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Juanola A, Ma AT, de Wit K, Gananandan K, Roux O, Zaccherini G, Jiménez C, Tonon M, Solé C, Villaseca C, Uschner FE, Graupera I, Pose E, Moreta MJ, Campion D, Beuers U, Mookerjee RP, Francoz C, Durand F, Vargas V, Piano S, Alonso S, Trebicka J, Laleman W, Asrani SK, Soriano G, Alessandria C, Serra-Burriel M, Morales-Ruiz M, Torres F, Allegretti AS, Krag A, Caraceni P, Watson H, Abraldes JG, Solà E, Kamath PS, Hernaez R, Ginès P. Novel prognostic biomarkers in decompensated cirrhosis: a systematic review and meta-analysis. Gut 2023; 73:156-165. [PMID: 37884354 DOI: 10.1136/gutjnl-2023-329923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Patients with decompensated cirrhosis experience high mortality rates. Current prognostic scores, including the model for end-stage liver disease (MELD), may underperform in settings other than in those they were initially developed. Novel biomarkers have been proposed to improve prognostication accuracy and even to predict development of complications. METHODS We performed a systematic review and meta-analysis on novel urine and blood biomarkers and their ability to predict 90-day mortality in patients with decompensated cirrhosis. Secondary outcomes included 28-day and 1-year mortality, and development of acute-on-chronic liver failure, acute kidney injury and other complications. To overcome differences in units, temporal changes in assays and reporting heterogeneity, we used the ratio of means (RoM) as measure of association for assessing strength in predicting outcomes. An RoM>1 implies that the mean biomarker level is higher in those that develop the outcome than in those that do not. RESULTS Of 6629 unique references, 103 were included, reporting on 29 different biomarkers, with a total of 31 362 biomarker patients. Most studies were prospective cohorts of hospitalised patients (median Child-Pugh-Turcotte score of 9 and MELD score of 18). The pooled 90-day mortality rate was 0.27 (95% CI 0.24 to 0.29). The RoM for predicting 90-day mortality was highest for interleukin 6 (IL-6) (2.56, 95% CI 2.39 to 2.74), followed by urinary neutrophil gelatinase-associated lipocalin (uNGAL) (2.42, 95% CI 2.20 to 2.66) and copeptin (2.33, 95% CI 2.17 to 2.50). These RoMs were all higher than for MELD (1.44, 95% CI 1.42 to 1.46). CONCLUSION Novel biomarkers, including IL-6, uNGAL and copeptin, can probably improve prognostication of patients with decompensated cirrhosis compared with MELD alone.
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Affiliation(s)
- Adrià Juanola
- Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Barcelona, Spain
| | - Ann Thu Ma
- Toronto Centre for Liver Disease Francis Family Liver Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Koos de Wit
- Gastroenterology and Hepatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Kohilan Gananandan
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Olivier Roux
- Department of Hepatology, Beaujon Hospital, Clichy, France
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - César Jiménez
- Liver Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marta Tonon
- Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Cristina Solé
- Department of Gastroenterology and Hepatology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Clara Villaseca
- Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Frank E Uschner
- Department of Internal Medicine B, University of Münster, Munster, Germany
| | - Isabel Graupera
- Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Barcelona, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Barcelona, Spain
| | - Maria José Moreta
- Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Daniela Campion
- Division of Gastroenterology and Hepatology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Ulrich Beuers
- Gastroenterology & Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Rajeshawar P Mookerjee
- Institute of Liver and Digestive Health, University College London Medical School, London, UK
| | - Claire Francoz
- Department of Hepatology, Beaujon Hospital, Clichy, France
| | - Francois Durand
- DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France
- Université Denis Diderot-Paris 7, Paris, France
| | - Victor Vargas
- Liver Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Salvatore Piano
- Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Sonia Alonso
- Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jonel Trebicka
- Department of Internal Medicine B, University of Münster, Munster, Germany
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Wim Laleman
- Division of Liver and Biliopanreatic Disorders, KU Leuven, University of Leuven, Leuven, Belgium
| | - Sumeet K Asrani
- Division of Hepatology, Department of Medicine, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - German Soriano
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Miquel Serra-Burriel
- University of Zurich Institute of Epidemiology Biostatistics and Prevention, Zurich, Switzerland
| | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ferran Torres
- Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aleksander Krag
- Department of Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Juan G Abraldes
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Elsa Solà
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, California, USA
| | - Patrick S Kamath
- Gastroenterology and Hepatology, Mayo Medical School, Rochester, Minnesota, USA
| | - Ruben Hernaez
- Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Pere Ginès
- Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
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Tan HQ, Zhao M, Huang Z, Liu Y, Li H, Ma LH, Liu JY. Circulating copeptin level and the clinical prognosis of patients with chronic liver disease. World J Gastroenterol 2023; 29:4797-4808. [PMID: 37664154 PMCID: PMC10473920 DOI: 10.3748/wjg.v29.i31.4797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The relationship between copeptin and the severity of circulatory dysfunction and systemic stress response in patients with chronic liver disease (CLD) has been established. Nevertheless, the potential of serum copeptin levels to predict the prognosis of CLD patients remains unclear. AIM To conduct a systematic review and meta-analysis to investigate the correlation between serum copeptin and transplant-free survival (TFS) in this population. METHODS To achieve the objective of the meta-analysis, PubMed, Embase, the Cochrane Library, and the Web of Science were searched to identify observational studies with longitudinal follow-up. The Cochrane Q test was utilized to assess between-study heterogeneity, and the I2 statistic was estimated. Random-effects models were employed to combine the outcomes, taking into account the potential influence of heterogeneity. RESULTS Ten datasets including 3133 patients were involved. The follow-up durations were 1 to 48 mo (mean: 12.5 mo). Overall, it was shown that a high level of serum copeptin was associated with a poor TFS [risk ratio (RR): 1.82, 95% confidence interval: 1.52-2.19, P < 0.001; I2 = 0%]. In addition, sensitivity analysis by omitting one dataset at a time showed consistent results (RR: 1.73-2.00, P < 0.05). Finally, subgroup analyses according to study country, study design, patient diagnosis, cutoff of copeptin, follow-up duration, and study quality score also showed similar results (P for subgroup difference all > 0.05). CONCLUSION Patients with CLD who have high serum copeptin concentrations may be associated with a poor clinical prognosis.
