Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis

Figure 1 Box plot of serum calprotectin levels among healthy controls, stable cirrhostics, and hospitalized cirrhotics with acute decompensation. The line across the box indicates the median value; the box contains the 25% to 75% interquartile range; and the whiskers represent the highest and the lower values. There were no differences in calprotectin levels between patients with acute decompensation and stable cirrhosis patients (P = 0.127). Significantly lower calprotectin levels were observed among healthy controls compared to stable cirrhosis (P < 0.001) and patients with acute decompensation (P < 0.001).

Figure 2 Box plot of serum calprotectin levels in patients with acute decompensation of cirrhosis according to the presence of specific complications. The line across the box indicates the median value; the box contains the 25% to 75% interquartile range; and the whiskers represent the highest and the lower values. A-D: Significantly higher calprotectin levels were observed among patients with (A) acute-on-chronic liver failure (P = 0.047), (B) infection (P = 0.012), (C) ascites (P = 0.004), and (D) hepatic encephalopathy (HE) (P = 0.026); E: Lower levels of calprotectin were observed among patients with upper gastrointestinal bleeding (UGIB) (P = 0.036); F: Higher levels in patients with hepatitis C virus infection (HCV) (P = 0.001).

Figure 3 Cumulative 30-d survival of patients hospitalized with acute decompensation of cirrhosis without acute-on-chronic liver failure according to calprotectin levels categorized at 580 ng/mL and CLIF-C acute decompensation score at 60. A: The Kaplan-Meier survival probability was 96.5% in subjects with a calprotectin level < 580 ng/mL and 72.7% in those with a value ≥ 580 ng/mL (P < 0.001); B: The Kaplan-Meier survival probability was 93.3% in individuals with a CLIF-C acute decompensation (AD) score < 60 and 54.5% in those with a value ≥ 60 (P < 0.001); C: The Kaplan-Meier survival probability was 98.7% in subjects with a CLIF-C AD score < 60 and calprotectin concentration < 580 ng/mL, 84.1% in subjects with a CLIF-C AD score ≥ 60 and calprotectin concentration < 580 ng/mL, 81.4% in subjects with a CLIF-C AD score < 60 and calprotectin concentration ≥ 580 ng/mL, and 27.3% in subjects with a CLIF-C AD score ≥ 60 and calprotectin concentration ≥ 580 ng/mL; D: The Kaplan-Meier survival probability was 98.7% in subjects with none of the factors (CLIF-C AD score < 60 and calprotectin concentration < 580 ng/mL), 83.6% in subjects with one of the factors (CLIF-C AD score ≥ 60 and calprotectin < 580 ng/mL or CLIF-C AD score < 60 and calprotectin ≥ 580 ng/mL), and 27.3% in subjects with both factors (CLIF-C AD score ≥ 60 and calprotectin ≥ 580 ng/mL), in which P = 0.002 between the first and second groups, and P < 0.001 between the first and third, and between the second and third groups.