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. 2021 Jul 27;29(2):82-95.
doi: 10.1159/000516913. eCollection 2022 Mar.

Soluble CD163 for Prediction of High-Risk Esophageal Varices and Variceal Hemorrhage in Patients with Liver Cirrhosis

Mohamed Yousri Taher  1 , Abeer El-Hadidi  2 , Assem El-Shendidi  1 , Ahmed Sedky  1
Affiliations

Soluble CD163 for Prediction of High-Risk Esophageal Varices and Variceal Hemorrhage in Patients with Liver Cirrhosis

Mohamed Yousri Taher et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Introduction: Activation of hepatic macrophages in liver disease is pathogenically related to portal hypertension (PH). Soluble CD163 (sCD163) is shed in blood by activated macrophages and may predict PH progression noninvasively. This study was designed to investigate the relation of serum sCD163 to the grade and bleeding risk of esophageal varices (EV) and its role for prediction of variceal hemorrhage (VH).

Methods: The study included cirrhotic patients divided into 3 groups: patients who presented with acute upper gastrointestinal bleeding (UGIB) proved to originate from EV on endoscopy, patients without any history of UGIB but who revealed EV on surveillance endoscopy, and patients without endoscopic evidence of varices. Variceal grade and risk signs and bleeding stigmata were noted simultaneously with measurement of serum sCD163 concentration.

Results: Serum sCD163 concentration showed a significant increase in cirrhotic patients compared to healthy subjects (p < 0.001) with a stepwise increase among the group without varices, nonbleeder group, and bleeder group sequentially. Serum sCD163 levels correlated positively with the variceal grade and risk signs in both the bleeder and nonbleeder groups (p = 0.002, p < 0.001 and p = 0.004, p < 0.001, respectively). Serum sCD163 at a cutoff value of 3.6 mg/L performed significantly for prediction of EV presence (AUC = 0.888). Serum sCD163 at a cutoff value >4 mg/L significantly predicted large-size and high-risk EV (AUC = 0.910 and AUC = 0.939, respectively) and the index bleed risk (AUC = 0.977). Serum sCD163 at a cutoff value >4.05 mg/L modestly discriminated bleeding EV from those that had never bled (AUC = 0.811).

Conclusions: Serum sCD163 levels accurately predicted high-grade and high-risk EV and could help plan for primary prophylaxis. However, it modestly identified VH occurrence, and endoscopy would be required to make a definitive diagnosis.

Introdução: A ativação dos macrófagos hepáticos na doença hepática está patogenicamente relacionada com a hipertensão portal (HP). O CD163 solúvel (sCD163) é libertado no sangue por macrófagos ativados e pode predizer a progressão da HP de forma não invasiva. Este estudo foi desenhado para investigar a relação do sCD163 ao grau e risco hemorrágico por varizes esofágicas (VE) e o seu papel da predição na hemorragia varicosa (HV).

Métodos: Estudo incluiu doentes cirróticos divididos em três grupos: doentes com hemorragia digestiva alta aguda (HDA) por VE, doentes sem história de HDA mas com VE comprovadas endoscopicamente e doentes sem evidência de VE. O grau, sinais de risco e estigmas hemorrágicos das varizes foram avaliados simultaneamente com a medição sérica da concentração de sCD163.

Resultados: A concentração sérica de sCD163 apresentou um aumento significativo nos doentes cirróticos comparados com os indivíduos saudáveis (>4 mg/L) previu de forma significativa VE grandes e de alto-risco (AUC = 0.910 e AUC = 0.939 respectivamente) e o risco index-hemorrágico (AUC = 0.977). O valor cut-off de sCD163 sérico >4.05 mg/L discriminou de forma modesta VE sangrantes daquelas que nunca sangraram (AUC = 0.811).

Conclusões: Os níveis de sCD163 sérico predizem com acuidade VE grandes e de alto-risco e podem ajudar a planear a profilaxia primária. Contudo, apenas modestamente identificaram a ocorrência de HV, sendo a endoscopia necessária para fazer um diagnóstico definitivo.

Keywords: Esophageal varices; Portal hypertension; Soluble CD163; Variceal hemorrhage.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Statistical comparison between the groups of cirrhotic patients included in the study and healthy subjects as regards soluble CD163 (sCD163) serum levels (mg/L).
Fig. 2
Fig. 2
Performance of soluble CD163 (sCD163) to predict presence of esophageal varices in the total sample of cirrhotic patients included in the study.
Fig. 3
Fig. 3
Performance of soluble CD163 (sCD163) and the other calculated noninvasive parameters (APRI, FIB-4, PSR) to predict high-grade esophageal varices in the total sample of cirrhotic patients included in the study.
Fig. 4
Fig. 4
Performance of soluble CD163 (sCD163) and the other calculated noninvasive parameters (APRI, FIB-4, PSR) to predict high-risk esophageal varices in the total sample of cirrhotic patients included in the study.
Fig. 5
Fig. 5
Performance of soluble CD163 (sCD163) and the other calculated noninvasive parameters (APRI, FIB-4, PSR) to predict the risk of index bleed in cirrhotic patients of the nonbleeder group included in the study.
Fig. 6
Fig. 6
Performance of soluble CD163 (sCD163) and the other calculated noninvasive parameters (APRI, FIB-4, PSR) to predict variceal hemorrhage occurrence in the total sample of cirrhotic patients included in the study.
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