title: Increased serum levels of quinolinic acid indicate enhanced severity of hepatic dysfunction in patients with liver cirrhosis.
abstract: BACKGROUND
  The Model for End-Stage Liver Disease (MELD) score is a tool for assessment of the degree of hepatic insufficiency/failure. Quinolinic acid (QuinA) is a tryptophan metabolite produced by activated macrophages. Here we investigate whether the degree of systemic inflammation (QuinA, neopterin, CRP and IL-6) correlates with clinical liver dysfunction according to the MELD Score.
  
  
  METHODS
  Ninety-four patients with liver cirrhosis were categorized into 2 groups according to baseline MELD score (group I, MELD <20, n = 61, and group II, MELD ≥20, n = 33).
  
  
  RESULTS
  Serum levels of QuinA, neopterin, CRP, and IL-6 significantly correlated with MELD score (r = 0.77, 0.75, 0.57, and 0.50; p < 0.0001, respectively). Patients of group II had significantly higher serum levels of QuinA, neopterin, CRP, and IL-6 than group I (p0.0001). ROC curve analysis showed that QuinA and neopterin are more sensitive markers for severity of liver disease than established markers of inflammation such as CRP and IL-6 (sensitivity = 86% and 79%, respectively) (AUC=0.89 and 0.89, respectively). QuinA provided the most sensitive index with regard to the identification of patients with hepatic encephalopathy.
  
  
  CONCLUSIONS
  Serum levels of QuinA reflect the degree of liver dysfunction. Moreover, high levels of QuinA may serve as a sensitive indicator of hepatic encephalopathy.
authors.affiliation: Department of Transplantation Immunology, University of Heidelberg, Germany. imad.lahdou@med.uni-heidelberg.de
authors.forename: Imad
authors.initials: I
authors.lastname: Lahdou
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Sadeghi
authors.forename: Hani
authors.initials: H
authors.lastname: Oweira
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fusch
authors.forename: Volker
authors.initials: V
authors.lastname: Daniel
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.forename: Ge
authors.initials: G
authors.lastname: Jung
authors.forename: Hazem
authors.initials: H
authors.lastname: Elhadedy
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Flavius
authors.initials: F
authors.lastname: Sandra-Petrescu
authors.forename: Mircea
authors.initials: M
authors.lastname: Iancu
authors.forename: Gerhard
authors.initials: G
authors.lastname: Opelz
authors.forename: Peter
authors.initials: P
authors.lastname: Terness
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D058625:End Stage Liver Disease / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D006501:Hepatic Encephalopathy / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood; D011379:Prognosis; D017378:Quinolinic Acid / Q000097:blood*; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D019798:Neopterin; D002097:C-Reactive Protein; D017378:Quinolinic Acid