Anemia and Systemic Inflammation Rather than Arterial Circulatory Dysfunction Predict Decompensation of Liver Cirrhosis

• Main Authors: Christina Bothou, Sabrina Rüschenbaum, Alica Kubesch, Leonie Quenstedt, Katharina Schwarzkopf, Christoph Welsch, Stefan Zeuzem, Tania Mara Welzel, Christian Markus Lange
• Format: Article
• Language: English
• Published: MDPI AG 2020-04-01
• Series: Journal of Clinical Medicine
• Subjects: portal hypertension; ascites; acute-on-chronic liver failure; decompensated liver cirrhosis
• Online Access: https://www.mdpi.com/2077-0383/9/5/1263

Background: While systemic inflammation is recognized as playing a central role in the pathogenesis of organ failures in patients with liver cirrhosis, less is known about its relevance in the development of classical hepatic decompensation. Aim: To characterize the relationship between systemic inflammation, hemodynamics, and anemia with decompensation of liver cirrhosis. Methods: This is a post-hoc analysis of a cohort study of outpatients with advanced liver fibrosis or cirrhosis. Results: Analysis included 338 patients of whom 51 patients (15%) were hospitalized due to decompensation of liver cirrhosis during a median follow-up time of six months. In univariate analysis, active alcoholism (<i>p</i> = 0.002), model of end-stage liver disease (MELD) score (<i>p</i> = 0.00002), serum IL-6 concentration (<i>p</i> = 0.006), heart rate (<i>p</i> = 0.03), low arterial blood pressure (<i>p</i> < 0.05), maximal portal venous flow (<i>p</i> = 0.008), and low hemoglobin concentration (<i>p</i> < 0.00001) were associated with hospitalization during follow-up. Multivariate analysis revealed an independent association of low hemoglobin (OR = 0.62, 95% CI = 0.51–0.78, <i>p</i> = 0.001) and serum IL-6 concentration (OR = 1.02, 95% CI = 1.01–1.04, <i>p</i> = 0.03)—but not of hemodynamic parameters—with hepatic decompensation. An inverse correlation between hemoglobin concentration and portal venous flow (<i>R</i> = −0.362, <i>p</i> < 0.0001) was detected for the non-hospitalized patients. Accuracy of baseline hemoglobin levels for predicting hospitalization (AUC = 0.84, <i>p</i> < 0.000001) was high. Conclusion: Anemia and systemic inflammation, rather than arterial circulatory dysfunction, are strong and independent predictors of hepatic decompensation in outpatients with liver cirrhosis.