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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


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Copeptin – a biomarker of short-term mortality risk (7 days) in patients with end-stage liver disease

Christoph Schneider
  • Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
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/ Johannes Remmler
  • Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
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/ Jeffrey Netto
  • Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
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/ Daniel Seehofer
  • Department of Visceral, Transplant, Thoracic and Vascular, Surgery, University Hospital Leipzig, Leipzig, Germany
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/ Cornelius Engelmann
  • Section of Hepatology, Clinic for Gastroenterology, University Clinic Leipzig, Leipzig, Germany
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/ Thomas Berg
  • Section of Hepatology, Clinic for Gastroenterology, University Clinic Leipzig, Leipzig, Germany
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/ Joachim Thiery
  • Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
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/ Thorsten Kaiser
  • Corresponding author
  • Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
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Published Online: 2019-06-13 | DOI: https://doi.org/10.1515/cclm-2019-0023

Abstract

Background

For many patients with end-stage liver disease, liver transplantation represents the only curative therapy. Transplant recipients are scored and ranked using the model for end-stage liver disease (MELD/MELD-Na). Circulatory impairment is known to deteriorate outcomes; however, it is not incorporated into the current allocation system’s score. The aim of our study is to analyze the predictive value of copeptin as a biomarker of circulatory impairment and increased short-term mortality risk in patients with end-stage liver disease.

Methods

We conducted a retrospective observational study of 615 patients with end-stage liver disease. Patients were recruited using assessments performed during the evaluation process for liver transplantation. Copeptin values were analyzed in comparison to MELD-Na, interleukin 6 (IL-6), and C-reactive protein (CRP).

Results

Elevated levels of copeptin, IL-6 and CRP, as well as high MELD-Na scores, were significantly correlated with mortality. In a comparison of copeptin-tertiles, patients in group T3 (16.3 pmol/L or more) showed a significantly higher mortality risk (hazard ratio 11.2, p < 0.001). After adjusting for MELD-Na, copeptin remains an independent predictor of mortality. It shows its greatest prognostic strength in short-term mortality, where it performs comparable to MELD-Na (AUROC for 7 day-mortality, 0.941/0.939; p = 0.981) and shows an additional predictive value to MELD-Na for short-term mortality (7 days, p: 0.046; 30 days, p: 0.006).

Conclusions

Copeptin presents a valuable individual biomarker in detecting patients at risk for short-term mortality. Further studies should be performed to confirm our findings.

This article offers supplementary material which is provided at the end of the article.

Keywords: cholesterol esterification; interleukin-6 (IL-6); liver transplantation; model of end-stage liver disease (MELD) score

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About the article

Corresponding author: Dr. med. Thorsten Kaiser, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Paul-List-Str. 13-15, 04103 Leipzig, Germany, Phone: +49 341 9722200, Fax: +49 341 22209

aChristoph Schneider and Johannes Remmler contributed equally to this work.


Received: 2019-01-07

Accepted: 2019-05-09

Published Online: 2019-06-13


Author contributions: Study concept and design: C.S., J.R., J.N., D.S., C.E., T.B., J.T., T.K.; acquisition of data: C.S., J.N.; analysis and/or interpretation of data: C.S., J.R., J.N., D.S., C.E., T.B., J.T., T.K.; statistical analysis: J.R., C.E., T.K.; drafting the manuscript: C.S., J.R., T.K.; critical revision of the manuscript for important intellectual content: C.S., J.R., J.N., D.S., C.E., T.B., J.T., T.K.; final approval of the version to be published: C.S., J.R., J.N., D.S., C.E., T.B., J.T., T.K.; study supervision: T.K. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), 20190023, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2019-0023.

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