title: Onset of heart failure determines the hepatic cell death pattern.
abstract: OBJECTIVE
  Acute and chronic heart failure (HF) may affect the liver, but the underlying mechanisms that lead to progressive liver damage are poorly understood. The hepatic cytokeratin-18 (CK18) epitopes M65 and M30 have been reported to distinguish between overall (necrotic) and apoptotic cell death, respectively. We aimed to evaluate the predominant hepatic cell death pattern in acute vs. chronic heart failure and examined if these assays predict the course of the disease.
  
  
  RESULTS
  In a prospective study comprising 21 patients with acute HF (AHF) and 18 patients with chronic HF (CHF) serum levels of M65 and M30 were assessed. Compared with CHF, M65 levels were significantly increased in patients with AHF (CHF: 1,283 ± 591.6U/l vs. AHF: 20,912 ± 15,132U/l, p < 0.001). In addition, M30 levels were significantly increased in AHF (CHF: 642.2 ± 177.4U/l vs. AHF: 3,844 ± 5,293U/l, p < 0.05), but the M30/M65 ratio was significantly higher in CHF (CHF: 0.54 ± 0.15 vs. AHF: 0.20 ± 0.19, p < 0.001), indicating a greater contribution of apoptotic cell death in CHF. AHF patients with higher M30 values had a worse prognosis.
  
  
  CONCLUSIONS
  The ratio of CK18 M30/M65 is a potential marker to discriminate AHF from CHF induced LF and M30 might be a prognostic marker for survival in AHF induced liver injury.
authors.affiliation: Department for Gastroenterology and Hepatology, University Hospital Essen, Hufelandstr, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Herzer
authors.forename: Guntje
authors.initials: G
authors.lastname: Kneiseler
authors.forename: Lars Peter
authors.initials: LP
authors.lastname: Bechmann
authors.forename: Felix
authors.initials: F
authors.lastname: Post
authors.forename: Martin
authors.initials: M
authors.lastname: Schlattjan
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Sowa
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.forename: Günter
authors.initials: G
authors.lastname: Marggraf
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
authors.forename: Christoph
authors.initials: C
authors.lastname: Jochum
mesh_terms: D000208:Acute Disease; D017209:Apoptosis / Q000502:physiology*; D015415:Biomarkers / Q000097:blood*; D002908:Chronic Disease; D000939:Epitopes / Q000378:metabolism; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000473:pathology; D006801:Humans; D053538:Keratin-18 / Q000097:blood*; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000097:blood / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D000939:Epitopes; D053538:Keratin-18