Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3020-3029
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3020
Adipokines levels are associated with the severity of liver disease in patients with alcoholic cirrhosis
Maria Kalafateli, Christos Triantos, Emmanuel Tsochatzis, Marina Michalaki, Efstratios Koutroumpakis, Konstantinos Thomopoulos, Venetsanea Kyriazopoulou, Eleni Jelastopulu, Andrew Burroughs, Chryssoula Lambropoulou-Karatza, Vasiliki Nikolopoulou
Maria Kalafateli, Christos Triantos, Efstratios Koutroumpakis, Konstantinos Thomopoulos, Vasiliki Nikolopoulou, Department of Gastroenterology, University Hospital of Patras, 26504 Patras, Greece
Emmanuel Tsochatzis, Andrew Burroughs, The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London NW32QG, United Kingdom
Marina Michalaki, Venetsanea Kyriazopoulou, Department of Endocrinology, University Hospital of Patras, 26504 Patras, Greece
Eleni Jelastopulu, Department of Public Health, Medical School, University of Patras, 26504 Patras, Greece
Chryssoula Lambropoulou-Karatza, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece
Author contributions: All authors substantially contributed to conception and design, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content and final approval of the version to be published; Kalafateli M collected, analyzed and interpreted the data, and drafted the manuscript; Triantos C contributed to conception and design of the study, collection, analysis and interpretation of data, drafting the manuscript; Tsochatzis E, Michalaki M and Kyriazopoulou V designed the study and drafted the manuscript; Koutroubakis E collected the data; Thomopoulos K contributed to collection of data, revising the manuscript; Jelastopulu E contributed to statistical analysis, drafting the manuscript; Nikolopoulou V contributed to interpretation of data, revising the manuscript; Lambropoulou-Karatza C contributed to revising the manuscript; Burroughs A contributed to conception and design of the study, analysis and interpretation of data, drafting the manuscript.
Ethics approval: The study was reviewed and approved by the Institutional Review Board of the University Hospital of Patras.
Informed consent: Informed consent was obtained from each participant.
Conflict-of-interest: Dr Triantos has received fees for serving as a speaker for Bristol-Myers Squibb and Gilead.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Christos Triantos, MD, Department of Gastroenterology, University Hospital of Patras, Stamatopoulou 4, Rio, 26504 Patras, Greece.
Telephone: +30-697-2894651 Fax: +30-261-0625382
Received: September 6, 2014
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.

Keywords: Adipokines, Adiponectin, Cirrhosis, Leptin, Resistin

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.