BACKGROUND Macrophage activation plays a central role in hepatic and systemic inflammation and is involved in the pathogenesis of acute-on-chronic liver failure (ACLF). AIMS This study aimed to investigate neopterin levels in patients admitted for acute decompensation (AD) of cirrhosis, evaluating its relationship with ACLF and prognosis. METHODS This prospective cohort study included 205 adult subjects hospitalized for AD of cirrhosis. Twenty-one healthy subjects and 89 patients with stable cirrhosis were evaluated as controls. RESULTS Circulating neopterin was higher in AD as compared to stable cirrhosis and healthy controls (p<0.001). ACLF was independently associated with higher neopterin levels (OR 1.015, 95% CI 1.002-1.028, p = 0.025). In the multivariate Cox regression analysis, neopterin levels (HR = 1.002, IC 95% 1.000-1.004, p = 0.041), Child-Pugh class C, and ACLF were predictors of 30-day survival. Among patients with ACLF, the Kaplan-Meier survival probability was 71.4% in those with neopterin levels < 25 nmol/L and 31.0% if neopterin ≥ 25 nmol/L (p<0.001). CONCLUSIONS Higher circulating neopterin was associated with ACLF in patients hospitalized for AD of cirrhosis. Neopterin levels were also independently predictors of high short-term mortality, especially among patients with ACLF, and could represent a useful biomarker of macrophage activation in clinical practice.

中文翻译：

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新蝶呤水平升高与肝硬化患者的急性慢性肝功能衰竭和死亡率相关

背景巨噬细胞活化在肝脏和全身炎症中起核心作用，并且参与急性加慢性肝衰竭(ACLF)的发病机制。目的 本研究旨在调查因肝硬化急性失代偿 (AD) 入院的患者的新蝶呤水平，评估其与 ACLF 和预后的关系。方法 这项前瞻性队列研究包括 205 名因肝硬化 AD 住院的成年受试者。21 名健康受试者和 89 名稳定肝硬化患者被评估为对照。结果 与稳定的肝硬化和健康对照相比，AD 中的循环新蝶呤更高 (p<0.001)。ACLF 与较高的新蝶呤水平独立相关（OR 1.015，95% CI 1.002-1.028，p = 0.025）。在多变量 Cox 回归分析中，新蝶呤水平 (HR = 1.002, IC 95% 1.000-1.004, p = 0. 041)、Child-Pugh C 级和 ACLF 是 30 天存活率的预测因子。在 ACLF 患者中，新蝶呤水平 < 25 nmol/L 患者的 Kaplan-Meier 生存概率为 71.4%，新蝶呤 ≥ 25 nmol/L 患者的 Kaplan-Meier 生存概率为 31.0%（p<0.001）。结论 在因肝硬化 AD 住院的患者中，较高的循环新蝶呤与 ACLF 相关。新蝶呤水平也是高短期死亡率的独立预测因子，尤其是在 ACLF 患者中，并且可以代表临床实践中巨噬细胞活化的有用生物标志物。结论 在因肝硬化 AD 住院的患者中，较高的循环新蝶呤与 ACLF 相关。新蝶呤水平也是高短期死亡率的独立预测因子，尤其是在 ACLF 患者中，并且可以代表临床实践中巨噬细胞活化的有用生物标志物。结论 在因肝硬化 AD 住院的患者中，较高的循环新蝶呤与 ACLF 相关。新蝶呤水平也是高短期死亡率的独立预测因子，尤其是在 ACLF 患者中，并且可以代表临床实践中巨噬细胞活化的有用生物标志物。