Low serum transferrin correlates with acute-on-chronic organ failure and indicates short-term mortality in decompensated cirrhosis
Low serum transferrin correlates with acute-on-chronic organ failure and indicates short-term mortality in decompensated cirrhosis
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DOI：
10.1111/liv.13211
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发表时间：
2017-02-01
影响因子：
6.7
通讯作者：
Strnad, Pavel
中科院分区：
文献类型：
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作者：
Bruns, Tony;Nuraldeen, Renwar;Strnad, Pavel
背景与目标铁是一种必需但可能有害的微量营养素，其调节与肝病的不良预后相关。它的稳态与氧化应激、细菌感染和全身炎症密切相关。旨在研究铁参数在有慢加急性肝衰竭 (ACLF) 风险的肝硬化失代偿患者队列研究中的预后短期意义。方法测定了 292 名因肝硬化失代偿腹水住院的德国患者的血清中的铁蛋白、转铁蛋白、铁、转铁蛋白饱和度 (TSAT) 和铁调素，其中 78 名 (27%) 患有 ACLF。纳入后 30 天和 90 天前瞻性评估短期死亡率。结果与未患 ACLF 的患者相比，ACLF 患者的转铁蛋白浓度显着较低，而铁蛋白和 TSAT 较高 (P.006)。转铁蛋白、TSAT 和铁蛋白与器官衰竭的严重程度、活动性酗酒以及全身炎症和巨噬细胞激活的替代物存在差异相关。与幸存者相比，30 天的非幸存者表现出较低的血清转铁蛋白 (P=.0003) 和较高的 TSAT (P=.003)，而 90 天的非幸存者则表现出较高的铁蛋白 (P=.03) 和较低的转铁蛋白 (P=.02)。较低的转铁蛋白（连续或二分在87mg/dL）和连续较高的TSAT（连续或二分>41%）表明30天内死亡率增加，并且在多变量回归模型和患者亚组中对器官衰竭和炎症进行调整后仍然显着。结论在铁代谢的研究指标中，血清转铁蛋白浓度是器官衰竭的最佳指标，也是30天内短期死亡率的独立预测因子。
Background & AimsIron represents an essential, but potentially harmful micronutrient, whose regulation has been associated with poor outcome in liver disease. Its homeostasis is tightly linked to oxidative stress, bacterial infections and systemic inflammation. To study the prognostic short-term significance of iron parameters in a cohort study of patients with decompensation of cirrhosis at risk of acute-on-chronic liver failure (ACLF).MethodsFerritin, transferrin, iron, transferrin saturation (TSAT) and hepcidin were determined in sera from 292 German patients hospitalized for decompensation of cirrhosis with ascites, of which 78 (27%) had ACLF. Short-term mortality was prospectively assessed 30 and 90days after inclusion.ResultsTransferrin concentrations were significantly lower, whereas ferritin and TSAT were higher in patients with ACLF compared to patients without ACLF (P.006). Transferrin, TSAT and ferritin differentially correlated with the severity of organ failure, active alcoholism and surrogates of systemic inflammation and macrophage activation. As compared with survivors, 30-day non-survivors displayed lower serum transferrin (P=.0003) and higher TSAT (P=.003), whereas 90-day non-survivors presented with higher ferritin (P=.03) and lower transferrin (P=.02). Lower transferrin (continuous or dichotomized at 87mg/dL) and consecutively higher TSAT (continuous or dichotomized >41%) indicated increased mortality within 30days and remained significant after adjustment for organ failure and inflammation in multivariate regression models and across subgroups of patients.ConclusionAmong the investigated indicators of iron metabolism, serum transferrin concentration was the best indicator of organ failure and an independent predictor of short-term mortality at 30days.