prognostic value of calprotectin for survival. No difference was found in calprotectin levels when comparing healthy controls with patients with compensated cirrhosis and those with decompensated cirrhosis. However, high calprotectin concentrations (> median) were a significant prognostic marker of poor survival (P = .001, log-rank test). Using a multivariate Cox proportional hazard model, the prognostic value of calprotectin seemed independent of severity of liver disease evaluated on eight clinical and biochemical variables of liver disease. Divided into groups by the median calprotectin concentration, analysis of survival was performed in the whole series of patients (n = 84) as well as in patients who were completely without signs of recent or actual infection (n = 54). In both groups, calprotectin levels (> median) showed a much higher prognostic value than albumin, prothrombin complex, bilirubin, and ascites. During follow-up, calprotectin levels (> median) were also a predictor of recurrent infection (P = .009). Thus, in patients with alcoholic cirrhosis, plasma calprotectin seems to be a new prognostic marker of survival, which seems independent of the severity of liver disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Emerging role of calprotectin in gastroenterology

“…Laboratory investigations currently used to provide prognostic information in alcoholic liver disease include tests of synthetic liver function such as albumin and prothrombin time. Plasma calprotectin has emerged as a prognostic marker of survival in alcohol‐induced cirrhosis 17 . No difference was found between healthy controls, compensated and decompensated cirrhotics; however, high calprotectin levels were a significant prognostic marker of poor survival in cirrhotic subjects.…”

Markers of bacterial translocation in end-stage liver disease

“…Initial studies conducted by a Danish research group, focused on the possible prognostic significance of calprotectin levels in the plasma and ascitic fluid samples from patients with end-stage liver disease. The authors did not find a significant difference between healthy controls and patients with cirrhosis (irrespectively if liver disease was compensated or decompensated), a finding that was confirmed in additional studies [74,75] . On the other hand, they reported that high plasma calprotectin levels were an indicator of poor survival in alcohol-related cirrhosis [74] .…”

“…The authors did not find a significant difference between healthy controls and patients with cirrhosis (irrespectively if liver disease was compensated or decompensated), a finding that was confirmed in additional studies [74,75] . On the other hand, they reported that high plasma calprotectin levels were an indicator of poor survival in alcohol-related cirrhosis [74] . The most important finding, however, regarding the role of calprotectin in relation to BT, was that during follow up of the patients higher calprotectin levels were an independent predictor of recurrent bacterial infections [76] .…”

“…Homann et al [75] , Homann et al [76] , Montalto et al [78] Procalcitonin Neutrophils, liver, thyroid…”

“…On the other hand, they reported that high plasma calprotectin levels were an indicator of poor survival in alcohol-related cirrhosis [74] . The most important finding, however, regarding the role of calprotectin in relation to BT, was that during follow up of the patients higher calprotectin levels were an independent predictor of recurrent bacterial infections [76] . Arguably the most important study regarding the role of fecal calprotectin in the diagnosis of BT complications, is the one conducted by Gundling et al [77] .…”