PLASMA CALPROTECTIN - A NEW PROGNOSTIC MARKER OF SURVIVAL IN ALCOHOL-INDUCED CIRRHOSIS

Plasma levels of calprotectin were determined in 84 patients with alco hol-induced cirrhosis. Calprotectin is released from disintegrating ne utrophils, and plasma levels seem to reflect activation and turnover o f such cells. The purpose of the study was to investigate the degree o f activation of neutrophils, which has been indicated to be increased and a cause of neutrophil exhaustion in these patients. Additionally, on follow-up after a median observation period of 559 days, we investi gated the prognostic value of calprotectin for survival. No difference was found in calprotectin levels when comparing healthy controls with patients with compensated cirrhosis and those with decompensated cirr hosis. However, high calprotectin concentrations (>median) were a sign ificant prognostic marker of poor survival (P = .001, log-rank test). Using a multivariate Cox proportional hazard model, the prognostic val ue of calprotectin seemed independent of severity of liver disease eva luated on eight clinical and biochemical variables of liver disease. D ivided into groups by the median calprotectin concentration, analysis of survival was performed in the whole series of patients (n = 84) as well as in patients who were completely without signs of recent or act ual infection (n = 54). In both groups, calprotectin levels (>median) showed a much higher prognostic value than albumin, prothrombin comple x, bilirubin, and ascites. During follow-up, calprotectin levels (>med ian) were also a predictor of recurrent infection (P = .009). Thus, in patients with alcoholic cirrhosis, plasma calprotectin seems to be a new prognostic marker of survival, which seems independent of the seve rity of liver disease. Furthermore, high plasma calprotectin levels ma y characterize a group of patients with cirrhosis with recurring bacte rial infections.