title: Circulating insulin-like growth factor-binding protein 3 as prognostic biomarker in liver cirrhosis.
abstract: OBJECTIVE
  To investigate the prognostic significance of insulin-like growth factor-binding protein 3 (IGFBP-3) in patients with cirrhosis.
  
  
  METHODS
  Prospective study that included two cohorts: outpatients with stable cirrhosis (n = 138) and patients hospitalized for acute decompensation (n = 189). Development of complications, mortality or liver transplantation was assessed by periodical phone calls and during outpatient visits. The cohort of stable cirrhosis also underwent clinical and laboratory evaluation yearly (2013 and 2014) in predefined study visits. In patients with stable cirrhosis, IGFBP-3 levels were measured at baseline (2012) and at second re-evaluation (2014). In hospitalized subjects, IGFBP-3 levels were measured in serum samples collected in the first and in the third day after admission and stored at -80 °C. IGFBP-3 levels were measured by immunochemiluminescence.
  
  
  RESULTS
  IGFBP-3 levels were lower in hospitalized patients as compared to outpatients (0.94 mcg/mL vs 1.69 mcg/mL, P < 0.001) and increased after liver transplantation (3.81 mcg/mL vs 1.33 mcg/mL, P = 0.008). During the follow-up of the stable cohort, 17 patients died and 11 received liver transplantation. Bivariate analysis showed that death or transplant was associated with lower IGFBP-3 levels (1.44 mcg/mL vs 1.74 mcg/mL, P = 0.027). The Kaplan-Meier transplant-free survival probability was 88.6% in patients with IGFBP-3 ≥ 1.67 mcg/mL and 72.1% for those with IGFBP3 < 1.67 mcg/mL (P = 0.015). In the hospitalized cohort, 30-d mortality was 24.3% and was independently associated with creatinine, INR, SpO2/FiO2 ratio and IGFBP-3 levels in the logistic regression. The 90-d transplant-free survival probability was 80.4% in patients with IGFBP-3 ≥ 0.86 mcg/mL and 56.1% for those with IGFBP3 < 0.86 mcg/mL (P < 0.001).
  
  
  CONCLUSIONS
  Lower IGFBP-3 levels were associated with worse outcomes in patients with cirrhosis, and might represent a promising prognostic tool that can be incorporated in clinical practice.
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Carina Gabriela
authors.initials: CG
authors.lastname: Correa
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Bruno da Silveira
authors.initials: Bda S
authors.lastname: Colombo
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Marcelo Fernando
authors.initials: MF
authors.lastname: Ronsoni
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Pedro Eduardo
authors.initials: PE
authors.lastname: Soares E Silva
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Fayad
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Telma Erotides
authors.initials: TE
authors.lastname: Silva
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Letícia Muraro
authors.initials: LM
authors.lastname: Wildner
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Bazzo
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Esther Buzaglo
authors.initials: EB
authors.lastname: Dantas-Correa
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Janaína Luz
authors.initials: JL
authors.lastname: Narciso-Schiavon
authors.affiliation: Carina Gabriela Correa, Bruno da Silveira Colombo, Marcelo Fernando Ronsoni, Pedro Eduardo Soares e Silva, Leonardo Fayad, Telma Erotides Silva, Esther Buzaglo Dantas-Correa, Janaína Luz Narciso-Schiavon, Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88.040-001, Brazil.
authors.forename: Leonardo de Lucca
authors.initials: Lde L
authors.lastname: Schiavon
keywords: Acute decompensation; Acute-on-chronic liver failure; Insulin-like growth factor binding protein 3; Liver cirrhosis; Prognosis