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http://hdl.handle.net/2445/176718
Title: | HDL-related biomarkers are robust predictors of survival in patients with chronic liver failure |
Author: | Trieb, Markus Rainer, Florian Stadlbauer, Vanessa Douschan, Philipp Horvath, Angela Binder, Lukas Trakaki, Athina Knuplez, Eva Scharnagl, Hubert Stojakovic, Tatjana Heinemann, Ákos Mandorfer, Mattias Paternostro, Rafael Reiberger, Thomas Pitarch Abaigar, Carla Amorós, Àlex Gerbes, Alexander L. Caraceni, Paolo Alessandria, Carlo Moreau, Richard Clària i Enrich, Joan Marsche, Gunther Stauber Rudolf E. |
Keywords: | Insuficiència hepàtica Marcadors bioquímics Liver failure Biochemical markers |
Issue Date: | 1-Mar-2020 |
Publisher: | Elsevier |
Abstract: | Background & Aims: High-density lipoprotein cholesterol (HDL-C) levels are reduced in patients with chronic liver disease and inversely correlate with disease severity. During acute conditions such as sepsis, HDL-C levels decrease rapidly and HDL particles undergo profound changes in their composition and function. We aimed to determine whether indices of HDL quantity and quality associate with progression and survival in patients with advanced liver disease. Methods: HDL-related biomarkers were studied in 508 patients with compensated or decompensated cirrhosis (including acute-on-chronic liver failure [ACLF]) and 40 age- and gender-matched controls. Specifically, we studied levels of HDL-C, its subclasses HDL2-C and HDL3-C, and apolipoprotein A1 (apoA-I), as well as HDL cholesterol efflux capacity as a metric of HDL functionality. Results: Baseline levels of HDL-C and apoA-I were significantly lower in patients with stable cirrhosis compared to controls and were further decreased in patients with acute decompensation (AD) and ACLF. In stable cirrhosis (n = 228), both HDL-C and apoA-I predicted the development of liver-related complications independently of model for end-stage liver disease (MELD) score. In patients with AD, with or without ACLF (n = 280), both HDL-C and apoA-I were MELD-independent predictors of 90-day mortality. On ROC analysis, both HDL-C and apoA-I had high diagnostic accuracy for 90-day mortality in patients with AD (AUROCs of 0.79 and 0.80, respectively, similar to that of MELD 0.81). On Kaplan-Meier analysis, HDL-C <17 mg/dl and apoA-I <50 mg/dl indicated poor short-term survival. The prognostic accuracy of HDL-C was validated in a large external validation cohort of 985 patients with portal hypertension due to advanced chronic liver disease (AUROCs HDL-C: 0.81 vs. MELD: 0.77). Conclusion: HDL-related biomarkers are robust predictors of disease progression and survival in chronic liver failure. |
Note: | Reproducció del document publicat a: https://doi.org/10.1016/j.jhep.2020.01.026 |
It is part of: | Journal of Hepatology, 2020, vol. 73, num. 1, p. 113-120 |
URI: | http://hdl.handle.net/2445/176718 |
Related resource: | https://doi.org/10.1016/j.jhep.2020.01.026 |
ISSN: | 0168-8278 |
Appears in Collections: | Articles publicats en revistes (Biomedicina) Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
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