title: Erythropoietin in Predicting Prognosis in Patients with Acute-on-Chronic Liver Failure.
abstract: OBJECTIVE
  Acute-on-chronic liver failure (ACLF) is characterized by a rapid progression to multiple organ failure and is associated with a very high mortality rate of 50-90%. Novel therapies are being investigated such as Erythropoietin (EPO). The aim of this prospective cohort study was to analyse the value of EPO in predicting prognosis and determine which patients may benefit most from EPO therapy.
  
  
  METHODS
  According to the EASL-CLIF criteria, 104 consecutive patients were diagnosed with ACLF, and separated into two groups based on the type of insult: bleeding (Group A=31) or non-bleeding (Group B=73). In addition to a complete biochemical work-up and calculation of relevant prognostic scores, levels of EPO were measured on admission and correlated to the type of insult and final outcome.
  
  
  RESULTS
  Fifteen patients from Group A (mean age 60.32+/-9.29 years) had a lethal outcome and higher values of EPO on admission (319.26+/-326.58 mIU/ml) (p<0.005), compared to the 37 patients from Group B (mean age 59.9+/-10.19 years) with EPO levels at admission of 29.88+/-34.6 mIU/mL. In Group B, a cut-off EPO value of 30.65 mIU/mL had a sensitivity of 87.5% and a specificity 57.4% in predicting lethal outcome with an AUROC of 0.823. In Group A, a cut-off value of 229.95 mlU/mL had a sensitivity and specificity of 53.3% and 92.7%, respectively. The AUROC for this cut-off was 0.847.
  
  
  CONCLUSIONS
  Erythropoietin is superior to the standard prognostic scores in predicting 28-day mortality. Lower levels of EPO were detected in patients without bleeding as an insult indicating a possible therapeutic benefit in these patients.
authors.affiliation: School of Medicine, University of Belgrade; Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia. tamara.alempijevic@med.bg.ac.rs.
authors.forename: Tamara
authors.initials: T
authors.lastname: Alempijevic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Simon
authors.initials: S
authors.lastname: Zec
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Nikolic
authors.affiliation: Faculty of Mathematics, University of Belgrade, Belgrade, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Veljkovic
authors.affiliation: Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Milivojevic
authors.affiliation: Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade;Center of Medical Biochemistry, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Violeta
authors.initials: V
authors.lastname: Dopsaj
authors.affiliation: Center of Medical Biochemistry, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Stankovic
authors.affiliation: School of Medicine, University of Belgrade; Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Tomica
authors.initials: T
authors.lastname: Milosavljevic
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D004921:Erythropoietin / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; C554270:EPO protein, human; D004921:Erythropoietin