Desempenho do grupo de proteínas 1 de alta mobilidade (HMG1) e da interleucina 6 como preditores de desfechos resultantes do sangramento varicoso em pacientes com hepatopatia crônica avançada descompensada

Abstract

Introduction: Bleeding resulting from rupture of esophagogastric varices is considered a serious complication resulting from portal hypertension and potentially fatal in patients with advanced chronic liver disease. In these patients, increased cytokine expression accentuates circulatory dysfunction through systemic inflammation. Among the inflammatory mediators of this process are the high mobility proteins 1 (HMG1) and interleukin-6 (IL-6). However, the role of these biomarkers as predictors of morbidity and mortality in these patients is not yet known. Objectives: To evaluate the performance of HMG1 and Interleukin 6 as predictors of outcomes resulting from esophagogastric variceal bleeding in patients with advanced decompensated chronic liver disease. Methods: Fifty patients of both sexes, aged over 18 years, hospitalized at the Clinical Hospital of the Federal University of Minas Gerais, Brazil, who had been diagnosed with decompensated advanced chronic liver disease and gastrointestinal bleeding due to the rupture of gastroesophageal varices, were included. Clinical and laboratory data were collected to investigate the predictors of acute renal injury, infection, and mortality. Results: mean age was 52.8 ± 10.8 years, of which 33 (66%) were male. Among the causes of chronic liver disease, alcoholism was the most common, 18 (36%) cases, followed by chronic hepatitis C virus, 11 patients (22%). Twenty-one (42%) patients were classified as Child-Pugh C, 21 (42%) Child-Pugh B and 8 (16%) Child-Pugh A. The mean MELD was 16.46 ± 5.98 and MELD-Na of 18.02 ± 7.35. The mean serum HMG1 level was 2872.36pg / mL ± 2491.94 and the median serum IL-6 level was 47.26pg / mL (0-1102.4). The acute renal injury was present in 14 (28%) patients; the infectious complications were diagnosed in 13 (26%) patients and 7 (14%) patients evolved to death. In the multivariate analysis, the variables that were associated with the acute renal injury and infection outcomes were MELD and HMG1. In acute renal injury, the serum HMG1 level that presented the best ROC curve yield was 3317.9 pg / mL. The area under the curve was 0.799 and the sensitivity and specificity rates were 76.9% and 72.2%. The infection was related to the risk of death. Serum values of the cutoff points that predicted the best infection were 3317.9pg / mL and 72.9pg / mL for HMG1 and IL-6, respectively. The area under the curve was 0.848 for HMG1 and 0.859 for IL-6 and the sensitivity and specificity rates were 92.3% and 77.8% for serum HMG1 and 90.9% and 78,4% for serum IL-6 level. For endpoint mortality, the cutoff points with best accuracy were 2668pg / mL and 84.5pg / mL for HMG1 and IL-6, respectively. The area under the curve was 0.794 for HMG1 and 0.848 for IL-6, and the sensitivity and specificity rates were 85.7% and 57.1% for serum HMG1 and 85.7% and 80.5% for serum IL-6 level. Conclusion: Through this study, it was possible to identify clinical and laboratory variables related to the outcomes acute kidney injury, infection and mortality in the acute phase of bleeding resulting from rupture of esophagogastric varices in patients with disease. Serum HMG1 levels were higher in patients who developed acute kidney injury, infection, and died as compared to patients who did not have these outcomes. Regarding serum IL-6 levels, there was no difference between the groups of patients with or without acute kidney injury and the values were higher for the infection and death outcomes. Such data will serve for comparisons and possible future validations.