title: Urine Monocyte Chemoattractant Protein-1 Is an Independent Predictive Factor of Hospital Readmission and Survival in Cirrhosis.
abstract: 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.
  
  
  OBJECTIVE
  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, β2microglobulin 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) μg/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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Graupera
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|School of Nursing, University of Barcelona, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Fabrellas
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Moreira
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Solé
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Huelin
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: de la Prada
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pose
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ariza
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Risso
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Albertos
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.|Biochemistry and Molecular Genetics Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Department of Physiological Sciences, University of Barcelona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Morales-Ruiz
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.|Biochemistry and Molecular Genetics Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Department of Physiological Sciences, University of Barcelona, Barcelona, Spain.
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jiménez
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D018932:Chemokine CCL2 / Q000097:blood / Q000652:urine*; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality* / Q000652:urine; D008297:Male; D008875:Middle Aged; D053495:Osteopontin / Q000652:urine; D010351:Patient Discharge; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D000071165:Trefoil Factor-3 / Q000652:urine; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018932:Chemokine CCL2; D050556:Fatty Acid-Binding Proteins; D000071165:Trefoil Factor-3; D053495:Osteopontin