sTREM-1 as promising prognostic biomarker for acute-on-chronic liver failure and mortality in patients with acute decompensation of cirrhosis

doi:10.3748/wjg.v30.i9.1177

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Mar 7, 2024; 30(9): 1177-1188
Published online Mar 7, 2024. doi: 10.3748/wjg.v30.i9.1177

Table 1 Baseline characteristics of patients from study cohort according to 365-d survival, n (%)

Variable	Survivors¹ (n = 220)	Non-survivors (n = 78)	P value	Multivariate Cox regression
Variable	Survivors¹ (n = 220)	Non-survivors (n = 78)	P value	HR (95%CI)	P value
Age (yr)	51 ± 12	52 ± 11	0.692
Sex, female	68 (31)	23 (30)	0.815
Etiology
HBV	149 (68)	48 (62)	0.321
HCV	17 (8)	3 (4)	0.239
Alcohol	30 (14)	15 (19)	0.236
Autoimmune	27 (12)	10 (13)	0.900
Others	15 (7)	10 (13)	0.100
ACLF	12 (6)	28 (36)	< 0.001
Bacterial infection	64 (29)	40 (51)	< 0.001
UGIB	40 (18)	16 (21)	0.651
Ascites	160 (73)	64 (82)	0.101
HE (I-II/III-IV)	18/3	12/6	0.003	1.669 (1.094-2.546)	0.017
WBC (×10⁹/L)	4.6 (3.1-6.0)	6.4 (4.4-9.4)	< 0.001		0.627
Hb (g/L)	111 (87-126)	106 (80-124)	0.132
Platelets (×10⁹/L)	71 (45-113)	60 (45-102)	0.226
Albumin (g/L)	30 (27-34)	29 (24-33)	0.030		0.213
ALT (U/L)	46 (27-120)	77 (35-296)	0.021		0.581
AST (U/L)	64 (38-138)	107 (62-258)	0.001		0.123
TBil (mg/dL)	3.0 (1.3-9.8)	11.7 (4.5-25.9)	< 0.001	1.333 (1.053-1.688)	0.017
INR	1.4 (1.2-1.7)	1.9 (1.5-2.6)	< 0.001	8.546 (3.850-18.968)	< 0.001
Creatinine (mg/dL)	0.8 (0.6-0.9)	0.8 (0.6-1.1)	0.112
BUN (mmol/L)	4.7 (3.5-6.7)	6.0 (3.8-10.2)	0.003	2.065 (1.345-3.171)	0.001
Sodium (mmol/L)	138 (135-140)	135 (130-138)	< 0.001		0.529
CRP (mg/L)	3.2 (1.9-4.0)	3.9 (3.4-4.3)	< 0.001		0.070
PCT (μg/L)	0.1 (0.1-0.3)	0.3 (0.1-0.7)	< 0.001		0.403
sCD14-ST (mg/L)	1.2 (1.0-1.5)	1.3 (1.0-1.6)	0.170
sTREM-1 (μg/L)	0.8 (0.6-1.1)	1.2 (0.9-1.6)	< 0.001	2.163 (1.295-3.614)	0.003
Organ failure
Liver	43 (20)	39 (50)	< 0.001
Coagulation	6 (3)	20 (26)	< 0.001
Cerebral	3 (1)	6 (8)	0.015
Lung	0 (0)	0 (0)	1.000
Circulation	2 (1)	0 (0)	1.000
Kidney	3 (1)	6 (8)	0.015
MELD	11 (6-17)	22 (11-26)	< 0.001
MELD-Na	11 (7-19)	24 (17-30)	< 0.001
CLIF-C ACLF	33 ± 7	40 ± 9	< 0.001
CLIF-C AD	44 ± 9	55 ± 12	< 0.001
P-AD	2.6 (2.1-3.4)	4.4 (3.2-5.1)	< 0.001

¹Transplanted-free survivors.

The data are expressed as mean ± SD, medians (interquartile range) or number of patients (%). Student’s t-test or Mann-Whitney U test was used for continuous variables and χ² test or Fisher exact test for categorical variables.

ACLF: Acute-on-chronic liver failure; UGIB: Upper gastrointestinal bleeding; BUN: Blood urea nitrogen; TBil: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; INR: International normalized ratio; HE: Hepatic encephalopathy; CRP: C-reactive protein; PCT: Procalcitonin; sCD14-ST: Soluble CD14 subtype; sTREM-1: Soluble triggering receptor expressed on myeloid cell-1; MELD: Model for end-stage liver disease; MELD-Na: Model for end-stage liver disease-sodium; CLIF-C ACLF: Chronic liver failure-consortium acute-on-chronic liver failure score; CLIF-C AD: Chronic liver failure-consortium acute decompensation score; P-AD: Prognostic model of acute decompensation; HR: Hazard ratio.

