Kivonat:
Background: Serum concentration of fetuin A/alpha 2HS-
glycoprotein (AHSG) is a good indicator of liver cell function
and 1-month mortality in patients with alcoholic liver cirrhosis
and liver cancer. We intended to determine whether decreased
serum AHSG levels are associated with long-term mortality and
whether the follow-up of serum AHSG levels can add to the
predictive value of the Child-Pugh (CP) and MELD scores.
Methods: We determined serum AHSG concentrations in 89 patients
by radial immunodiffusion. Samples were taken at the time of
enrolment and in the 1st, 3rd, 6th, and the 12th month
thereafter. Results: Forty-one patients died during the 1-year
follow-up period, 37 of them had liver failure. Data of these
patients were analysed further. Deceased patients had lower
baseline AHSG levels than the 52 patients who survived (293 +/-
77 vs. 490 +/- 106 mu g/ml, mean +/- SD, p < 0.001). Of all
laboratory parameters serum AHSG level, CP and MELD scores
showed the greatest difference between deceased and survived
patients. The cutoff AHSG level 365 mu g/ml could differentiate
between deceased and survived patients (AUC: 0.937 +/- 0.025, p
< 0.001, sensitivity: 0.865, specificity: 0.942) better than the
MELD score of 20 (AUC: 0.739 +/- 0.052, p < 0.001, sensitivity:
0.595, specificity: 0.729). Initial AHSG concentrations < 365 mu
g/ml were associated with high mortality rate (91.4%, relative
risk: 9.874, 95% C.I.: 4.258-22.898, p < 0.001) compared to
those with = 365 mu g/ml (9.3%). Fourteen out of these 37
fatalities occurred during the first month of observation.
During months 1-12 low AHSG concentration proved to be a strong
indicator of mortality (relative risk: 9.257, 95% C.I.: 3.945-
21.724, p < 0.001). Multiple logistic regression analysis
indicated that decrease of serum AHSG concentration was
independent of all variables that differed between survived and
deceased patients during univariate analysis. Multivariate
analysis showed that correlation of low serum AHSG levels with
mortality was stronger than that with CP and MELD scores.
Patients with AHSG < 365 mu g/ml had significantly shortened
survival both in groups with MELD < 20 and MELD = 20 (p < 0.0001
and p = 0.0014, respectively). Conclusion: Serum AHSG
concentration is a reliable and sensitive indicator of 1-year
mortality in patients with alcoholic liver cirrhosis that
compares well to the predictive value of CP score and may
further improve that of MELD score.
