Serum Transferrin Is an Independent Predictor of Mortality in Severe Alcoholic Hepatitis.
Serum Transferrin Is an Independent Predictor of Mortality in Severe Alcoholic Hepatitis.
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DOI：
10.14309/ajg.0000000000000492
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发表时间：
2020-03
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重度酒精性肝炎（sAH）死亡率高，但病程难以预测.由于铁参数是其他肝脏疾病中有吸引力的预后预测因子，因此我们检测了其在sAH中的预后能力。通过STOPAH试验前瞻性招募828例sAH患者，测定血清铁蛋白、转铁蛋白、铁、转铁蛋白饱和度、非转铁蛋白结合铁、可溶性转铁蛋白受体和铁调素。队列随机分为探索性（n = 200）和验证集（n = 628）。sAH患者血清转铁蛋白减少，但转铁蛋白饱和度增加。在铁参数中，基线转铁蛋白是28天（受试者操作特征下的面积0.72 [95%置信区间0.67-0.78]）和90天生存率（受试者操作特征下的面积0.65 [0.61-0.70]）的最佳预测因子。转铁蛋白的预测能力与综合评分，即终末期肝病模型，格拉斯哥酒精性肝炎评分和判别函数，并在多变量分析中与生存独立相关。这些结果在验证队列中得到证实。转铁蛋白与肝脏合成标记物无关，也与非转铁蛋白结合铁或可溶性转铁蛋白受体（分别作为过量未结合铁和功能性铁缺乏的标记物）无关。在sAH患者中，血清转铁蛋白预测死亡率的性能与常用的复合评分系统相当。因此，这个常规可用的参数可能是一个有用的标志物单独或作为预后模型的组成部分。
Severe alcoholic hepatitis (sAH) confers substantial mortality, but the disease course is difficult to predict. As iron parameters are attractive outcome predictors in other liver diseases, we tested their prognostic ability in sAH. Serum ferritin, transferrin, iron, transferrin saturation, nontransferrin-bound iron, soluble transferrin receptor, and hepcidin were measured in 828 patients with sAH recruited prospectively through the STOPAH trial. The cohort was randomly divided into exploratory (n = 200) and validation sets (n = 628). Patients with sAH had diminished serum transferrin but increased transferrin saturation. Among iron parameters, baseline transferrin was the best predictor of 28-day (area under the receiver operated characteristic 0.72 [95% confidence interval 0.67–0.78]) and 90-day survival (area under the receiver operated characteristic 0.65 [0.61–0.70]). Transferrin’s predictive ability was comparable with the composite scores, namely model of end-stage liver disease, Glasgow alcoholic hepatitis score, and discriminant function, and was independently associated with survival in multivariable analysis. These results were confirmed in a validation cohort. Transferrin did not correlate with markers of liver synthesis nor with non-transferrin-bound iron or soluble transferrin receptor (as markers of excess unbound iron and functional iron deficiency, respectively). In patients with sAH, serum transferrin predicts mortality with a performance comparable with commonly used composite scoring systems. Hence, this routinely available parameter might be a useful marker alone or as a component of prognostic models.