A prospective pilot study of circulating endothelial cells as a potential new biomarker in portal hypertension

Soha S. Abdelmoneim, Jayant Talwalkar, Saurabh Sethi, Patrick Sequeira Kamath, Mohamed Mahmoud Fahmy Fathalla, Benjamin R. Kipp, Michael B. Campion, Amy C. Clayton, Kevin C. Halling, Vijay Shah

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background/Aims: Peripheral circulating endothelial cells (CEC) have been proposed as a prognostic marker in cardiovascular diseases. Cirrhosis and portal hypertension are associated with vascular injury yet little is known about CEC count in these conditions. Therefore, we evaluated CEC count in patients with cirrhosis, and correlated it with markers of portal hypertension/disease severity. Patients/Methods:: Fifteen patients with cirrhosis/portal hypertension and 15 matched controls were prospectively recruited for study participation. An automated rare cell analysis system was used to enumerate CEC from peripheral blood and correlated with clinical features. Results:: Median CEC levels were significantly higher in patients with cirrhosis as compared with controls (median [interquartile range (IQR)]; cirrhosis: 73.7 cells/4 ml [53.7-140.3]; controls: 28.7 cells/4 ml [21-58.7]; P=0.021). Ratio of CEC to platelet count (CEC/PC) also distinguished patients with cirrhosis from controls (IQR; cirrhosis: 0.723 [0.396-1.672]; controls: 0.126 [0.103-0.333]; P<0.001). Receiver operator characteristic analysis revealed that CEC cut-off of 42 cells/4 ml showed sensitivity of 87% and specificity of 74% for differentiating cirrhosis from controls (AUC: 0.74), while CEC/PC ratio at 0.21 showed sensitivity of 100% and specificity of 73% (AUC: 0.89). Furthermore, CEC/PC index was significantly elevated in patients with hepatic decompensation as defined by Child B/C (P<0.05). The intra- and interobserver variability correlation coefficients for CEC measurement were 0.9989 and 0.9986 respectively. Conclusion:: Median CEC count and CEC/PC ratio are significantly elevated in patients with cirrhosis, with CEC/PC also increased in patients with decompensated cirrhosis. These data provide rationale for larger validation studies to assess if CEC may have prognostic utility in patients with cirrhosis and portal hypertension.

Original languageEnglish (US)
Pages (from-to)191-197
Number of pages7
JournalLiver International
Volume30
Issue number2
DOIs
StatePublished - Feb 2010

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Portal Hypertension
Endothelial Cells
Biomarkers
Prospective Studies
Fibrosis
Cell Count
Area Under Curve
Sensitivity and Specificity
Observer Variation
Validation Studies
Vascular System Injuries
Platelet Count
Cardiovascular Diseases

Keywords

  • Circulating endothelial cells
  • Cirrhosis
  • Portal hypertension

ASJC Scopus subject areas

  • Hepatology

Cite this

A prospective pilot study of circulating endothelial cells as a potential new biomarker in portal hypertension. / Abdelmoneim, Soha S.; Talwalkar, Jayant; Sethi, Saurabh; Kamath, Patrick Sequeira; Fathalla, Mohamed Mahmoud Fahmy; Kipp, Benjamin R.; Campion, Michael B.; Clayton, Amy C.; Halling, Kevin C.; Shah, Vijay.

In: Liver International, Vol. 30, No. 2, 02.2010, p. 191-197.

