Published online May 28, 2015. doi: 10.4254/wjh.v7.i9.1244
Peer-review started: December 2, 2014
First decision: January 8, 2015
Revised: February 2, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 28, 2015
Determining the prognosis of cirrhotic patients is not an easy task. Prognostic scores, like Child-Pugh and Model of End-stage Liver Disease scores, are commonly used by hepatologists, but do not always reflect superimposed events that may strongly influence the prognosis. Among them, bacterial intestinal translocation is a key phenomenon for the development of cirrhosis-related complications. Several biological variables (C-reactive protein, serum free cortisol, copeptin, von Willebrand factor antigen) are surrogates of “inflammatory stress” and have recently been identified as potential prognostic markers in cirrhotic patients. Most of these above mentioned markers were investigated in pilot studies with sometimes a modest sample size but allow us to catch a glimpse of the pathophysiological mechanisms leading to the worsening of cirrhosis. These new data should generate further well-designed studies to better assess the benefit for liver function of preventing intestinal bacterial translocation and microvascular thrombosis. The control of infection is vital and among all actors of immunity, vitamin D also appears to act as an anti-infective agent and therefore has probably a prognostic value.
Core tip: This review provides new insights on the prognosis of cirrhotic patients. Several biological markers account for events that strongly impact on prognosis but are not taken into account by common prognosis scores such as Child-Pugh or Model of End-stage Liver Disease. The rationale for the use of these markers is discussed on the basis of the most recent available data.