High serum lipopolysaccharide binding protein is associated with increased mortality in patients with decompensated cirrhosis. (31st October 2016)

• Record Type: Journal Article
• Authors: Agiasotelli, Danai; Alexopoulou, Alexandra; Vasilieva, Larisa; Hadziyannis, Emilia; Goukos, Dimitris; Daikos, George L.; Dourakis, Spyros P.
• Is Part Of: Liver international. Volume 37:Number 4(2017)
• Page Start: 576
• Page End: 582
• Publication Date: 2016-10-31
• Subjects: bacterial translocation -- decompensated cirrhosis -- lipopolysaccharide binding protein -- predictors of mortality; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.13264
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background & Aims: Lipopolysaccharide‐binding‐protein (LBP) is an acute‐phase‐protein produced by hepatocytes. Changes in LBP are associated with the dynamics of bacterial translocation and intestinal permeability in decompensated cirrhosis (DC). We assessed serum and ascitic‐fluid (AF) LBP and examined their association with mortality in patients with DC. Methods: Eighty‐eight consecutive patients (73.9% males) underwent thorough diagnostic investigations for infection. LBP (ng/mL) was assessed in serum (N=88) and AF (n=49) by enzyme‐linked‐immunosorbent‐assay and expressed in natural logarithm (ln). Results: Serum lnLBP was higher in 18 patients with overt infection compared to those without ( P <.001). Serum and AF lnLBP 13.49 and 12.11 displayed a very good‐negative‐predictive value of 90% and 95.1% to rule out infection and spontaneous‐bacterial‐peritonitis (SBP), respectively. LBP was higher in serum than in AF ( P <.001). Serum and AF LBP levels showed a positive correlation with surrogate markers of inflammation. Patients without overt infection were prospectively followed up. The 90‐day‐mortality rate was 48% and 24.4% in patients with high (≥13.49) and low (<13.49) lnLBP, respectively, (log rank P=0.045). In univariate Cox regression analysis, neutrophils, LBP, MELD score and CRP were predictive of mortality. However, only high LBP (HR 8.1 95%CI 2.0‐31.5, P =0.003) and MELD (HR 1.1 95%CI 1.0‐1.2, P =0.002) were predictive of mortality in multivariate analysis. Conclusions: Serum and AF LBP concentrations showed a high negative‐predictive‐value to exclude infection and SBP, respectively. High serum LBP was detected in patients without infection at presentation who died during the 90‐day‐follow‐up period. Elevated serum LBP is a marker of short‐term mortality in patients without overt bacterial infection.