Biomarkers of inflammation and risk of adverse events in patients with cirrhosis

Acute kidney injury (AKI) is a frequent and severe complication in patients with cirrhosis. Identifying patients at high risk for AKI progression and in-hospital complications could enable timely targeted interventions. Given the central role of inflammation in AKI and cirrhosis, we investigated whether inflammatory biomarkers could provide prognostic insights. In this multicenter, prospective cohort study, we enrolled 188 patients with cirrhosis and AKI from 4 tertiary care centers. Urine and plasma samples were analyzed for 4 biomarkers: urine monocyte chemoattractant protein-1 (MCP-1), urine YKL-40, and plasma tumor necrosis factor receptors 1 and 2 (TNFR-1, TNFR-2). Biomarkers were assessed for their associations with AKI progression, mortality, and in-hospital complications using multivariate analyses adjusted for demographics, baseline kidney function, and MELD score. Urine MCP-1, plasma TNFR-1, and plasma TNFR-2 were each associated with increased odds of AKI progression and mortality: urine MCP-1 had odds ratio (OR) 2.35 (95% CI, 1.26-5.65), plasma TNFR-1 OR 6.90 (95% CI, 2.45-25.50), and plasma TNFR-2 OR 2.69 (95% CI, 1.34-6.17) per standard deviation (SD) higher biomarker level. Plasma TNFR-1 had the strongest associations with in-hospital complications. Each SD higher plasma TNFR-1 was associated with developing hepatic encephalopathy (OR 2.53; 95% CI, 1.37-5.06), developing spontaneous bacterial peritonitis (OR 2.20; 95% CI, 1.14-4.47), variceal bleeding during admission (OR 3.47; 95% CI, 1.05-14.46), and requiring dialysis (OR 2.81; 95% CI, 1.39-6.23). Inflammatory biomarkers effectively identify high-risk patients with AKI and cirrhosis. Incorporating these biomarkers into clinical decision-making has the potential to guide treatment.