Urinary biomarker may help predict cirrhosis outcomes, study finds

Levels of urine liver fatty acid-binding protein could be used together with Model for End-stage Liver Disease scoring to improve predictions of liver failure or death, according to an analysis of patients hospitalized for decompensated cirrhosis.

Urine liver fatty acid-binding protein (uL-FABP) may be a useful prognostic biomarker in patients with decompensated cirrhosis, a study found.

The prospective study included 444 patients hospitalized for decompensated cirrhosis who were divided into a study cohort (n=305) and validation cohort (n=139). Their levels of L-FABP were measured in urine and plasma samples collected at admission, as were levels of neutrophil gelatinase-associated lipocalin (NGAL). The results were published by the Journal of Hepatology on Sept. 12.

In a univariate analysis of the study cohort, patients with higher uL-FABP levels had lower three-month survival rates, whereas plasma L-FABP level was not correlated with survival. Multivariate analysis found that both uL-FABP levels and Model for End-stage Liver Disease (MELD)-Na scores were predictors of prognosis. Higher urine L-FABP levels were found in patients who had acute-on-chronic liver failure (ACLF) at baseline and in those who developed it during follow-up. In patients with ACLF, uL-FABP levels were correlated with liver, coagulation, and circulatory failure. Acute kidney injury was also associated with elevated uL-FABP levels. The validation cohort confirmed the value of uL-FABP in predicting survival and ACLF. Urine NGAL levels predicted survival in univariate but not multivariate analysis.

“If confirmed in larger studies, urinary L-FABP appears to be a good biomarker candidate for use in prognosis prediction in DC [decompensated cirrhosis], together with MELD-Na score,” the authors concluded. They noted that previous research has identified limitations of the MELD-Na score when used alone and that there is no widely validated biomarker for predicting development of ACLF. However, the authors also cautioned that their results should be validated, given that the study was conducted at a single center and among relatively few patients who developed ACLF, among other limitations.

Although the study could not determine the mechanisms by which the urinary test improved prognostication, the authors offered some theories. “First, uL-FABP levels may reflect not only liver injury, but also multiorgan dysfunction of patients with DC. Second, uL-FABP levels may reflect the systemic inflammatory milieu occurring in DC, which is not captured by MELD-Na score variables,” they wrote.