Hepatocyte-derived biomarkers predict liver-related events in alcohol-related cirrhosis

The combination of hepatocyte-derived biomarkers and FibroTest or model for end-stage liver disease (MELD) scores can help identify patients with Child-Pugh class A alcohol-related cirrhosis who are prone to liver-related events at 2 years, reports a study.

Such method may also be used for risk stratification and patient selection in clinical trials, according to the investigators.

This study included 500 patients with Child-Pugh class A alcohol-related cirrhosis, who had their plasma keratin-18 and hepatocyte-derived large extracellular vesicle (LEV) concentrations measured.

The investigators analysed the ability of these hepatocyte-derived biomarkers, alone or combined with MELD and FibroTest scores, to predict liver-related events at 2 years, considering alcohol intake at inclusion and during follow-up.

Alcohol consumption could increase keratin-18 and hepatocyte LEV concentrations. Keratin-18 concentration predicted liver-related events at 2 years, independent of FibroTest and MELD, in 419 patients without active alcohol consumption at enrolment.

Additionally, patients with both keratin-18 concentrations <285 U/L and FibroTest >0.74 showed a 24-percent cumulative incidence of liver-related events at 2 years compared with 5 percent to 14 percent in other group of patients. When the investigators combined keratin-18 concentrations >285 U/L with MELD >10, they obtained comparable results.

In 81 patients with active alcohol intake at enrolment, hepatocyte LEV alone predicted liver-related events at 2 years. Those with both hepatocyte LEV concentrations >50 U/L and FibroTest >0.74 showed a 62-percent cumulative incidence of liver-related events at 2 years relative to other patient groups with only 8-percent to 13-percent incidence.

These results were consistent when using cirrhosis decompensation, defined according to Baveno VII criteria, as endpoint.

“The identified patients at high risk of liver-related events are the target-of-choice population for intensive surveillance (eg, referral to tertiary care centres; intensive control of risk factors) and inclusion in clinical trials,” the investigators said.