The Vasopressin Biomarker Copeptin Is Linked to Systemic Inflammation and Refines Prognostication in Decompensated Cirrhosis

作者：Lukas Hartl, Marlene Hintersteininger, Benedikt Simbrunner, Mathias Jachs, Benedikt Hofer, David Bauer, Nina Dominik, Michael Schwarz, Lorenz Balcar, Georg Kramer, Annarein Kerbert, Minneke J. Coenraad, Thierry Thévenot, Richard Moreau, Jonel Trebicka, Joan Clària, Rodrig Marculescu, Michael Trauner, Mattias Mandorfer, Thomas Reiberger · 发表于：Clinical Gastroenterology and Hepatology · 年份：2025 · DOI：10.1016/j.cgh.2025.04.030 · 被引用次数：6 · 研究领域：Liver Disease and Transplantation、Electrolyte and hormonal disorders、Sepsis Diagnosis and Treatment

BACKGROUND & AIMS: Copeptin, an arginine-vasopressin biomarker, may confer prognostic information in patients with advanced chronic liver disease (ACLD). METHODS: Patients with ACLD included in the Vienna Cirrhosis Study (NCT03267615) between January 2017 and April 2023 and available copeptin levels were prospectively recruited and classified into 6 predefined clinical ACLD stages from S0 (subclinical portal hypertension) to S5 (further decompensation). A prognostic score (MELD-copeptin score) in patients with decompensated ACLD (dACLD) was developed in a derivation cohort (n = 150) and validated in an internal (n = 148) and an external validation cohort (n = 771). RESULTS: Among 475 patients with ACLD, 177 were compensated, whereas 298 were decompensated. Median levels of copeptin increased with progressive ACLD severity (S0, 7.5 pmol/L vs S5, 14.3 pmol/L; P < .001). Copeptin (adjusted Beta, 0.10; P < .001) was independently associated with interleukin-6 levels in dACLD. In dACLD, copeptin was linked to higher risk of further decompensation (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.00-1.01; P = .039), acute-on-chronic liver failure (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.01-1.02; P < .001), and liver-related death (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.01-1.02; P < .001) independently of relevant cofactors. The MELD-copeptin score yielded higher area under the receiver operating...