Correlation of Serum Prolactin Levels With Chronic Liver Disease Severity in a Tertiary Care Hospital in Eastern...

Introduction Chronic liver disease (CLD) is a health concern in India and is associated with significant morbidity and mortality. Hormonal dysregulation, including impaired, hepatic elimination of hormones, is a common feature of CLD. Prolactin, a hormone traditionally associated with reproductive functions, is a potential biomarker for assessing the severity and complications of CLD. This study aimed to evaluate the relationship between serum prolactin levels and the severity of CLD, as assessed by the Child-Turcotte-Pugh (CTP) score, and to explore its association with various complications of the disease. Methods This prospective observational study was conducted in the Department of Medicine at Tata Main Hospital, Jamshedpur, India, from June 2022 to December 2023. Patients diagnosed with CLD were evaluated for demographic characteristics, clinical history, and examination findings. Comprehensive diagnostic work-ups for CLD and its complications were performed, and disease severity was assessed using the CTP score. Serum prolactin levels were measured using an electrochemiluminescence assay. Statistical analyses, including the Chi-square test, Kruskal-Wallis test, and independent sample t-tests, were employed to evaluate the relationship between serum prolactin levels, disease severity, and complications. A p-value of <0.05 was considered statistically significant. Results The study included 120 patients with a mean age of 47.3 ± 10.4 years. There was a marked male predominance, with a male-to-female ratio of 6.5:1. Alcohol consumption was the most common cause of CLD (n=75, 62.5%), followed by metabolic dysfunction-associated steatohepatitis (n=11, 9.2%) and hepatitis B infection (n=10, 8.3%). The mean serum prolactin level was 35.3 ±, 9.25 ng/mL (range: 16 to 52 ng/mL), and the mean CTP score was 9.68 ±, 2.11. Most patients were classified as CTP Class B (n=31, 51.7%), followed by Class C (n=55, 45.8%) and Class A (n=3, 2.5%). Serum prolactin levels showed significant positive correlations with CTP scores, serum bilirubin (R = 0.377, p < 0.001), and international normalized ratio (R = 0.317, p < 0.001) and a significant negative correlation with serum albumin (R = -0.393, p < 0.001). The Kruskal-Wallis test demonstrated a significant association between serum prolactin levels and the severity of ascites (p < 0.001) and hepatic encephalopathy (p < 0.001). Using receiver operating characteristic analysis, a serum prolactin cut-off > 35 ng/mL predicted severe CLD (CTP Class C) with 83.6% sensitivity and 83.1% specificity. Elevated serum prolactin levels were observed in 77.4% of patients (n=60) with oesophageal varices, 88.2% (n=30) with upper gastrointestinal bleeding, 93.7% (n=39) with hepatic encephalopathy, 75.5% (n=53) with moderate to severe ascites, and 82.8% (n=3) with spontaneous bacterial peritonitis. The overall mortality rate was 3.33% (n=4), and serum prolactin levels were significantly higher in deceased patients compared to those in survivors (p < 0.001). Conclusion Serum prolactin levels strongly correlate with the severity of CLD as measured by the CTP scoring system. Our results support the potential utility of serum prolactin as a prognostic biomarker for complications and outcomes in CLD. Its non-invasive nature and significant association with disease severity and complications make it a valuable clinical assessment and management tool.