Prognostic value of C-reactive protein in cirrhosis: external validation from the CANONIC cohort

• Published in: European journal of gastroenterology & hepatology Vol. 28; no. 9; p. 1028
• Main Authors: Cervoni, Jean-Paul, Amorós, Àlex, Bañares, Rafael, Luis Montero, Jose, Soriano, German, Weil, Delphine, Moreau, Richard, Pavesi, Marco, Thévenot, Thierry, Di Martino, Vincent
• Format: Journal Article
• Language: English
• Published: England 01.09.2016
• Subjects: Age Factors; Aged; Area Under Curve; Biomarkers - blood; C-Reactive Protein - metabolism; Chi-Square Distribution; Decision Support Techniques; Disease Progression; Europe; Female; Humans; Liver Cirrhosis - blood; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Liver Cirrhosis - surgery; Liver Failure - blood; Liver Failure - diagnosis; Liver Failure - mortality; Liver Failure - surgery; Liver Transplantation; Male; Middle Aged; Multivariate Analysis; Patient Selection; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Reproducibility of Results; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index; Time Factors
• ISSN: 1473-5687
• DOI: 10.1097/MEG.0000000000000676

The variations in C-reactive protein (CRP) levels have been reported to have prognostic significance in decompensated cirrhotic patients. We aimed to provide an external validation of a prognostic model combining model for end-stage liver disease (MELD) and 'sustained high CRP levels' as main variables and to optimize the model to the context of liver transplantation by focusing on 3-month mortality with no consideration of severe chronic extrahepatic diseases. Data from cirrhotic patients enrolled in the CANONIC study were collected. Multivariate analyses used the competing risk model. The prognostic performance [area under receiver operating characteristic curve (AUROC)] of the model incorporating CRP variations within 15 days was compared with that of the MELD score alone. 583 decompensated cirrhotic patients with Child-Pugh more than B7 and serial CRP measures available were included. Of these, 111 patients had baseline CRP at least 29 mg/l and 60 still had CRP at least 29 mg/l at day 15±6 (group A). Multivariate analysis (competing risk) identified three predictors of 3-month mortality: high MELD score [hazard ratio (HR)=1.14; 95% confidence intervals (CI): 1.11-1.17, P<0.001], age (HR=1.04; 95% CI: 1.02-1.06, P<0.001), and group A (HR=1.69; 95% CI: 1.01-2.81, P=0.046). The performance of the three variables taken together for predicting 3-month mortality was 0.796 (AUROC), which was significantly higher than that of the MELD score (AUROC=0.769; P=0.019). In Child-Pugh higher than B7 cirrhotic patients with decompensation, prognostic models incorporating variations in CRP within 15 days and age predict 3-month mortality better than the MELD score alone. Such models would improve the ranking of candidates for liver transplantation by differentiating the severe patients with persistent systemic inflammation and intermediate MELD scores.