New prognostic score based on galectin-3 has similar performance to model for end-stage liver disease and sodium score in patients with stable decompensated cirrhosis

Authors Theodora Oikonomou, Afroditi Orfanidou, Ioannis Goulis, Fani Ntogramatzi, Zoi Athanasiadou, George V. Papatheodoridis, Evangelos Cholongitas.

Abstract

Background Galectin-3 (gal-3) has been proposed as a marker of established renal impairment, with predictive value in stable decompensated cirrhosis.


Methods 150 stable decompensated patients were assessed in 2 transplant centers. Patients’ renal function was assessed using 51Chromium-EDTA (“true” glomerular filtration rate). We measured basic laboratory variables and gal-3 in serum samples. Factors associated with patients’ outcomes were determined.


Results Our patients were followed up for 12 months (range 1-48, interquartile range [IQR] 6, 95% confidence interval [CI] 10-13.5) and their mean prognostic scores were Child-Turcotte-Pugh (CTP) 7±2 and model for end-stage liver disease and sodium (MELD-Na) 15±6. Median gal-3 levels were 22 ng/mL. In a multivariate analysis of 94 patients (training group), gal-3 (hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.011-1.041; P=0.003) and serum sodium (HR 1.032, 95%CI 1.006- 1.062; P=0.05) were the only factors independently associated with patients’ outcomes. Kaplan-Meier analysis using the median gal-3 values revealed different times of survival (log-rank P=0.006). We derived a new prognostic score, (0.026) × serum gal-3+ (-0.079) × serum sodium, with very good discriminative accuracy for the outcome (area under the curve [AUC] 0.71, 95%CI 0.63-0.88), similar to that of the MELD-Na score (AUC 0.69, 95%CI 0.67-0.89; P=0.73), while its diagnostic accuracy was validated in the remaining 56 decompensated patients (AUC 0.81, 95%CI 0.65-0.97).


Conclusions Gal-3 proved to be an accurate and plausible biomarker of renal dysfunction in patients with decompensated cirrhosis. A new prognostic model incorporating gal-3 and sodium was derived, with very good discriminative accuracy for the outcome.


Keywords Decompensated cirrhosis, galectin-3, renal function, liver cirrhosis, prognostic scores


Ann Gastroenterol 2021; 34 (5): 728-735

Published
2021-08-19
Section
Original Articles