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Affiliation(s)
- Hao-Qian Tan
- Department of Gastroenterology, Zhoukou Central Hospital Affiliated to Xinxiang Medical University, Zhoukou 466000, Henan Province, China
| | - Ming Zhao
- Department of Gastroenterology, Zhoukou Central Hospital, Zhoukou 466000, Henan Province, China
| | - Zan Huang
- Department of Teaching and Research, Zhoukou Central Hospital, Zhoukou 466000, Henan Province, China
| | - Yang Liu
- Department of Gastroenterology, Zhoukou Central Hospital, Zhoukou 466000, Henan Province, China
| | - Han Li
- Department of Gastroenterology, Zhoukou Central Hospital, Zhoukou 466000, Henan Province, China
| | - Long-Hui Ma
- Department of Teaching and Research, Zhoukou Central Hospital, Zhoukou 466000, Henan Province, China
| | - Jun-Ying Liu
- Department of Gastroenterology, Zhoukou Central Hospital, Zhoukou 466000, Henan Province, China
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Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease. Nutrients 2022; 14:nu14163433. [PMID: 36014939 PMCID: PMC9413764 DOI: 10.3390/nu14163433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Knowledge about cardiac and inflammatory biomarkers in patients with stable coronary artery disease (CAD) is limited. To address this, we analyzed 3072 patients (36% female) with a median follow-up of 10 years in the Leipzig LIFE Heart Study with suspected CAD with coronary angiography. Selected biomarkers included troponin T (hsTNT), N-terminal pro B-type natriuretic peptide (NT-proBNP), copeptin, C-reactive protein (hsCRP), and interleukin-6 (IL-6). Patients were stratified by CAD severity: CAD0 (no sclerosis), CAD1 (non-obstructive, i.e., stenosis < 50%), and CAD2 (≥one stenosis ≥ 50%). Group comparison (GC) included GC1: CAD0 + 1 vs. CAD2; GC2: CAD0 vs. CAD1 + 2. CAD0, CAD1, and CAD2 were apparent in 1271, 631, and 1170 patients, respectively. Adjusted for classical risk factors, hs-cTnT, NT-proBNP, and IL-6 differed significantly in both GC and hsCRP only in GC2. After multivariate analysis, hs-cTnT, NT-proBNP, and IL-6 remained significant in GC1. In GC2, hs-cTnT (p < 0.001) and copeptin (p = 0.014) reached significance. Ten-year survival in groups CAD0, CAD1, and CAD2 was 88.3%, 77.3%, and 72.4%. Incorporation of hs-cTnT, NT-proBNP, copeptin, and IL-6 improved risk prediction (p < 0.001). The studied cardiac and inflammatory biomarkers enable fast and precise non-invasive identification of mortality risk in CAD patients, allowing the tailoring of primary and secondary CAD prevention.
