The online version of this article (doi:10.1186/s13054-017-1894-8) contains supplementary material, which is available to authorized users.
Acute-on-chronic liver failure (ACLF) is characterized by the presence of acute decompensation (AD) of cirrhosis, organ failure, and high short-term mortality rates. Hemodynamic dysfunction and activation of endogenous vasoconstrictor systems are thought to contribute to the pathogenesis of ACLF. We explored whether copeptin, a surrogate marker of arginine vasopressin, is a potential marker of outcome in patients admitted for AD or ACLF and whether it might be of additional value to conventional prognostic scoring systems in these patients.
All 779 patients hospitalized for AD of cirrhosis from the CANONIC database with at least one serum sample available for copeptin measurement were included. Presence of ACLF was defined according to the CLIF-consortium organ failure (CLIF-C OF) score. Serum copeptin was measured in samples collected at days 0–2, 3–7, 8–14, 15–21, and 22–28 when available. Competing-risk regression analysis was applied to evaluate the impact of serum copeptin and laboratory and clinical data on short-term survival.
Serum copeptin concentration was found to be significantly higher in patients with ACLF compared with those without ACLF at days 0–2 (33 (14–64) vs. 11 (4–26) pmol/L; p < 0.001). Serum copeptin at admission was shown to be a predictor of mortality independently of MELD and CLIF-C OF scores. Moreover, baseline serum copeptin was found to be predictive of ACLF development within 28 days of follow-up.
ACLF is associated with significantly higher serum copeptin concentrations at hospital admission compared with those with traditional AD. Copeptin is independently associated with short-term survival and ACLF development in patients admitted for AD or ACLF.
Additional file 1: Table S1. List of CANONIC study investigators in alphabetical order. (PDF 123 kb)
Additional file 2: Table S2. Comparison of baseline characteristics between the complete cohort of the CANONIC study (n = 1349) and the cohort of the current ancillary study (n = 779). (PDF 38 kb)
Additional file 4: Table S4. Changes in laboratory values over time according to the clinical course of ACLF in patients with ACLF at baseline and a sample available at days 0–2 and days 3–7 (n = 100). (PDF 31 kb)
Additional file 5: Table S5. Correlation coefficients of changes in laboratory and clinical values of patients with a sample available at days 0–2 and days 3–7 (n = 179). (PDF 23 kb)
Additional file 6: Table S6. Parameters associated with 28-day survival in a population of 779 patients admitted for acute decompensation of cirrhosis. Univariate analysis. (PDF 26 kb)
Additional file 7: Table S7. Parameters associated with 90-day survival in a population of 779 patients admitted for acute decompensation of cirrhosis. Univariate analysis. (PDF 26 kb)
Additional file 8: Table S8. Independent predictive factors of ACLF development in 600 patients admitted for acute decompensation of cirrhosis and without ACLF. Multivariate analysis including copeptin as a continuous variable (A) and using its optimal cut-off point in predicting ACLF (B). (PDF 19 kb)
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- Copeptin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival
Annarein J. C. Kerbert
Hein W. Verspaget
Àlex Amorós Navarro
Johan J. van der Reijden
Bart van Hoek
Minneke J. Coenraad
for the CANONIC Study Investigators of the EASL-CLIF Consortium
- BioMed Central
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