Fibroblast growth factor 21 is an early predictor of acute-on-chronic liver failure in critically ill patients with cirrhosis

Astrid Ruiz-Margáin, Alessandra Pohlmann, Patrick Ryan, Robert Schierwagen, Luis A Chi-Cervera, Christian Jansen, Osvely Mendez-Guerrero, Nayelli C Flores-García, Jennifer Lehmann, Aldo Torre, Ricardo Ulises Macías-Rodríguez, Jonel Trebicka

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Acute-on-chronic liver failure (ACLF) develops in acute decompensation (AD) of cirrhosis and shows high mortality. In critically ill patients, early diagnosis of ACLF could be important for therapeutic decisions (eg, renal replacement, artificial liver support, liver transplantation). This study evaluated fibroblast growth factor 21 (FGF21) as a marker of mitochondrial dysfunction in the context of ACLF. The study included 154 individuals (112 critically patients and 42 healthy controls) divided into a training and a validation cohort. In the training cohort of 42 healthy controls and 34 critically ill patients (of whom 24 were patients with cirrhosis), levels of FGF21, interleukin (IL) 6, and IL8 were measured. In the validation cohort of 78 patients with cirrhosis, 17 patients were admitted with or developed ACLF during follow-up and underwent daily clinical and nutritional assessment. Levels of FGF21 were higher in critically ill patients, especially in patients with cirrhosis admitted to the intensive care unit (ICU). Moreover, FGF21 as well as IL6 and IL8 levels were higher in patients with ACLF, but they did not increase with the severity of ACLF. Interestingly, in the validation cohort, FGF21 was also elevated in the patients who developed ACLF in the next 7 days. In these patients, FGF21 levels were an independent predictor of ACLF presence and development in multivariate analysis together with Child-Pugh score. FGF21 levels had no impact on the survival of critically ill patients with cirrhosis. In conclusion, this study demonstrates that FGF21 levels are of specific diagnostic value regarding the presence and development of ACLF in patients admitted to ICU for AD of liver cirrhosis. Further studies are warranted to address pathophysiological and possible therapeutic implications. Liver Transplantation 24 595-605 2018 AASLD.

OriginalsprogEngelsk
TidsskriftLiver Transplantation
Vol/bind24
Udgave nummer5
Sider (fra-til)595-605
ISSN1527-6465
DOI
StatusUdgivet - 1. maj 2018

Fingeraftryk

Critical Illness
Interleukin-8
Liver Transplantation
Acute-On-Chronic Liver Failure
fibroblast growth factor 21
Intensive Care Units
Interleukin-6
Artificial Liver
Nutrition Assessment
Liver Cirrhosis
Multivariate Analysis
Kidney

Citer dette

Ruiz-Margáin, Astrid ; Pohlmann, Alessandra ; Ryan, Patrick ; Schierwagen, Robert ; Chi-Cervera, Luis A ; Jansen, Christian ; Mendez-Guerrero, Osvely ; Flores-García, Nayelli C ; Lehmann, Jennifer ; Torre, Aldo ; Macías-Rodríguez, Ricardo Ulises ; Trebicka, Jonel. / Fibroblast growth factor 21 is an early predictor of acute-on-chronic liver failure in critically ill patients with cirrhosis. I: Liver Transplantation. 2018 ; Bind 24, Nr. 5. s. 595-605.
@article{d4eeb80da3e44dfcb9b87c11c7318037,
title = "Fibroblast growth factor 21 is an early predictor of acute-on-chronic liver failure in critically ill patients with cirrhosis",
abstract = "Acute-on-chronic liver failure (ACLF) develops in acute decompensation (AD) of cirrhosis and shows high mortality. In critically ill patients, early diagnosis of ACLF could be important for therapeutic decisions (eg, renal replacement, artificial liver support, liver transplantation). This study evaluated fibroblast growth factor 21 (FGF21) as a marker of mitochondrial dysfunction in the context of ACLF. The study included 154 individuals (112 critically patients and 42 healthy controls) divided into a training and a validation cohort. In the training cohort of 42 healthy controls and 34 critically ill patients (of whom 24 were patients with cirrhosis), levels of FGF21, interleukin (IL) 6, and IL8 were measured. In the validation cohort of 78 patients with cirrhosis, 17 patients were admitted with or developed ACLF during follow-up and underwent daily clinical and nutritional assessment. Levels of FGF21 were higher in critically ill patients, especially in patients with cirrhosis admitted to the intensive care unit (ICU). Moreover, FGF21 as well as IL6 and IL8 levels were higher in patients with ACLF, but they did not increase with the severity of ACLF. Interestingly, in the validation cohort, FGF21 was also elevated in the patients who developed ACLF in the next 7 days. In these patients, FGF21 levels were an independent predictor of ACLF presence and development in multivariate analysis together with Child-Pugh score. FGF21 levels had no impact on the survival of critically ill patients with cirrhosis. In conclusion, this study demonstrates that FGF21 levels are of specific diagnostic value regarding the presence and development of ACLF in patients admitted to ICU for AD of liver cirrhosis. Further studies are warranted to address pathophysiological and possible therapeutic implications. Liver Transplantation 24 595-605 2018 AASLD.",
author = "Astrid Ruiz-Marg{\'a}in and Alessandra Pohlmann and Patrick Ryan and Robert Schierwagen and Chi-Cervera, {Luis A} and Christian Jansen and Osvely Mendez-Guerrero and Flores-Garc{\'i}a, {Nayelli C} and Jennifer Lehmann and Aldo Torre and Mac{\'i}as-Rodr{\'i}guez, {Ricardo Ulises} and Jonel Trebicka",
note = "{\circledC} 2018 by the American Association for the Study of Liver Diseases.",
year = "2018",
month = "5",
day = "1",
doi = "10.1002/lt.25041",
language = "English",
volume = "24",
pages = "595--605",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "JohnWiley & Sons, Inc.",
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Ruiz-Margáin, A, Pohlmann, A, Ryan, P, Schierwagen, R, Chi-Cervera, LA, Jansen, C, Mendez-Guerrero, O, Flores-García, NC, Lehmann, J, Torre, A, Macías-Rodríguez, RU & Trebicka, J 2018, 'Fibroblast growth factor 21 is an early predictor of acute-on-chronic liver failure in critically ill patients with cirrhosis', Liver Transplantation, bind 24, nr. 5, s. 595-605. https://doi.org/10.1002/lt.25041

