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Complement C3 predicting acute-on-chronic liver failure in cirrhotic patients with bacterial infection within 90
Shuling Chen1, Ruiqi Li1, Hongli Liu1
1Department of Hepatology, The Second Hospital of Nanjing, Medical School, Southeast University.
Insights
Serum complement component 3 (C3) can predict 90-day acute-on-chronic liver failure (ACLF) and mortality in cirrhotic patients with bacterial infections. Lower C3 levels indicate a higher risk, aiding clinical assessment.
Area of Science:
- Hepatology
- Immunology
- Clinical Diagnostics
Background:
- Cirrhotic patients with bacterial infections (BI) have a high risk of acute-on-chronic liver failure (ACLF) and mortality.
- Effective biomarkers are needed for early risk stratification in this vulnerable population.
Purpose of the Study:
- To evaluate the diagnostic value of serum complement component 3 (C3) in predicting 90-day ACLF and mortality in cirrhotic patients with BI.
- To assess the performance of C3 in risk stratification models.
Main Methods:
- Prospective analysis of clinical data from 105 cirrhotic patients with BI.
- Assessment of ACLF development and mortality within 90 days as primary outcomes.
- Statistical analysis including hazard ratios, time-dependent ROC curves, and random forest regression.
Main Results:
- Lower serum C3 levels independently predicted both ACLF (HR: 0.14) and mortality (HR: 0.10) within 90 days.
- C3 demonstrated good predictive performance for ACLF (AUROC 0.72-0.76) and mortality (AUROC 0.68-0.76) over time.
- C3 inclusion improved the predictive accuracy of established scoring systems for mortality.
Conclusions:
- Serum C3 is a valuable prognostic marker for 90-day ACLF and mortality in cirrhotic patients with bacterial infections.
- C3 offers potential clinical utility for risk stratification, enabling timely interventions.
Objective:
Cirrhotic patients with bacterial infections (BI) face high risks of acute-on-chronic liver failure (ACLF) and mortality. This study assessed the diagnostic value of serum complement component 3 (C3) for predicting 90-day ACLF and mortality in this population.
Methods:
We prospectively analyzed clinical data from 105 cirrhotic patients with BI (mean age 57.2 ± 11.6 years; 57 male) admitted to the Second Hospital of Nanjing between September 2023 and March 2024. Primary outcomes were ACLF development and mortality within 90 days.
Results:
Thirty-one patients (29.5%) developed ACLF within 90 days. Lower C3 levels independently predicted both ACLF [hazard ratio (HR): 0.14, 95% confidence interval (CI): 0.02-0.93; P = 0.04) and mortality (HR: 0.10, 95% CI: 0.00-0.89; P = 0.01). Time-dependent receiver operating characteristic analysis showed C3 predicted ACLF with AUROCs of 0.76 (30 day), 0.73 (60 day), and 0.72 (90 day). For mortality, areas under the time-dependent receiver operating characteristic curves (AUROCs) were 0.76 (30 day), 0.69 (60 day), and 0.68 (90 day). A cutoff of 0.66 g/L was established using etiology-adjusted restricted cubic spline. C3 correction improved the predictive AUROCs of Child-Turcotte-Pugh, Model of End-Stage Liver Disease, and the Chronic Liver Failure Consortium Acute Decompensation scores for mortality (all P > 0.05). Random forest regression identified C3 among the top 10 risk factors for ACLF development.
Conclusion:
Serum C3 demonstrates significant prognostic value as a predictor for 90-day ACLF and mortality in cirrhotic patients with bacterial infections, offering potential clinical utility in risk stratification.
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