Published online Nov 27, 2022. doi: 10.4254/wjh.v14.i11.1964
Peer-review started: October 2, 2022
First decision: October 11, 2022
Revised: October 18, 2022
Accepted: November 2, 2022
Article in press: November 2, 2022
Published online: November 27, 2022
Systemic inflammation is a hallmark of advanced cirrhosis. Calprotectin is a biomarker of neutrophil activity with high stability in biological fluids. Circulating levels of calprotectin may be an interesting biomarker of systemic inflammation in cirrhosis.
There is a need for inflammatory biomarkers for practical and objective use in cirrhosis. Serum calprotectin has gained relevance in recent years in several other diseases characterized by systemic inflammation.
To investigate factors associated with serum calprotectin levels in acute decompensation of cirrhosis, and to evaluate circulating calprotectin as a prognostic biomarker in patients with complications of cirrhosis.
This is a prospective cohort study that included three study groups: 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was collected at hospital admission in the group with acute decompensation. Hospitalized patients were followed for 30 d for survival analysis
Higher calprotectin was associated with variables related to more advanced liver disease, acute-on-chronic liver failure (ACLF), and infection. Calprotectin was not associated with survival among patients with ACLF. In patients with acute decompensation without ACLF, higher calprotectin was inversely associated with 30-d survival. The combination of calprotectin with the CLIF-C AD score offered a better prognostic discrimination than the variables alone.
Serum calprotectin are increased in liver cirrhosis and correlated with variables associated with the severity of liver disease. Higher circulating calprotectin is associated with a worse 30-d survival in those hospitalized for complications of cirrhosis without ACLF. The combination of serum calprotectin and CLIF-C AD score is able to better stratify the prognosis than any of the factors alone.
The routine incorporation of the calprotectin test is a reality. Serum calprotectin may allow early identification of patients with a very low short-term survival, even in the absence of ACLF at admission. Larger, multicentric future studies are recommended to validate these results.