New prognostic markers in liver cirrhosis

Abstract

Determining the prognosis of cirrhotic patients is not an easy task. Prognostic scores, like Child-Pugh and Model of End-stage Liver Disease scores, are commonly used by hepatologists, but do not always reflect superimposed events that may strongly influence the prognosis. Among them, bacterial intestinal translocation is a key phenomenon for the development of cirrhosis-related complications. Several biological variables (C-reactive protein, serum free cortisol, copeptin, von Willebrand factor antigen) are surrogates of "inflammatory stress" and have recently been identified as potential prognostic markers in cirrhotic patients. Most of these above mentioned markers were investigated in pilot studies with sometimes a modest sample size but allow us to catch a glimpse of the pathophysiological mechanisms leading to the worsening of cirrhosis. These new data should generate further well-designed studies to better assess the benefit for liver function of preventing intestinal bacterial translocation and microvascular thrombosis. The control of infection is vital and among all actors of immunity, vitamin D also appears to act as an anti-infective agent and therefore has probably a prognostic value.

Keywords: C-reactive protein; Cirrhosis; Copeptin; Serum free cortisol; Vitamin D; Von Willebrand factor antigen.

Figure 1

Mechanisms involved in the poor prognosis of cirrhosis (favoring the occurrence of multiorgan failures) and their related markers. Systemic inflammation and endothelial dysfunction appear as high relevant factors not reflected by Child-Pugh, MELD score, or measure of the HVPG. They worsen liver function, increase portal hypertension, and self-sustain the processes. HVPG: Hepatic venous pressure gradient; CRP: C-reactive protein; ADAMTS13: A metalloprotease with decreased activity.