Urine Monocyte Chemoattractant Protein 1 Is an Independent Predictive Factor of Hospital Readmission and Survival in Cirrhosis
MCP 1 (monocyte chemoattractant protein 1) is a proinflammatory cytokine involved in chemotaxis of monocytes. In several diseases, such as acute coronary syndromes and heart failure, elevated MCP 1 levels have been associated with poor outcomes. Little is known about MCP 1 in cirrhosis. AIM: To investigate the relationship between MCP 1 and outcome in decompensated cirrhosis. METHODS: Prospective study of 218 patients discharged from hospital after an admission for complications of cirrhosis. Urine and plasma levels of MCP 1 and other urine proinflammatroy biomarkers: osteopontin(OPN) trefoil factor3 and liver fatty acid binding protein were measured at admission. Urine non inflammatory mediators cystatin C, b2microglobulin and albumin were measured as control biomarkers. The relationship between these biomarkers and the 3 month hospital readmission, complications of cirrhosis, and mortality were assessed. RESULTS: 69 patients(32% had at least one readmission during the 3 month period of follow up and 30 patients died(14% Urine MCP 1 and OPN levels, were associated with 3 month probability of readmission (0.85 (0.27 2.1) and 2003 (705 4586) ug/g creat vs 0.47 (0.2 1.1) and 1188 (512 2958) ug/g creat, in patients with and without readmission, respectively; p<0.05; median (IQR) Furthermore, urine levels of MCP 1 were significantly associated with mortality (1.01 (1 3.6) vs 0.5 (0.2 1.1) mg/g creat, in dead and alive patients at 3 months; p<0.05) Patients with higher levels of urine MCP 1 (above percentile 75th) had higher probability of development of hepatic encephalopathy, bacterial infections or AKI. Urine MCP 1 was an independent predictive factor of hospital readmission and combined end point of readmission or dead at 3 months. Plasma levels of MCP 1 did not correlated with outcomes. CONCLUSION: Urine, but not plasma, MCP 1 levels are associated with hospital readmission, development of complications of cirrhosis, and mortality. These results suggest that in cirrhosis there is an inflammatory response that is associated with poor outcomes.
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