Modification Patterns of Urinary Albumin Correlates With Serum Albumin and Outcome in Severe Alcoholic Hepatitis

Das, Subodh K.; Hussain, Md. Shabir; Maras, Jaswinder Singh; Kumar, Jitendra; Shasthry, Saggere Muralikrishna; Nayak, Subhashree; Arora, Vinod; Rangachari, Vijayaraghavan; Sharma, Shvetank; Maiwall, Rakhi; Sarin, Shiv Kumar

doi:10.1097/mcg.0000000000000990

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Alternatively, high circulating levels of bacterial DNA may predict the development of infection within the first 7 days of corticosteroid therapy and identify non‐responders . A further study found that circulating microvesicles, reflective of oxidative stress, are more numerous and larger in patients with a Lille non‐response as are higher levels of urinary albumin . Higher levels of lipopolysaccharide, procalcitonin and the presence of the systemic inflammatory response syndrome (SIRS) have also been shown to indicate a worse outcome at 90 days in corticosteroid treated patients .…”

Section: Discussionmentioning

confidence: 97%

“…as are higher levels of urinary albumin. 19 Higher levels of lipopolysaccharide, procalcitonin and the presence of the systemic inflammatory response syndrome (SIRS) have also been shown to indicate a worse outcome at 90 days in corticosteroid treated patients. 20 Unfortunately it was not possible to calculate the SIRS for our patients as the respiratory component was not recorded.…”

Section: Discussionmentioning

confidence: 99%

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Baseline neutrophil‐to‐lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Forrest

Storey

Sinha³

et al. 2019

Aliment Pharmacol Ther

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Summary Background Treating severe alcoholic hepatitis involves the exposure of patients to corticosteroids for 7 days to assess “response”. Aim To assess the prognostic and therapeutic implications of baseline neutrophil‐to‐lymphocyte ratio (NLR) in patients with severe alcoholic hepatitis. Methods Patients recruited to the STOPAH trial and an independent validation group were analysed retrospectively. Area under the receiver operating curve (AUC) analysis was performed. Kaplan‐Meier analysis was used to assess survival. Log‐rank test and odds ratio (OR) were used for comparative analysis. Results Baseline NLR was available for 789 STOPAH patients. The AUC for NLR was modest for 90‐day outcome (0.660), but was associated with infection, acute kidney injury (AKI) and severity of alcoholic hepatitis. Ninety‐day survival was not affected by prednisolone treatment if NLR < 5 or > 8 but mortality was reduced with prednisolone treatment when the NLR was 5‐8 (21.0% cf. 34.5%; P = 0.012). Prednisolone treatment increased the chance of Lille response if the NLR was ≥ 5 (56.5% cf. 41.1%: P = 0.01; OR 1.86) but increased the risk of day 7 infection (17.3% cf. 7.4%: P = 0.006; OR 2.60) and AKI (20.8% cf. 7.0%: P = 0.008; OR 3.46) if the NLR was > 8. Incorporation of NLR into a modified Glasgow alcoholic hepatitis score (mGAHS) improved the AUC to 0.783 and 0.739 for 28‐day and 90‐day outcome, respectively. Conclusion The NLR is associated with AKI and infection in severe alcoholic hepatitis. The NLR identifies those most likely to benefit from corticosteroids at baseline (NLR 5‐8). The mGAHS has a good predictive value for 28‐ and 90‐day outcomes.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Baseline neutrophil‐to‐lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Forrest

Storey

Sinha³

et al. 2019

Aliment Pharmacol Ther

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“…Oxidative stress is involved in the development of alcoholic liver disease as a trigger for cellular immune responses . In 2018, Das et al conducted a cross‐sectional study of 100 biopsy‐proven severe alcoholic hepatitis patients. Their results revealed that, compared to stable compensated alcoholic liver cirrhosis patients or healthy controls, the AOPPs in severe alcoholic hepatitis patients were significantly higher, both in the urine and serum.…”