Fibroblast growth factor 21 is an early predictor of acute-on-chronic liver failure in critically ill patients with cirrhosis. / Ruiz-Margáin, Astrid; Pohlmann, Alessandra; Ryan, Patrick; Schierwagen, Robert; Chi-Cervera, Luis A; Jansen, Christian; Mendez-Guerrero, Osvely; Flores-García, Nayelli C; Lehmann, Jennifer; Torre, Aldo; Macías-Rodríguez, Ricardo Ulises; Trebicka, Jonel.

I: Liver Transplantation, Bind 24, Nr. 5, 01.05.2018, s. 595-605.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Fibroblast growth factor 21 is an early predictor of acute-on-chronic liver failure in critically ill patients with cirrhosis

AU - Ruiz-Margáin, Astrid

AU - Pohlmann, Alessandra

AU - Ryan, Patrick

AU - Schierwagen, Robert

AU - Chi-Cervera, Luis A

AU - Jansen, Christian

AU - Mendez-Guerrero, Osvely

AU - Flores-García, Nayelli C

AU - Lehmann, Jennifer

AU - Torre, Aldo

AU - Macías-Rodríguez, Ricardo Ulises

AU - Trebicka, Jonel

N1 - © 2018 by the American Association for the Study of Liver Diseases.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Acute-on-chronic liver failure (ACLF) develops in acute decompensation (AD) of cirrhosis and shows high mortality. In critically ill patients, early diagnosis of ACLF could be important for therapeutic decisions (eg, renal replacement, artificial liver support, liver transplantation). This study evaluated fibroblast growth factor 21 (FGF21) as a marker of mitochondrial dysfunction in the context of ACLF. The study included 154 individuals (112 critically patients and 42 healthy controls) divided into a training and a validation cohort. In the training cohort of 42 healthy controls and 34 critically ill patients (of whom 24 were patients with cirrhosis), levels of FGF21, interleukin (IL) 6, and IL8 were measured. In the validation cohort of 78 patients with cirrhosis, 17 patients were admitted with or developed ACLF during follow-up and underwent daily clinical and nutritional assessment. Levels of FGF21 were higher in critically ill patients, especially in patients with cirrhosis admitted to the intensive care unit (ICU). Moreover, FGF21 as well as IL6 and IL8 levels were higher in patients with ACLF, but they did not increase with the severity of ACLF. Interestingly, in the validation cohort, FGF21 was also elevated in the patients who developed ACLF in the next 7 days. In these patients, FGF21 levels were an independent predictor of ACLF presence and development in multivariate analysis together with Child-Pugh score. FGF21 levels had no impact on the survival of critically ill patients with cirrhosis. In conclusion, this study demonstrates that FGF21 levels are of specific diagnostic value regarding the presence and development of ACLF in patients admitted to ICU for AD of liver cirrhosis. Further studies are warranted to address pathophysiological and possible therapeutic implications. Liver Transplantation 24 595-605 2018 AASLD.

AB - Acute-on-chronic liver failure (ACLF) develops in acute decompensation (AD) of cirrhosis and shows high mortality. In critically ill patients, early diagnosis of ACLF could be important for therapeutic decisions (eg, renal replacement, artificial liver support, liver transplantation). This study evaluated fibroblast growth factor 21 (FGF21) as a marker of mitochondrial dysfunction in the context of ACLF. The study included 154 individuals (112 critically patients and 42 healthy controls) divided into a training and a validation cohort. In the training cohort of 42 healthy controls and 34 critically ill patients (of whom 24 were patients with cirrhosis), levels of FGF21, interleukin (IL) 6, and IL8 were measured. In the validation cohort of 78 patients with cirrhosis, 17 patients were admitted with or developed ACLF during follow-up and underwent daily clinical and nutritional assessment. Levels of FGF21 were higher in critically ill patients, especially in patients with cirrhosis admitted to the intensive care unit (ICU). Moreover, FGF21 as well as IL6 and IL8 levels were higher in patients with ACLF, but they did not increase with the severity of ACLF. Interestingly, in the validation cohort, FGF21 was also elevated in the patients who developed ACLF in the next 7 days. In these patients, FGF21 levels were an independent predictor of ACLF presence and development in multivariate analysis together with Child-Pugh score. FGF21 levels had no impact on the survival of critically ill patients with cirrhosis. In conclusion, this study demonstrates that FGF21 levels are of specific diagnostic value regarding the presence and development of ACLF in patients admitted to ICU for AD of liver cirrhosis. Further studies are warranted to address pathophysiological and possible therapeutic implications. Liver Transplantation 24 595-605 2018 AASLD.

U2 - 10.1002/lt.25041

DO - 10.1002/lt.25041

M3 - Journal article

C2 - 29476704

VL - 24

SP - 595

EP - 605

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 5

ER -