Pro-adrenomedullin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival

Abstract

Background and aim: Acute-on-chronic liver failure (ACLF) is characterized by the presence of acute decompensation (AD) of cirrhosis, organ failures, and high short-term mortality rates. In present study, we explored whether Pro-adrenomedullin (Pro-ADM), a biomarker of sepsis, 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.

Methods: 332 consecutive patients with AD of cirrhosis were prospectively enrolled. Pro-ADM was measured for all patients at baseline. Cox regression analysis was used to evaluate the impact of pro-ADM on short-term survival and developing ACLF during hospital stay.

Results: Serum pro-ADM levels were significantly high in non-survivors (p < .001) and showed significant correlation with ALT (r = 0.181, p = .001), INR (r = 0.144, p = .009), TB (r = 0.368, p < .001), Creatinine (r = 0.145, p = .004), MELD score (r = 0.334, p = <.001) and CLI-C OF score (r = 0.375, p= <.001). Serum pro-ADM at admission was shown to be a predictor of 28-day mortality independently of MELD and CLIF-C OF scores. Prognostic models incorporating pro-ADM achieved high C index for predicting 28-day mortality in AD patients of cirrhosis. Moreover, baseline pro-ADM was found to be predictive of ACLF development during hospital stay.

Conclusions: Serum pro-ADM levels correlate with multiorgan failure and are independently associated with short-term survival and ACLF development in patients admitted for AD or ACLF.

Keywords:

• Acute-on-chronic liver failure
• acute decompensation of cirrhosis
• organ failure
• biomarker
• pro-adrenomedullin

Acknowledgements

We would like to acknowledge the medical and nursing staff of the Liver center, Hwamei Hospital, Ningbo, for their work and help during the period of the study.

Disclosure statement

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest related to this manuscript.

Additional information

Funding

This work was supported by the grants from Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2015KYB344), the Social Development Major Projects of Ningbo City (2016C51005), Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2018ZD039), Zhejiang Provincial natural science foundation (LGF20H030006).