Serum Transferrin Is an Independent Predictor of Mortality in Severe Alcoholic Hepatitis
Stephen R Atkinson (1), Karim Hamesch (2), Igor Spivak (2), Nurdan Guldiken (2), Joaquín Cabezas (3, 4, 5), Josepmaria Argemi (6), Igor Theurl (7), Heinz Zoller (8), Sheng Cao (9), Philippe Mathurin (10), Vijay H Shah (9), Christian Trautwein (2), Ramon Bataller (3, 6), Mark R Thursz (1) , Pavel Strnad (2)
(1) Department of Hepatology, Imperial College London, London, United Kingdom.
(2) Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
(3) Liver Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
(4) Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain.
(5) Research Institute Valdecilla (Instituto de Investigación Sanitaria Valdedilla), Santander, Spain.
(6) Pittsburgh Liver Research Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
(7) Department of Internal Medicine II (Infectious Diseases, Immunology, Rheumatology, Pneumology), Innsbruck Medical University, Innsbruck, Austria.
(8) Department of Medicine, Medical University and University Hospital of Innsbruck, Innsbruck, Austria.
(9) Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
(10) Hôpital Claude Huriez, Services des Maladies de l'Appareil Digestif, CHRU Lille, and Unité INSERM 995, Lille, France.
Objectives: Severe alcoholic hepatitis (sAH) confers substantial mortality, but the disease course is difficult to predict. As iron parameters are attractive outcome predictors in other liver diseases, we tested their prognostic ability in sAH.
Methods: Serum ferritin, transferrin, iron, transferrin saturation, nontransferrin-bound iron, soluble transferrin receptor, and hepcidin were measured in 828 patients with sAH recruited prospectively through the STOPAH trial. The cohort was randomly divided into exploratory (n = 200) and validation sets (n = 628).
Results: Patients with sAH had diminished serum transferrin but increased transferrin saturation. Among iron parameters, baseline transferrin was the best predictor of 28-day (area under the receiver operated characteristic 0.72 [95% confidence interval 0.67-0.78]) and 90-day survival (area under the receiver operated characteristic 0.65 [0.61-0.70]).
Transferrin's predictive ability was comparable with the composite scores, namely model of end-stage liver disease, Glasgow alcoholic hepatitis score, and discriminant function, and was independently associated with survival in multivariable analysis.
These results were confirmed in a validation cohort. Transferrin did not correlate with markers of liver synthesis nor with non-transferrin-bound iron or soluble transferrin receptor (as markers of excess unbound iron and functional iron deficiency, respectively).
Discussion: In patients with sAH, serum transferrin predicts mortality with a performance comparable with commonly used composite scoring systems. Hence, this routinely available parameter might be a useful marker alone or as a component of prognostic models.
CITA DEL ARTÍCULO Am J Gastroenterol . 2020 Mar;115(3):398-405.