Markers of inflammation predict survival in newly diagnosed cirrhosis: a prospective registry study

Abstract

The inflammatory activity in cirrhosis is often pronounced and related to episodes of decompensation. Systemic markers of inflammation may contain prognostic information, and we investigated their possible correlation with admissions and mortality among patients with newly diagnosed liver cirrhosis. We collected plasma samples from 149 patients with newly diagnosed (within the past 6 months) cirrhosis, and registered deaths and hospital admissions within 180 days. Ninety-two inflammatory markers were quantified and correlated with clinical variables, mortality, and admissions. Prediction models were calculated by logistic regression. We compared the disease courses of our cohort with a validation cohort of 86 patients with cirrhosis. Twenty of 92 markers of inflammation correlated significantly with mortality within 180 days (q-values of 0.00-0.044), whereas we found no significant correlations with liver-related admissions. The logistic regression models yielded AUROCs of 0.73 to 0.79 for mortality and 0.61 to 0.73 for liver-related admissions, based on a variety of modalities (clinical variables, inflammatory markers, clinical scores, or combinations thereof). The models performed moderately well in the validation cohort and were better able to predict mortality than liver-related admissions. In conclusion, markers of inflammation can be used to predict 180-day mortality in patients with newly diagnosed cirrhosis. Prediction models for newly diagnosed cirrhotic patients need further validation before implementation in clinical practice.Trial registration: NCT04422223 (and NCT03443934 for the validation cohort), and Scientific Ethics Committee No.: H-19024348.

Figure 1

Kaplan–Meier curves for the four most significant inflammatory markers correlated with 180-day mortality. Concentrations of a marker higher than the cut-off are represented as orange curves, lower concentrations as blue curves. Pred = 1 indicates death within 180 days. Curves for each marker are compared by log rank tests.

Figure 2

UMAP 2D-embedding of inflammatory markers among patients according to (a) 180-day mortality and (b) 180-day liver-related admissions, based on selected features for the model using clinical and inflammatory markers. Blue and red dots represent patients with no liver-related admissions, green and yellow dots represent patients who were admitted for liver-related reasons. FN, False negative; FP, False positive; TN, True negative; TP, True positive.