Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3020
Peer-review started: September 7, 2014
First decision: October 14, 2014
Revised: October 31, 2014
Accepted: December 14, 2014
Article in press: December 16, 2014
Published online: March 14, 2015
AIM: To investigate the adipokine levels of leptin, adiponectin, resistin, visfatin, retinol-binding protein 4 (RBP4), apelin in alcoholic liver cirrhosis (ALC).
METHODS: Forty non-diabetic ALC patients [median age: 59 years, males: 35 (87.5%), Child-Pugh (CP) score: median 7 (5-12), CP A/B/C: 18/10/12, Model for End-stage Liver Disease (MELD): median 10 (6-25), follow-up: median 32.5 mo (10-43)] were prospectively included. The serum adipokine levels were estimated in duplicate by ELISA. Somatometric characteristics were assessed with tetrapolar bioelectrical impedance analysis. Pearson’s rank correlation coefficient was used to assess possible associations with adipokine levels. Univariate and multivariate Cox regression analysis was used to determine independent predictors for overall survival.
RESULTS: Body mass index: median 25.9 (range: 20.1-39.3), fat: 23.4% (7.6-42.1), fat mass: 17.8 (5.49-45.4), free fat mass: 56.1 (39.6-74.4), total body water (TBW): 40.6 (29.8-58.8). Leptin and visfatin levels were positively associated with fat mass (P < 0.001/P = 0.027, respectively) and RBP4 with TBW (P = 0.025). Median adiponectin levels were significantly higher in CPC compared to CPA (CPA: 7.99 ± 14.07, CPB: 7.66 ± 3.48, CPC: 25.73 ± 26.8, P = 0.04), whereas median RBP4 and apelin levels decreased across the spectrum of disease severity (P = 0.006/P = 0.034, respectively). Following adjustment for fat mass, visfatin and adiponectin levels were significantly increased from CPA to CPC (both P < 0.001), whereas an inverse correlation was observed for both RBP4 and apelin (both P < 0.001). In the multivariate Cox regression analysis, only MELD had an independent association with overall survival (HR = 1.53, 95%CI: 1.05-2.32; P = 0.029).
CONCLUSION: Adipokines are associated with deteriorating liver function in a complex manner in patients with alcoholic liver cirrhosis.
Core tip: Ongoing data suggest that obesity and insulin resistance are associated with a more rapid progression of the fibrogenic process in chronic liver diseases, with different adipokines contributing to the complex pathophysiology of hepatic injury and repair. In cirrhosis, accumulating data demonstrate an alteration in the levels of different adipokines; although most studies did not exclude patients with baseline diabetes which is itself associated with altered adipokines. Alcoholic cirrhosis has been the least studied. The present study evaluates the serum levels of six adipokines in non-diabetic patients with alcoholic cirrhosis and investigates their potential association with liver disease severity.