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[Prognostic value of plasmatic fibronectin and Child-Pugh classification in alcoholic cirrhotic patients. A
Edison Roberto Parise1, Flávio Hugo Parisi, Marilisa de Moraes B Leite-Mór
1Disciplina de Gastroenterologia da Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP. parise@gastro.epm.br
Insights
Plasmatic fibronectin (FN) levels predict survival in alcoholic cirrhosis patients. Higher FN levels indicate better survival, outperforming the Child-Pugh score for predicting patient outcomes.
Area of Science:
- Hepatology
- Biochemistry
- Prognostic Biomarkers
Background:
- Alcoholic cirrhosis is a significant health concern.
- Accurate prognostic markers are crucial for patient management.
- Existing markers like Child-Pugh score have limitations.
Purpose of the Study:
- To evaluate plasmatic fibronectin (FN) as a prognostic marker in alcoholic cirrhosis.
- To compare FN's prognostic value against the Child-Pugh classification and its biochemical parameters.
- To assess FN's role in predicting survival over an 18-month prospective follow-up.
Main Methods:
- Prospective study of 50 alcoholic cirrhosis patients.
- Exclusion criteria: hepatocarcinoma, GI bleeding, infection, recent alcohol intake.
- Plasmatic FN measured by radial immunodiffusion; Child-Pugh score and biochemical parameters (bilirubin, albumin, prothrombin time) assessed.
Main Results:
- The Child-Pugh score (>10) and elevated total bilirubin (>2.5 mg/dL) were significant predictors of mortality.
- Mean plasmatic FN was significantly higher in survivors (185 mg/L) than non-survivors (131 mg/L) (p<0.01).
- Plasmatic FN < 165 mg/L was associated with a Relative Risk of 6.59 for mortality; 96% survival observed with FN > 165 mg/L.
Conclusions:
- Plasmatic fibronectin (FN) is a valuable prognostic marker in alcoholic cirrhosis.
- Higher FN levels (>165 mg/L) are strongly associated with improved patient survival.
- While less accurate for predicting death, FN demonstrates superior predictive value for survival compared to Child-Pugh score and its components.
Background:
To assess the prognostic value of plasmatic fibronectin (FN), compared to numeric Child-Pugh classification and its biochemical parameters in patients with alcoholic cirrhosis followed prospectively during a 18 months-period.
Methods:
Fifty patients with the diagnosis of cirrhosis by hepatic biopsy or clinical and biochemical criteria, were included in the study after the exclusion of hepatocarcinoma and GI bleeding, infection or continous alcohol ingestion in the last 30 days. The mean age was 51.3+/-12.6 years, being 72% males and 17 of them were classified as Child-Pugh A, 18 as B and 15 as C. Serum bilirubin concentration was measured in autoanalyzer, protein electrophoresis was performed on cellulose acetate and prothrombin time by the Quick test. Plasmatic FN was assessed by radial immunodiffusion with anti-human FN in 1% agarose gel slabs.
Results:
One patient was excluded because no natural death and 12 died owing to hepatic disease. The numeric Child-Pugh [score > 10, Relative Risk (RR)=11.33] and total bilirubins (> 2.5 mg/dL, RR=9.47) were the best predictors of death. Mean plasmatic FN concentration was significantly higher among those who survived when compared with those who died (185+/-66 mg/L x 131+/-38 mg/L, p<0.01), with a RR=6.59, for FN < 165 mg/L. Higher levels of FN, on the other hand, were the best variable to predict survival, since 96% of these 29 patients were alive at the end of follow-up.
Conclusion:
Although having less accuracy in predicting the risk of death of these patients, plasmatic FN > 165 mg/L was better predictor of survival than Child-Pugh score or any one of its biochemical parameters.
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