Table 2 Baseline characteristics of patients according to the development of acute-on-chronic liver failure during 28-d follow-up, n (%)

Variable	No ACLF during¹ Follow-up (n = 340)	ACLF during Follow-up (n = 36)	P value	Multivariate logistic regression
Variable	No ACLF during¹ Follow-up (n = 340)	ACLF during Follow-up (n = 36)	P value	RR (95%CI)	P value
Age (yr)	51 ± 12	51 ± 12	0.959
Sex, female	120 (35%)	8 (22%)	0.115
Etiology
HBV	204 (60%)	27 (75%)	0.079
HCV	28 (8%)	1 (3%)	0.402
Alcohol	54 (16%)	5 (14%)	0.755
Autoimmune	48 (14%)	3 (8%)	0.479
Others	29 (9%)	3 (8%)	0.968
Bacterial infection	105 (31%)	21 (58%)	0.001
UGIB	71 (21%)	4 (11%)	0.240
Ascites	240 (71%)	33 (92%)	0.012		0.057
HE (I-II/III-IV)	25/6	0/0	0.167
WBC (×10⁹/L)	4.5 (3.0-6.1)	6.3 (4.8-8.1)	< 0.001		0.991
Hb (g/L)	108 (87-124)	116 (102-126)	0.165
Platelets (×10⁹/L)	69 (47-111)	63 (45-91)	0.247
Albumin (g/L)	30 (27-34)	30 (26-33)	0.744
ALT (U/L)	46 (26-118)	132 (67-321)	< 0.001		0.236
AST (U/L)	63 (38-136)	183 (107-326)	< 0.001	1.971 (1.228-3.163)	0.005
TBil (mg/dL)	3.1 (1.4-8.9)	16.1 (10.0-26.8)	< 0.001	3.151 (1.717-5.782)	< 0.001
INR	1.4 (1.2-1.7)	1.9 (1.6-2.2)	< 0.001	13.841 (2.021-94.767)	0.007
Creatinine (mg/dL)	0.7 (0.6-0.9)	0.8 (0.6-1.0)	0.297		0.929
BUN (mmol/L)	4.6 (3.5-6.7)	5.6 (3.5-8.2)	0.219	3.302 (1.352-8.067)	0.009
Sodium (mmol/L)	138 (135-140)	136 (132-139)	0.016		0.962
CRP (mg/L)	3.2 (1.6-4.0)	3.7 (3.3-4.1)	0.006		0.339
PCT (μg/L)	0.1 (0.1-0.3)	0.4 (0.2-0.6)	< 0.001		0.709
sCD14-ST (mg/L)	1.2 (1.0-1.5)	1.2 (1.0-1.6)	0.226
sTREM-1 (μg/L)	0.8 (0.6-1.0)	1.2 (1.0-1.3)	< 0.001	3.023 (1.053-8.677)	0.040
Organ failure
Liver	58 (17%)	21 (58%)	< 0.001
Coagulation	5 (2%)	5 (14%)	< 0.001
Cerebral	6 (2%)	0 (0%)	1.000
Lung	0 (0%)	0 (0%)	1.000
Circulation	1 (0%)	0 (0%)	1.000
Kidney	0 (0%)	0 (0%)	1.000
MELD	11 ± 7	20 ± 5	< 0.001
MELD-Na	12 (7-18)	24 (20-29)	< 0.001
CLIF-C ACLF	33 (28-38)	39 (35-42)	< 0.001
CLIF-C AD	44 ± 8	53 ± 8	< 0.001
P-AD	2.6 (2.1-3.3)	4.1 (3.5-4.5)	< 0.001
ACLF-R	6.6 (5.0-8.4)	10.5 (9.7-11.3)	< 0.001

¹No liver transplantation and acute-on-chronic liver failure score development during 28-d follow-up.

ACLF: Acute-on-chronic liver failure score; UGIB: Upper gastrointestinal bleeding; BUN: Blood urea nitrogen; TBil: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; INR: International normalized ratio; HE: Hepatic encephalopathy; CRP: C-reactive protein; PCT: Procalcitonin; sCD14-ST: Soluble CD14 subtype; sTREM-1: Soluble triggering receptor expressed on myeloid cell-1; MELD: Model for end-stage liver disease; MELD-Na: Model for end-stage liver disease -sodium; CLIF-C ACLF: Chronic liver failure-consortium acute-on-chronic liver failure score score. CLIF-C AD: Chronic liver failure-consortium acute decompensation score; P-AD: Prognostic model of acute decompensation; ACLF-R: Acute-on-chronic liver failure score risk score; RR: Relative risk.

Table 3 Efficiency of prognostic scores to predict development of acute-on-chronic liver failure during 28-d follow-up

Score	AUROC	95% CI	P value¹	P value²
ACLF-R	0.91	0.88-0.94
P-AD	0.87	0.83-0.90		0.012
MELD	0.84	0.80-0.88	0.397	0.013
MELD-Na	0.83	0.79-0.87	0.225	0.004
CLIF-C AD	0.80	0.75-0.84	0.029	0.003
CLIF-C ACLF	0.78	0.74-0.82	0.006	< 0.001

¹Prognostic model of acute decompensation area under the receiver operating curve (AUROC) vs prognostic score AUROC.

²Acute-on-chronic liver failure risk score AUROC vs prognostic score AUROC.

ACLF-R: Acute-on-chronic liver failure risk score; P-AD: Prognostic model of acute decompensation; MELD: Model for end-stage liver disease; MELD-Na: Model for end-stage liver disease-sodium; CLIF-C ACLF: Chronic liver failure-consortium acute-on-chronic liver failure risk score; CLIF-C AD: Chronic liver failure-consortium acute decompensation score; AUROC: Area under the receiver operating curve.

Citation: Yu SM, Li H, Deng GH, Wang XB, Zheng X, Chen JJ, Meng ZJ, Zheng YB, Gao YH, Qian ZP, Liu F, Lu XB, Shi Y, Shang J, Chen RC, Huang Y. sTREM-1 as promising prognostic biomarker for acute-on-chronic liver failure and mortality in patients with acute decompensation of cirrhosis. World J Gastroenterol 2024; 30(9): 1177-1188
URL: https://www.wjgnet.com/1007-9327/full/v30/i9/1177.htm
DOI: https://dx.doi.org/10.3748/wjg.v30.i9.1177