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Mieszczański P, Górniewski G, Błaszczyk B, Pacholczyk M, Trzebicki J. Copeptin (CTproAVP) - A Biomarker of a Circulatory Impairment in Liver Transplant Recipients? A Prospective, Observational Study. Transplant Proc 2021; 53:1969-1974. [PMID: 34243965 DOI: 10.1016/j.transproceed.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Copeptin, an easily measured and stable surrogate marker of arginine vasopressin, is a biomarker of a homeostasis disorder and a circulatory impairment in a wide spectrum of morbidities. The aim of this study was to evaluate the potential of copeptin as a biomarker of a circulatory impairment in patients undergoing liver transplantation (LT). METHODS This was a prospective, observational study. Blood samples were obtained from 38 patients undergoing LT. Serum copeptin level was measured by means of a sandwich immunoassay pre-, intra-, and postoperatively up to 21 days after the operation. RESULTS The mean concentration of copeptin remained in the range of values slightly below 1000 pg/mL during the analyzed observation period and remained higher than the values observed in healthy individuals. Intraoperative and immediately postoperative copeptin levels did not correlate with hemodynamic parameters. There was also no correlation between preoperative copeptin levels (C1) and preoperative Model for End-Stage Liver Disease scores, serum creatinine levels, plasma transaminase levels, international normalized ratio, or hematocrit (Spearman ρ, P > .05). CONCLUSIONS Preoperative copeptin levels are elevated in most LT recipients and remain elevated for 21 days after surgery. There was no correlation between the concentration of copeptin and the Model for End-Stage Liver Disease-Sodium score or the cause of a hepatic failure. It cannot be concluded that copeptin is a biomarker of a circulatory impairment in patients with transplanted liver in the perioperative period. The secretion of vasopressin, as measured by copeptin concentration during and after LT, requires further study.
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Affiliation(s)
- Piotr Mieszczański
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
| | - Grzegorz Górniewski
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland; Departments of Anaesthesiology and Intensive Care Teaching Section, Medical University of Warsaw, Warsaw, Poland
| | - Beata Błaszczyk
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Marek Pacholczyk
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Trzebicki
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Dragoumi M, Dragoumis D, Karatzoglou S, Spiridakis I, Chitoglou-Makedou A, Giakoumettis G, Alexidis P, Tremmas I, Papageorgiou I, Drevelegas K, Ntemourtsidis L, Fotoulaki M, Tramma D, Sfougaris D, Kaselas C, Kosmidis C, Sapalidis K, Romanidis K, Zarogoulidis P. The Fluctuations of Melatonin and Copeptin Levels in Blood Serum During Surgical Stress Regarding the Pediatric Population. Curr Pediatr Rev 2021; 17:127-144. [PMID: 33618648 DOI: 10.2174/1573396317666210222115321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Copeptin is known to be associated with heart damage, while melatonin is a regulatory hormone related to circadian rhythm and represents the levels of inflammation in the body. METHODS AND PATIENTS The aim of the study was to measure in different surgeries the levels of copeptin and melatonin at different times before and after surgery in 56 patients aged from 5 days to 13.6 years. We measured copeptin in 50-microL serum and plasma samples from patients before surgery, immediately after surgery, and 24 hours after surgery. The measured levels are aligned with the published GC / MS data, and the sensitivity of the analysis is such that serum and plasma levels can only be measured by rapid extraction. The measurement was made before surgery, immediately after surgery, and 24 hours after surgery. RESULTS The multifactorial statistical analysis revealed a statistically significant difference between the 24-hour postoperative copeptin values in group 1 (mild-moderate gravity surgery) and group 2 (severe surgery) of the severity of the surgery. Post-hoc tests with Tukey correction for age groups in multiple comparisons of the multifactorial analysis revealed a statistically significant difference (p <0.05) between 24-hour postoperative melatonin values in age groups 3 (3-6 years) and 5 (6-12 years old). The age group 3 showed significantly (p <0.05) lower 24 hours postoperative melatonin values compared to the age group 5 (6-12 years). Again, these 3-6-year-olds were more likely to have inflammation due to the severity of the surgery and the presence of inflammation after the surgery. DISCUSSION In summary, copeptin is a reliable biomarker for assessing a patient's health both preoperatively and postoperatively. Copeptin and melatonin are two independent agents and are not related to each other, and more studies will be needed with more patients of the same age and with the same underlying disease to assess their diagnostic value. Finally, melatonin could be considered an indicator of inflammation on its own and based on pre-and post-surgery values to determine a patient's health status and take appropriate actions.
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Affiliation(s)
- Maria Dragoumi
- Pediatrics Surgery Department Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Dragoumis
- Neurosurgical Department G. Papanikolaou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Sotirios Karatzoglou
- Neurosurgical Department G. Papanikolaou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Ioannis Spiridakis
- Pediatrics Surgery Department Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Areti Chitoglou-Makedou
- Biopathology-Clinical Biochemistry Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Petros Alexidis
- Department of radiation oncology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Tremmas
- Orthopaedic Department, Limassol General Hospital, Kato Polemidia, Cyprus
| | - Irini Papageorgiou
- Department of Pediatric Surgery Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Leonidas Ntemourtsidis
- Neurosurgical Department G. Papanikolaou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Maria Fotoulaki
- Pediatrics Department Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Despina Tramma
- Pediatrics Department Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Sfougaris
- 1st Pediatrics Surgery Department Genimatas General Hospital Thessaloniki, Thessaloniki, Greece
| | - Christos Kaselas
- Pediatrics Surgery Department Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Christoforos Kosmidis
- Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos Romanidis
- Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paul Zarogoulidis
- Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
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