IgG, a novel predictor for acute-on-chronic liver failure and survival in patients with decompensated cirrhosis?

Tergast, Tammo L.; Schultalbers, Marie; Wedemeyer, Heiner; Cornberg, Markus; Maasoumy, Benjamin

doi:10.1016/j.jhep.2021.01.040

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…Indeed, patients with liver cirrhosis have an increased risk of developing infections 24 and the risk further increases with the severity of the liver disease, which is mainly the result of cirrhosis-associated immune dysfunction. 25,26 This might explain the high SBP incidence in our cohort. Other studies report survival benefits of Norfloxacin administration in patients with advanced liver disease and ascites.…”

Section: Discussionmentioning

confidence: 84%

“…Whilst the overall peritonitis incidence was much lower in the respective study, many of our patients had a history of SBP and the mean MELD scores were also higher. Indeed, patients with liver cirrhosis have an increased risk of developing infections 24 and the risk further increases with the severity of the liver disease, which is mainly the result of cirrhosis‐associated immune dysfunction 25,26 . This might explain the high SBP incidence in our cohort.…”

Section: Discussionmentioning

confidence: 89%

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Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Tergast

Griemsmann

Stockhoff

et al. 2022

Aliment Pharmacol Ther

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Summary Background Onset of refractory ascites is the hallmark of end‐stage liver disease. If liver transplantation (LTx) is not available and contraindications for a transjugular portosystemic shunt (TIPS) are present, repeated paracentesis remains the standard of care (SOC). Home‐based, tunnelled peritoneal catheters (PeCa) have been suggested as an alternative treatment option. However, data on patients with cirrhosis are scarce. Aim To evaluate the safety of PeCa in these patients compared to SOC. Methods Overall, 223 patients with cirrhosis, a contraindication for TIPS and refractory ascites were included in this retrospective study. PeCa implant was performed in 152 patients, whereas 71 were treated with SOC. Analysed end points included device explant‐free survival, mortality, acute kidney injury (AKI) and hyponatraemia. In the second approach, propensity score matching (PPSM) was performed to adjust for confounding factors. Results In patients with PeCa, median device explant‐free survival was 74 days and 52 explants were recorded within the first 90 days. Within 90 days, patients with PeCa had lower mortality than SOC (p = 0.11), and spontaneous bacterial peritonitis (SBP) incidence did not differ (p = 0.82). Regarding AKI and hyponatraemia, there was a trend towards a higher incidence in the PeCa group (p = 0.13 and p = 0.08), and the risk for rehospitalisation was higher in those with a PeCa (HR: 2.11, p = 0.04). After PPSM, mortality was lower in the PeCa group (HR:0.40; p = 0.03), whereas the incidence of SBP and hyponatraemia was comparable (p = 0.80 and p = 0.28) and AKI was more frequent in those with a PeCa (p = 0.08). Conclusion The implant of PeCa allows home‐based therapy of patients with cirrhosis and refractory ascites and a contraindication for TIPS. However, the risk for complications has to be considered and prospective studies are needed.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 89%

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Tergast

Griemsmann

Stockhoff

et al. 2022

Aliment Pharmacol Ther

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“…We also included patients with advanced or decompensated liver cirrhosis-often treated in real-life practice-and the role of immunoglobulins in cirrhotic patients is controversially discussed. While decreased values may be protective in earlier stages of liver disease [18], they seem to be negatively associated with outcomes in decompensated patients [21,22]. To avoid potential bias, we not only adjusted for disease severity, but also confirmed our results-in part-in patients with preserved liver function in separate models.…”

Section: Plos Onementioning

confidence: 60%

“…Hence, they proposed hypergammaglobulinemia as an indicator for a preserved immune system [21]. IgG also independently predicted development of acute-on-chronic liver failure (ACLF) and short-term transplant-free survival [22]. Prognostic implications of immunoglobulins might also convert from early…”

Section: Discussionmentioning

confidence: 99%

Early changes in immunoglobulin G levels during immune checkpoint inhibitor treatment are associated with survival in hepatocellular carcinoma patients

et al. 2023

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Background & aims Immunotherapy represents the new standard of care in systemic first-line treatment of hepatocellular carcinoma (HCC). Biomarkers that predict treatment response and survival remain an unmet clinical need. Methods Patients with HCC treated with immune-checkpoint inhibitors (ICI) between 10/2017 and 03/2022 were retrospectively evaluated. Immunoglobulin levels (IgG, IgM, IgA) were measured at baseline and six weeks after initiation of ICI treatment. Impact of relative changes on overall survival (OS), progression-free survival (PFS), and time to progression (TTP) were evaluated. Results Seventy-two patients with HCC receiving ICI (mostly atezolizumab/bevacizumab n = 54,75%) were included (mean age: 68±12 years, cirrhosis: 72%, mean Child-Turcotte-Pugh [CTP] score: 7±2 points). Most patients had a preserved performance status (ECOG-PS 0, n = 45, 63%), 25 (35%) showed macrovascular invasion, and 32 (44%) had extrahepatic spread. Baseline immunoglobulin values (median, IgG: 1395mg/dL, IgM: 337mg/dL, IgA: 89mg/dL) were not different between responders and non-responders, and neither baseline nor follow-up immunoglobulin values correlated with OS, PFS, and TTP. However, the relative change in IgG (Δ-IgG) independently predicted OS in multivariable Cox regression analysis after adjusting for severity of liver disease, baseline AFP and CRP as well as for Δ-IgA and Δ-IgM. Patients could be stratified into high (Δ-IgG≥+14%) vs. low (Δ-IgG<+14%) risk groups (median OS: 6.4 vs. 15.9 months; p = 0.001). Importantly, Δ-IgG was also associated with PFS and TTP on adjusted multivariable Cox regression analyses. Conclusion Our study proposes a higher increase of Δ-IgG upon ICI treatment as a negative prognostic marker in patients with HCC, independent of underlying liver disease severity. These results require independent validation.

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Reply to: “IgG, a novel predictor for acute-on-chronic liver failure and survival in patients with decompensated cirrhosis?”

Basho

Bettinger

Böettler

2021

Journal of Hepatology

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IgG, a novel predictor for acute-on-chronic liver failure and survival in patients with decompensated cirrhosis?

Cited by 3 publications

References 7 publications

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Early changes in immunoglobulin G levels during immune checkpoint inhibitor treatment are associated with survival in hepatocellular carcinoma patients

Reply to: “IgG, a novel predictor for acute-on-chronic liver failure and survival in patients with decompensated cirrhosis?”

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