Abstract：
BACKGROUND: Calprotectin is a calcium-binding-S100-protein synthetized mainly in neutrophils which has been demonstrated to be an accurate biomarker of the presence of these cells. Gut barrier dysfunction in patients with advanced chronic liver disease (ACLD), in addition to the lack of noninvasive tools for diagnosis and prognosis of cirrhosis decompensations, has raised interest in this biomarker.
OBJECTIVE: Our aim is to summarize the current evidence regarding the role of calprotectin in terms of its diagnostic and prognostic utility in ACLD.
METHODS: We performed a systematic search (PROSPERO registration no. CRD42023389069) of original articles published without any restrictions on the publication date until January 2023 providing information about calprotectin for the prognosis or diagnosis of ACLD and its decompensations in adult patients.
RESULTS: A total 227 articles were identified, and 26 observational studies finally met the inclusion criteria. In 14 studies, calprotectin was measured in ascitic fluid, all of which reported higher calprotectin values in spontaneous bacterial peritonitis, while cut-off points for its diagnosis were proposed in nine studies. Three studies reported higher faecal calprotectin levels in patients with hepatic encephalopathy and portal hypertension. Four studies evaluated faecal calprotectin and one plasma calprotectin as biomarkers for gut barrier integrity and bacterial translocation.
CONCLUSIONS: Calprotectin is emerging as a promising biomarker in ACLD, particularly for the management of bacterial infections and alcohol-related liver disease. Further research with better study designs should help to determine the feasibility of calprotectin measurement in routine clinical practice.
OBJECTIVE: Our aim is to summarize the current evidence regarding the role of calprotectin in terms of its diagnostic and prognostic utility in ACLD.
METHODS: We performed a systematic search (PROSPERO registration no. CRD42023389069) of original articles published without any restrictions on the publication date until January 2023 providing information about calprotectin for the prognosis or diagnosis of ACLD and its decompensations in adult patients.
RESULTS: A total 227 articles were identified, and 26 observational studies finally met the inclusion criteria. In 14 studies, calprotectin was measured in ascitic fluid, all of which reported higher calprotectin values in spontaneous bacterial peritonitis, while cut-off points for its diagnosis were proposed in nine studies. Three studies reported higher faecal calprotectin levels in patients with hepatic encephalopathy and portal hypertension. Four studies evaluated faecal calprotectin and one plasma calprotectin as biomarkers for gut barrier integrity and bacterial translocation.
CONCLUSIONS: Calprotectin is emerging as a promising biomarker in ACLD, particularly for the management of bacterial infections and alcohol-related liver disease. Further research with better study designs should help to determine the feasibility of calprotectin measurement in routine clinical practice.
摘要：
背景：钙卫蛋白是主要在嗜中性粒细胞中合成的钙结合S100蛋白，已被证明是这些细胞存在的准确生物标志物。晚期慢性肝病（ACLD）患者的肠道屏障功能障碍，除了缺乏用于肝硬化失代偿的诊断和预后的非侵入性工具，引起了人们对这种生物标志物的兴趣。
目的：我们的目的是总结当前关于钙卫蛋白在ACLD中的诊断和预后效用方面的作用的证据。
方法：我们进行了系统搜索（PROSPERO注册号：CRD42023389069）的原始文章发表，直到2023年1月为止，都没有任何限制，提供了有关钙卫蛋白的信息，用于成年患者的ACLD及其代偿失调的预后或诊断。
结果：共鉴定出227篇文章，26项观察性研究最终符合纳入标准.在14项研究中，钙卫蛋白在腹水中测量，所有这些都报道了自发性细菌性腹膜炎中更高的钙卫蛋白值，而九项研究提出了其诊断的临界点。三项研究报道，肝性脑病和门脉高压患者的粪便钙卫蛋白水平较高。四项研究评估了粪便钙卫蛋白和一种血浆钙卫蛋白作为肠道屏障完整性和细菌易位的生物标志物。
结论：钙卫蛋白正在成为ACLD中一种有前途的生物标志物，特别是对于细菌感染和酒精相关性肝病的管理。具有更好的研究设计的进一步研究应有助于确定钙卫蛋白测量在常规临床实践中的可行性。
目的：我们的目的是总结当前关于钙卫蛋白在ACLD中的诊断和预后效用方面的作用的证据。
方法：我们进行了系统搜索（PROSPERO注册号：CRD42023389069）的原始文章发表，直到2023年1月为止，都没有任何限制，提供了有关钙卫蛋白的信息，用于成年患者的ACLD及其代偿失调的预后或诊断。
结果：共鉴定出227篇文章，26项观察性研究最终符合纳入标准.在14项研究中，钙卫蛋白在腹水中测量，所有这些都报道了自发性细菌性腹膜炎中更高的钙卫蛋白值，而九项研究提出了其诊断的临界点。三项研究报道，肝性脑病和门脉高压患者的粪便钙卫蛋白水平较高。四项研究评估了粪便钙卫蛋白和一种血浆钙卫蛋白作为肠道屏障完整性和细菌易位的生物标志物。
结论：钙卫蛋白正在成为ACLD中一种有前途的生物标志物，特别是对于细菌感染和酒精相关性肝病的管理。具有更好的研究设计的进一步研究应有助于确定钙卫蛋白测量在常规临床实践中的可行性。
