High-sensitivity C-reactive protein levels predict survival ... : European Journal of Gastroenterology & Hepatology (original) (raw)
Original Articles: Metabolic Liver Disease
High-sensitivity C-reactive protein levels predict survival and are related to haemodynamics in alcoholic cirrhosis
Mortensen, Christiana; Andersen, Oveb; Krag, Aleksandera; Bendtsen, Flemminga; Møller, Sørenc
aDepartment of Gastroenterology
bClinical Research Centre
cDepartment of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
Correspondence to Christian Mortensen, MD, Department of Gastroenterology, Hvidovre Hospital, Kettegaard Alle 30, DK-2650 Hvidovre, Copenhagen, Denmark Tel: +45 386 23181; fax: +45 386 23777; e-mail: [email protected]
Received October 26, 2011
Accepted January 26, 2012
European Journal of Gastroenterology & Hepatology 24(6):p 619-626, June 2012. | DOI: 10.1097/MEG.0b013e328351db6e
Abstract
Objectives
Inflammation may be implicated in the haemodynamic deterioration and in the development of complications in patients with cirrhosis. High-sensitivity C-reactive protein (hsCRP) is a marker of low-grade inflammation, and predicts outcomes in patients at risk of ischaemic heart disease. Proinflammatory cytokines reflect immune activation and have been found to be elevated in cirrhosis. We investigated a possible association between markers of inflammation and splanchnic and systemic haemodynamics, complications and survival in patients with cirrhosis.
Methods
In 45 stable patients with cirrhosis on the basis of alcohol consumption, we measured hsCRP, as well as monocyte chemoattractant protein-1, tumour necrosis factor-α, interleukin-6, interleukin-8 and vascular endothelial growth factor in patients and in 12 healthy controls. Systemic and splanchnic haemodynamics were investigated in patients.
Results
hsCRP levels were significantly higher in patients compared with controls (P<0.05) and the highest in patients belonging to Child–Pugh class C. hsCRP levels correlated with markers of liver dysfunction and with the hepatic venous pressure gradient (_r_=0.48, P<0.001). hsCRP values above the median level of 5.3 mg/l were associated with a highly increased mortality (_P_=0.001). Model for End-Stage Liver Disease score (_P_=0.01) and hsCRP (P<0.05) provided independent prognostic information. Cytokines had no discernible value in predicting survival.
Conclusion
hsCRP is elevated in patients with cirrhosis and is associated with portal hypertension and decreased survival. hsCRP is a promising prognostic marker in cirrhosis, which may improve the selection of candidates for liver transplantation.
© 2012 Lippincott Williams & Wilkins, Inc.