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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2020; 26(1): 97-108
Published online Jan 7, 2020. doi: 10.3748/wjg.v26.i1.97
Usefulness of autotaxin for the complications of liver cirrhosis
Xue Shao, Haruki Uojima, Toru Setsu, Tomomi Okubo, Masanori Atsukawa, Yoshihiro Furuichi, Yoshitaka Arase, Hisashi Hidaka, Yoshiaki Tanaka, Takahide Nakazawa, Makoto Kako, Tatehiro Kagawa, Katsuhiko Iwakiri, Shuji Terai, Wasaburo Koizumi
Xue Shao, Haruki Uojima, Hisashi Hidaka, Yoshiaki Tanaka, Takahide Nakazawa, Wasaburo Koizumi, Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0375, Japan
Xue Shao, Department of Hepatopancreatobiliary Medicine, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Haruki Uojima, Makoto Kako, Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, Japan
Toru Setsu, Shuji Terai, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
Tomomi Okubo, Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
Masanori Atsukawa, Katsuhiko Iwakiri, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo 113-8603, Japan
Yoshihiro Furuichi, Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Shinjuku, Tokyo 113-8510, Japan
Yoshitaka Arase, Tatehiro Kagawa, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa 259-1193, Japan
Author contributions: Shao X, Uojima H, Setsu T, Okubo T, Atsukawa M, Furuichi Y, Arase Y, Hidaka H, Tanaka Y, Nakazawa T, Kako M, Kagawa T, Iwakiri K, Terai S and Koizumi W contributed equally to this work; Hidaka H, Shao X, Setsu T, Okubo T and Tanaka Y collected and analyzed the data; Uojima H drafted the manuscript; Hidaka H and Nakazawa T designed and supervised the study; Atsukawa M, Tanaka Y, Arase Y, Kagawa T, Iwakiri K and Koizumi W offered technical or material support. Kako M and Terai S were general supervising of the study group. All authors read and approved the final manuscript
Institutional review board statement: This study was approved by the Institutional Review Board Ethics Committee of the Tokushukai Medical Group, and the protocol for this study conforms to the provisions of the Declaration of Helsinki.
Informed consent statement: This study is a retrospective observational study. Informed consent was obtained from all individual participants included in the study by the opt-out method of our hospital website.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at kiruha@kitasato-u.ac.jp. 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Haruki Uojima, MD, Doctor, Department of Gastroenterology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan. kiruha@kitasato-u.ac.jp
Received: October 31, 2019
Peer-review started: October 31, 2019
First decision: November 22, 2019
Revised: December 4, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: January 7, 2020
ARTICLE HIGHLIGHTS
Research background
Developments of serum biomarkers have focused on the diagnosis of cirrhosis, but more recent researches have emphasized the availability of these markers to assess patients with more advanced fibrosis.
Research motivation
The autotaxin (ATX) level may be a useful biomarker to select treatment therapy for ascites, hepatic encephalopathy, and varix ruptures. And the assessment for the complications of liver cirrhosis (LC) is especially valuable in helping to make treatment decisions.
Research objectives
The aim of this study was to assess the clinical usefulness of ATX for assessing the complications of LC.
Research methods
This multicenter, retrospective study was conducted at six locations in Japan. We include patients with LC, n = 400. The ATX level was evaluated separately in men and women because of its high level in female patients. To assess the clinical usefulness of ATX for the complications of LC, the area under the curve (AUC) of ATX assessing for the severe complications was analyzed in comparison with the model for end-stage liver disease score, albumin-bilirubin (ALBI) score, fibrosis-4 index, and aspartate aminotransferase-to-platelet ratio index.
Research results
The AUCs of ATX in men for hepatic encephalopathy, hepatic ascites, and varix ruptures were 0.853, 0.816, and 0.706, respectively. The AUCs of ATX in women for hepatic encephalopathy, hepatic ascites, and varix rupture were 0.759, 0.717, and 0.697, respectively. The AUCs of ATX in men were higher than those in women, as were all the other biomarkers used to detect encephalopathy and varix ruptures. However, for detecting ascites, the AUC of ALBI in men was more effective than using ATX.
Research conclusions
ATX is a useful biomarker for assessing the complications of LC. Especially, the use of ATX in men was more effective than any other biomarker for detecting hepatic encephalopathy and varix ruptures. The ATX level is especially valuable in helping to make treatment decisions for hepatic encephalopathy and varix ruptures. ATX in men was more effective than any other biomarkers for detecting hepatic encephalopathy and varix ruptures. Developments of serum biomarkers have focused on the diagnosis of cirrhosis and the assessment of advanced fibrosis. Using ATX as a biomarker in men was more efficacious than that of any other biomarkers for hepatic encephalopathy and varix ruptures. To make treatment decisions, it is necessary to consider that patients with high ATX levels may have complications of LC. ATX is a useful clinical biomarker for assessing the complications of LC because it could reflect not only hepatic fibrosis but also hepatic function. Direct biomarkers reflect not only hepatic fibrosis but also hepatic function. The gold standard for assessment of the severity of portal hypertension is the hepatic venous pressure gradient (HVPG). Future studies on the HVPG may make it the first-choice biomarker for the assessment of portal hypertension.
Research perspectives
Direct biomarkers reflect not only hepatic fibrosis but also hepatic function. The gold standard for assessment of the severity of portal hypertension is the HVPG. Future studies on the HVPG may make it the first-choice biomarker for the assessment of portal hypertension. The best method is a direct comparison of the ATX and HVPG for assessing the complications of LC.
