■肝硬化预后模型低估了肝硬化和腹水患者的疾病严重程度。微纤相关蛋白4(MFAP4)是一种与肝脏新血管生成和纤维发生相关的细胞外基质蛋白。我们调查了腹水MFAP4作为肝硬化和腹水患者无移植生存的预测因子。
■对连续招募的肝硬化和腹水患者进行了一项双中心观察性研究。患者随访1年,直到死亡或肝移植(LTx)。用终末期肝病模型(MELD-Na)测试腹水MFAP4,CLIF财团急性失代偿(CLIF-CAD),Cox回归模型中的Child-Pugh评分。
■93例需要穿刺的患者被包括在内。腹水MFAP4中位数为29.7U/L[22.3-41.3],MELD-Na为19[16-23]。在49例患者(53%)中观察到低MELD-Na评分(<20)。随访期间,20例患者死亡(22%),6人获得LTx(6%)。高腹水MFAP4(>29.7U/L)与1年无移植生存率相关(p=0.002)。在Cox回归中,腹水MFAP4和MELD-Na独立预测1年无移植生存率(风险比[HR]=0.97,p=0.03,HR=1.08,p=0.01)。腹水MFAP4和CLIF-CAD也独立预测生存期(分别为HR=0.96,p=0.02和HR=1.05,p=0.03),而只有腹水MFAP4,控制Child-Pugh评分(分别为HR=0.97,p=0.03,HR=1.18,p=0.16)。对于MELD-Na<20的患者,腹水MFAP4而不是腹水蛋白可预测1年无移植生存率(分别为HR0.91,p=0.02,HR=0.94,p=0.17)。
■腹水MFAP4预测肝硬化和腹水患者1年无移植生存率。在MELD-Na评分较低的患者中,腹水MFAP4,但不是总腹水蛋白,显著预测1年无移植生存期。
■肝硬化患者腹部有液体,腹水,死亡风险增加,需要肝移植。我们的研究通过测量微纤维相关蛋白4(MFAP4)来确定腹水和预后不良的患者。一种存在于腹腔液中的蛋白质.MFAP4蛋白水平低的患者死亡或肝移植的风险特别高。建议应加强对这组患者的临床护理。
UNASSIGNED: Prognostic models of cirrhosis underestimate disease severity for patients with cirrhosis and ascites. Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein linked to hepatic neoangiogenesis and fibrogenesis. We investigated ascites MFAP4 as a predictor of transplant-free survival in patients with cirrhosis and ascites.
UNASSIGNED: A dual-centre observational study of patients with cirrhosis and ascites recruited consecutively in relation to a paracentesis was carried out. Patients were followed up for 1 year, until death or liver transplantation (LTx). Ascites MFAP4 was tested with the model for end-stage liver disease (MELD-Na), CLIF Consortium Acute Decompensation (CLIF-C AD), and Child-Pugh score in Cox regression models.
UNASSIGNED: Ninety-three patients requiring paracentesis were included. Median ascites MFAP4 was 29.7 U/L [22.3-41.3], and MELD-Na was 19 [16-23]. A low MELD-Na score (<20) was observed in 49 patients (53%). During follow-up, 20 patients died (22%), and 6 received LTx (6%). High ascites MFAP4 (>29.7 U/L) was associated with 1-year transplant-free survival (p = 0.002). In Cox regression, ascites MFAP4 and MELD-Na independently predicted 1-year transplant-free survival (hazard ratio [HR] = 0.97, p = 0.03, and HR = 1.08, p = 0.01, respectively). Ascites MFAP4 and CLIF-C AD also predicted survival independently (HR = 0.96, p = 0.02, and HR = 1.05, p = 0.03, respectively), whereas only ascites MFAP4 did, controlling for the Child-Pugh score (HR = 0.97, p = 0.03, and HR = 1.18, p = 0.16, respectively). For patients with MELD-Na <20, ascites MFAP4 but not ascites protein predicted 1-year transplant-free survival (HR 0.91, p = 0.02, and HR = 0.94, p = 0.17, respectively).
UNASSIGNED: Ascites MFAP4 predicts 1-year transplant-free survival in patients with cirrhosis and ascites. In patients with low MELD-Na scores, ascites MFAP4, but not total ascites protein, significantly predicted 1-year transplant-free survival.
UNASSIGNED: Patients with cirrhosis who have fluid in the abdomen, ascites, are at an increased risk of death and in need for liver transplantation. Our study identified patients with ascites and a poor prognosis by measuring microfibrillar associated protein 4 (MFAP4), a protein present in the abdominal fluid. Patients with low levels of the MFAP4 protein are at particularly increased risk of death or liver transplantation, suggesting that clinical care should be intensified in this group of patients.