TY - JOUR
T1 - Serum Transferrin Is an Independent Predictor of Mortality in Severe Alcoholic Hepatitis
AU - Atkinson, Stephen R.
AU - Hamesch, Karim
AU - Spivak, Igor
AU - Guldiken, Nurdan
AU - Cabezas, Joaquín
AU - Argemi, Josepmaria
AU - Theurl, Igor
AU - Zoller, Heinz
AU - Cao, Sheng
AU - Mathurin, Philippe
AU - Shah, Vijay H.
AU - Trautwein, Christian
AU - Bataller, Ramon
AU - Thursz, Mark R.
AU - Strnad, Pavel
N1 - Publisher Copyright:
© 2020 Wolters Kluwer Health. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - OBJECTIVES:Severe alcoholic hepatitis (sAH) confers substantial mortality, but the disease course is difficult to predict. As iron parameters are attractive outcome predictors in other liver diseases, we tested their prognostic ability in sAH.METHODS:Serum ferritin, transferrin, iron, transferrin saturation, nontransferrin-bound iron, soluble transferrin receptor, and hepcidin were measured in 828 patients with sAH recruited prospectively through the STOPAH trial. The cohort was randomly divided into exploratory (n = 200) and validation sets (n = 628).RESULTS:Patients with sAH had diminished serum transferrin but increased transferrin saturation. Among iron parameters, baseline transferrin was the best predictor of 28-day (area under the receiver operated characteristic 0.72 [95% confidence interval 0.67-0.78]) and 90-day survival (area under the receiver operated characteristic 0.65 [0.61-0.70]). Transferrin's predictive ability was comparable with the composite scores, namely model of end-stage liver disease, Glasgow alcoholic hepatitis score, and discriminant function, and was independently associated with survival in multivariable analysis. These results were confirmed in a validation cohort. Transferrin did not correlate with markers of liver synthesis nor with non-transferrin-bound iron or soluble transferrin receptor (as markers of excess unbound iron and functional iron deficiency, respectively).DISCUSSION:In patients with sAH, serum transferrin predicts mortality with a performance comparable with commonly used composite scoring systems. Hence, this routinely available parameter might be a useful marker alone or as a component of prognostic models.
AB - OBJECTIVES:Severe alcoholic hepatitis (sAH) confers substantial mortality, but the disease course is difficult to predict. As iron parameters are attractive outcome predictors in other liver diseases, we tested their prognostic ability in sAH.METHODS:Serum ferritin, transferrin, iron, transferrin saturation, nontransferrin-bound iron, soluble transferrin receptor, and hepcidin were measured in 828 patients with sAH recruited prospectively through the STOPAH trial. The cohort was randomly divided into exploratory (n = 200) and validation sets (n = 628).RESULTS:Patients with sAH had diminished serum transferrin but increased transferrin saturation. Among iron parameters, baseline transferrin was the best predictor of 28-day (area under the receiver operated characteristic 0.72 [95% confidence interval 0.67-0.78]) and 90-day survival (area under the receiver operated characteristic 0.65 [0.61-0.70]). Transferrin's predictive ability was comparable with the composite scores, namely model of end-stage liver disease, Glasgow alcoholic hepatitis score, and discriminant function, and was independently associated with survival in multivariable analysis. These results were confirmed in a validation cohort. Transferrin did not correlate with markers of liver synthesis nor with non-transferrin-bound iron or soluble transferrin receptor (as markers of excess unbound iron and functional iron deficiency, respectively).DISCUSSION:In patients with sAH, serum transferrin predicts mortality with a performance comparable with commonly used composite scoring systems. Hence, this routinely available parameter might be a useful marker alone or as a component of prognostic models.
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U2 - 10.14309/ajg.0000000000000492
DO - 10.14309/ajg.0000000000000492
M3 - Article
C2 - 31985531
AN - SCOPUS:85081945368
SN - 0002-9270
VL - 115
SP - 398
EP - 405
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 3
ER -