title: Siglec-7 as a Novel Biomarker to Predict Mortality in Decompensated Cirrhosis and Acute Kidney Injury.
abstract: Patients with decompensated cirrhosis have high morbidity and are commonly hospitalized with acute kidney injury.
  
  
  
  We examined serum levels of Siglec-7, a transmembrane receptor that regulates immune activity, as a biomarker for mortality in patients with cirrhosis and acute kidney injury.
  
  
  
  Serum Siglec-7 was measured in hospitalized patients with cirrhosis and acute kidney injury, as well as in reference groups with acute liver injury/acute kidney injury, cirrhosis without acute kidney injury, and sepsis without liver disease. Clinical characteristics and subsequent outcomes were examined using univariate and multivariable analyses according to initial Siglec-7 levels. Primary outcome was death by 90 days.
  
  
  
  One hundred twenty-eight subjects were included, 92 of which had cirrhosis and acute kidney injury and were used in the primary analysis. Average Model for End-Stage Liver Disease (MELD) score was 24 [95 % CI 23, 26], and serum creatinine was 2.5 [2.2, 2.8] mg/dL at the time Siglec-7 was measured. After adjusting for age and MELD score, high serum Siglec-7 level predicted mortality with a hazard ratio of 1.96 [1.04, 3.69; p = 0.04]. There was no difference in Siglec-7 levels by etiology of AKI (p = 0.24). Addition of serum Siglec-7 to MELD score improved discrimination for 90-day mortality [category-free net reclassification index = 0.38 (p = 0.04); integrated discrimination increment = 0.043 (p = 0.04)].
  
  
  
  Serum Siglec-7 was associated with increased mortality among hospitalized patients with cirrhosis and acute kidney injury. Addition of Siglec-7 to MELD score may increase discrimination to predict 90-day mortality.
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA. aallegretti@partners.org.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Allegretti
authors.affiliation: Department of Medicine, St. Elizabeth's Hospital, Boston, MA, USA.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ortiz
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
authors.forename: Sahir
authors.initials: S
authors.lastname: Kalim
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Wibecan
authors.affiliation: Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Hui Yi
authors.initials: HY
authors.lastname: Shan
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
authors.forename: Dihua
authors.initials: D
authors.lastname: Xu
authors.affiliation: Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
authors.affiliation: Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
authors.forename: Ravi I
authors.initials: RI
authors.lastname: Thadhani
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications / Q000401:mortality; D015214:Antigens, Differentiation, Myelomonocytic / Q000097:blood*; D015415:Biomarkers; D016022:Case-Control Studies; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D058625:End Stage Liver Disease; D005260:Female; D006760:Hospitalization; D006801:Humans; D037102:Lectins / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000401:mortality; D017114:Liver Failure, Acute / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood; D012720:Severity of Illness Index
chemical_list: D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D037102:Lectins; C402206:SIGLEC7 protein, human; D003404:Creatinine
keywords: Acute kidney injury; Cirrhosis; Hepatitis C; Hepatorenal syndrome; Liver immunology