Pro-adrenomedullin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival. (3rd May 2020)

• Record Type: Journal Article
• Authors: Yan, Huadong; Jin, Susu; Liang, Lili; Du, Jingyuan; Aithal, Guruprasad P.; Li, Lanjuan
• Is Part Of: Scandinavian journal of gastroenterology. Volume 55:Number 5(2020)
• Page Start: 606
• Page End: 614
• Publication Date: 2020-05-03
• Subjects: Acute-on-chronic liver failure -- acute decompensation of cirrhosis -- organ failure -- biomarker -- pro-adrenomedullin; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.1080/00365521.2020.1764616
• Languages: English
• ISSNs: 0036-5521

Abstract

Abstract: Background and aim: Acute-on-chronic liver failure (ACLF) is characterized by the presence of acute decompensation (AD) of cirrhosis, organ failures, and high short-term mortality rates. In present study, we explored whether Pro-adrenomedullin (Pro-ADM), a biomarker of sepsis, is a potential marker of outcome in patients admitted for AD or ACLF and whether it might be of additional value to conventional prognostic scoring systems in these patients. Methods: 332 consecutive patients with AD of cirrhosis were prospectively enrolled. Pro-ADM was measured for all patients at baseline. Cox regression analysis was used to evaluate the impact of pro-ADM on short-term survival and developing ACLF during hospital stay. Results: Serum pro-ADM levels were significantly high in non-survivors ( p < .001) and showed significant correlation with ALT ( r = 0.181, p = .001), INR ( r = 0.144, p = .009), TB ( r = 0.368, p < .001), Creatinine ( r = 0.145, p = .004), MELD score ( r = 0.334, p = <.001) and CLI-C OF score ( r = 0.375, p = <.001). Serum pro-ADM at admission was shown to be a predictor of 28-day mortality independently of MELD and CLIF-C OF scores. Prognostic models incorporating pro-ADM achieved high C index for predicting 28-day mortality in AD patients of cirrhosis. Moreover, baseline pro-ADM was found to be predictive of ACLF development during hospital stay. Conclusions: Serum pro-ADM levels correlate with multiorgan failure and are independently associated with short-term survival and ACLF development in patients admitted for AD or ACLF.