Prognostic value of C-reactive protein in cirrhosis: external validation from the CANONIC cohort.
OBJECTIVE
The variations in C-reactive protein (CRP) levels have been reported to have prognostic significance in decompensated cirrhotic patients. We aimed to provide an external validation of a prognostic model combining model for end-stage liver disease (MELD) and 'sustained high CRP levels' as main variables and to optimize the model to the context of liver transplantation by focusing on 3-month mortality with no consideration of severe chronic extrahepatic diseases.


METHODS
Data from cirrhotic patients enrolled in the CANONIC study were collected. Multivariate analyses used the competing risk model. The prognostic performance [area under receiver operating characteristic curve (AUROC)] of the model incorporating CRP variations within 15 days was compared with that of the MELD score alone.


RESULTS
583 decompensated cirrhotic patients with Child-Pugh more than B7 and serial CRP measures available were included. Of these, 111 patients had baseline CRP at least 29 mg/l and 60 still had CRP at least 29 mg/l at day 15±6 (group A). Multivariate analysis (competing risk) identified three predictors of 3-month mortality: high MELD score [hazard ratio (HR)=1.14; 95% confidence intervals (CI): 1.11-1.17, P<0.001], age (HR=1.04; 95% CI: 1.02-1.06, P<0.001), and group A (HR=1.69; 95% CI: 1.01-2.81, P=0.046). The performance of the three variables taken together for predicting 3-month mortality was 0.796 (AUROC), which was significantly higher than that of the MELD score (AUROC=0.769; P=0.019).


CONCLUSIONS
In Child-Pugh higher than B7 cirrhotic patients with decompensation, prognostic models incorporating variations in CRP within 15 days and age predict 3-month mortality better than the MELD score alone. Such models would improve the ranking of candidates for liver transplantation by differentiating the severe patients with persistent systemic inflammation and intermediate MELD scores.
aDepartment of Hepatology, University Hospital of Besançon bUniversity of Franche Comte, Besançon cDepartment of Hepatology, University Hospital Beaujon, Clichy, France dLiver and Transplant Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Facultad de Medicina, CIBEREHD, Madrid eDepartment of Hepatology, University Hospital Reina Sofía, Córdoba fData Management Center, CLIF Consortium gDepartment of Gastroenterology, University Hospital Santa Creu i Sant Pau, Barcelona, Spain.
Jean-Paul
JP
Cervoni
Àlex
À
Amorós
Rafael
R
Bañares
Jose
J
Luis Montero
German
G
Soriano
Delphine
D
Weil
Richard
R
Moreau
Marco
M
Pavesi
Thierry
T
Thévenot
Vincent
V
Di Martino
D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018450:Disease Progression; D005060:Europe; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D017093:Liver Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D015415:Biomarkers; D002097:C-Reactive Protein