Section: Data Sourcesmentioning

confidence: 99%

Advanced oxidation protein products play critical roles in liver diseases

Zhao

Zhang

Ouyang

et al. 2019

Eur J Clin Investigation

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There is a complex oxidant and antioxidant system that maintains the redox homoeostasis in the liver. While suffering from exogenous or endogenous risk factors, the balance between oxidants and antioxidants is disturbed and excessive reactive oxygen species are generated, resulting in oxidative stress. Oxidative stress is prevalent in various liver diseases and is thought to be involved in their pathophysiology. Advanced oxidation protein products are generated under conditions of oxidative damage and are newly described protein markers of oxidative stress. Previous studies have underscored the universal pathogenic roles of oxidation protein products in various diseases. However, investigations into how these products participate in the development of liver diseases have been superficial and insufficient. In this review, we highlight the current understanding of the roles of advanced oxidation protein products in liver disease pathogenesis and the underlying mechanisms. Moreover, we summarize the current studies on advanced oxidation protein products in infectious and noninfectious, acute and chronic liver diseases. Different strategies for targeting these advanced oxidation protein products and future perspectives, which may pave the way for developing new therapeutic strategies, will also be discussed here.

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“…Studies included in the systematic review reported data on 1844 participants (909 with NAFLD, 169 with ALD and 766 healthy controls). Three studies focused on ALD [37][38][39] and eight studies on NAFLD [29][30][31][32][33][34][35][36]. In studies on ALD, the diagnosis was confirmed with a biopsy.…”

Section: Systematic Reviewmentioning

confidence: 99%

Advanced Glycation End-Products in Common Non-Infectious Liver Diseases: Systematic Review and Meta-Analysis

2021

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Background: Excessive intake of fructose, glucose and alcohol is associated with the development of non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD). At the same time, these dietetic factors create an environment favorable for the generation of advanced glycation end-products. For this reason, advanced glycation end-products (AGEs) are hypothesized to play role in the development of NAFLD and ALD. In this systematic review and meta-analysis, we explore the relationship between NAFLD and ALD with AGE levels, including their diagnostic accuracy. Methods: The systematic review and meta-analysis has been pre-registered with PROSPERO (CRD42021240954) and was performed in accordance with the PRISMA guidelines. Meta-analyses were performed using the meta R package. Results: We have obtained 11 studies meeting our inclusion criteria, reporting data on 1844 participants (909 with NAFLD, 169 with ALD and 766 healthy controls). NAFLD was associated with significantly higher AGE fluorescence and serum N-(carboxyethyl)lysine (CEL) levels. Patients with alcoholic cirrhosis had significantly higher levels of N-(carboxymethyl)lysine (CML). Only individual studies examined AGEs in the context of their diagnostic accuracy. AGE fluorescence distinguished low and moderate steatosis with an AUC of 0.76. The ratio of CML, CEL and pentosidine to a soluble variant of the AGE receptor differentiated patients with NAFLD from healthy controls with high AUC (0.83–0.85). Glyceraldehyde-derived AGE separated non-alcoholic fatty liver (NAFL) from non-alcoholic steatohepatitis (NASH) with acceptable performance (AUC 0.78). Conclusions: In conclusion, NAFLD and ALD are associated with significantly higher levels of several AGEs. More research is needed to examine the diagnostic accuracy of AGEs, however individual studies show that AGEs perform well in distinguishing NAFL from NASH.

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Modification Patterns of Urinary Albumin Correlates With Serum Albumin and Outcome in Severe Alcoholic Hepatitis

Abstract: u-Alb modifications are reflective of serum albumin modifications. Further baseline u-Alb levels could be exploited to predict steroid response and mortality in SAH patients.

Cited by 11 publications

References 22 publications

Baseline neutrophil‐to‐lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Baseline neutrophil‐to‐lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Advanced oxidation protein products play critical roles in liver diseases

Advanced Glycation End-Products in Common Non-Infectious Liver Diseases: Systematic Review and Meta-Analysis

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