Research output: Contribution to journalArticle

Abdelmoneim, SS, Talwalkar, J, Sethi, S, Kamath, PS, Fathalla, MMF, Kipp, BR, Campion, MB, Clayton, AC, Halling, KC & Shah, V 2010, 'A prospective pilot study of circulating endothelial cells as a potential new biomarker in portal hypertension', Liver International, vol. 30, no. 2, pp. 191-197. https://doi.org/10.1111/j.1478-3231.2009.02132.x
Abdelmoneim, Soha S. ; Talwalkar, Jayant ; Sethi, Saurabh ; Kamath, Patrick Sequeira ; Fathalla, Mohamed Mahmoud Fahmy ; Kipp, Benjamin R. ; Campion, Michael B. ; Clayton, Amy C. ; Halling, Kevin C. ; Shah, Vijay. / A prospective pilot study of circulating endothelial cells as a potential new biomarker in portal hypertension. In: Liver International. 2010 ; Vol. 30, No. 2. pp. 191-197.
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abstract = "Background/Aims: Peripheral circulating endothelial cells (CEC) have been proposed as a prognostic marker in cardiovascular diseases. Cirrhosis and portal hypertension are associated with vascular injury yet little is known about CEC count in these conditions. Therefore, we evaluated CEC count in patients with cirrhosis, and correlated it with markers of portal hypertension/disease severity. Patients/Methods:: Fifteen patients with cirrhosis/portal hypertension and 15 matched controls were prospectively recruited for study participation. An automated rare cell analysis system was used to enumerate CEC from peripheral blood and correlated with clinical features. Results:: Median CEC levels were significantly higher in patients with cirrhosis as compared with controls (median [interquartile range (IQR)]; cirrhosis: 73.7 cells/4 ml [53.7-140.3]; controls: 28.7 cells/4 ml [21-58.7]; P=0.021). Ratio of CEC to platelet count (CEC/PC) also distinguished patients with cirrhosis from controls (IQR; cirrhosis: 0.723 [0.396-1.672]; controls: 0.126 [0.103-0.333]; P<0.001). Receiver operator characteristic analysis revealed that CEC cut-off of 42 cells/4 ml showed sensitivity of 87{\%} and specificity of 74{\%} for differentiating cirrhosis from controls (AUC: 0.74), while CEC/PC ratio at 0.21 showed sensitivity of 100{\%} and specificity of 73{\%} (AUC: 0.89). Furthermore, CEC/PC index was significantly elevated in patients with hepatic decompensation as defined by Child B/C (P<0.05). The intra- and interobserver variability correlation coefficients for CEC measurement were 0.9989 and 0.9986 respectively. Conclusion:: Median CEC count and CEC/PC ratio are significantly elevated in patients with cirrhosis, with CEC/PC also increased in patients with decompensated cirrhosis. These data provide rationale for larger validation studies to assess if CEC may have prognostic utility in patients with cirrhosis and portal hypertension.",
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AU - Sethi, Saurabh

AU - Kamath, Patrick Sequeira

AU - Fathalla, Mohamed Mahmoud Fahmy

AU - Kipp, Benjamin R.

AU - Campion, Michael B.

AU - Clayton, Amy C.

AU - Halling, Kevin C.

AU - Shah, Vijay

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N2 - Background/Aims: Peripheral circulating endothelial cells (CEC) have been proposed as a prognostic marker in cardiovascular diseases. Cirrhosis and portal hypertension are associated with vascular injury yet little is known about CEC count in these conditions. Therefore, we evaluated CEC count in patients with cirrhosis, and correlated it with markers of portal hypertension/disease severity. Patients/Methods:: Fifteen patients with cirrhosis/portal hypertension and 15 matched controls were prospectively recruited for study participation. An automated rare cell analysis system was used to enumerate CEC from peripheral blood and correlated with clinical features. Results:: Median CEC levels were significantly higher in patients with cirrhosis as compared with controls (median [interquartile range (IQR)]; cirrhosis: 73.7 cells/4 ml [53.7-140.3]; controls: 28.7 cells/4 ml [21-58.7]; P=0.021). Ratio of CEC to platelet count (CEC/PC) also distinguished patients with cirrhosis from controls (IQR; cirrhosis: 0.723 [0.396-1.672]; controls: 0.126 [0.103-0.333]; P<0.001). Receiver operator characteristic analysis revealed that CEC cut-off of 42 cells/4 ml showed sensitivity of 87% and specificity of 74% for differentiating cirrhosis from controls (AUC: 0.74), while CEC/PC ratio at 0.21 showed sensitivity of 100% and specificity of 73% (AUC: 0.89). Furthermore, CEC/PC index was significantly elevated in patients with hepatic decompensation as defined by Child B/C (P<0.05). The intra- and interobserver variability correlation coefficients for CEC measurement were 0.9989 and 0.9986 respectively. Conclusion:: Median CEC count and CEC/PC ratio are significantly elevated in patients with cirrhosis, with CEC/PC also increased in patients with decompensated cirrhosis. These data provide rationale for larger validation studies to assess if CEC may have prognostic utility in patients with cirrhosis and portal hypertension.

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