title: High serum lipopolysaccharide binding protein is associated with increased mortality in patients with decompensated cirrhosis.
abstract: Lipopolysaccharide-binding-protein (LBP) is an acute-phase-protein produced by hepatocytes. Changes in LBP are associated with the dynamics of bacterial translocation and intestinal permeability in decompensated cirrhosis (DC). We assessed serum and ascitic-fluid (AF) LBP and examined their association with mortality in patients with DC.
  
  
  
  Eighty-eight consecutive patients (73.9% males) underwent thorough diagnostic investigations for infection. LBP (ng/mL) was assessed in serum (N=88) and AF (n=49) by enzyme-linked-immunosorbent-assay and expressed in natural logarithm (ln).
  
  
  
  Serum lnLBP was higher in 18 patients with overt infection compared to those without (P<.001). Serum and AF lnLBP 13.49 and 12.11 displayed a very good-negative-predictive value of 90% and 95.1% to rule out infection and spontaneous-bacterial-peritonitis (SBP), respectively. LBP was higher in serum than in AF (P<.001). Serum and AF LBP levels showed a positive correlation with surrogate markers of inflammation. Patients without overt infection were prospectively followed up. The 90-day-mortality rate was 48% and 24.4% in patients with high (≥13.49) and low (<13.49) lnLBP, respectively, (log rank P=0.045). In univariate Cox regression analysis, neutrophils, LBP, MELD score and CRP were predictive of mortality. However, only high LBP (HR 8.1 95%CI 2.0-31.5, P=0.003) and MELD (HR 1.1 95%CI 1.0-1.2, P=0.002) were predictive of mortality in multivariate analysis.
  
  
  
  Serum and AF LBP concentrations showed a high negative-predictive-value to exclude infection and SBP, respectively. High serum LBP was detected in patients without infection at presentation who died during the 90-day-follow-up period. Elevated serum LBP is a marker of short-term mortality in patients without overt bacterial infection.
authors.affiliation: 2nd Department of Internal Medicine, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Danai
authors.initials: D
authors.lastname: Agiasotelli
authors.affiliation: 2nd Department of Internal Medicine, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Alexopoulou
authors.affiliation: 2nd Department of Internal Medicine, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Larisa
authors.initials: L
authors.lastname: Vasilieva
authors.affiliation: 2nd Department of Internal Medicine, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Emilia
authors.initials: E
authors.lastname: Hadziyannis
authors.affiliation: 1st Department of Propedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Goukos
authors.affiliation: 1st Department of Propedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.affiliation: 2nd Department of Internal Medicine, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Spyros P
authors.initials: SP
authors.lastname: Dourakis
mesh_terms: D000209:Acute-Phase Proteins; D000368:Aged; D001202:Ascitic Fluid / Q000737:chemistry; D001424:Bacterial Infections / Q000097:blood*; D018988:Bacterial Translocation; D015415:Biomarkers; D002352:Carrier Proteins / Q000097:blood*; D005260:Female; D006115:Greece; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000097:blood* / Q000382:microbiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D016019:Survival Analysis; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein
keywords: bacterial translocation; decompensated cirrhosis; lipopolysaccharide binding protein; predictors of mortality