Z Gastroenterol 2016; 54 - KV269
DOI: 10.1055/s-0036-1587045

Low ascites levels of cell membrane-derived microparticles indicate worse short-term prognosis in patients with decompensated cirrhosis

C Engelmann 1, K Splith 2, S Krohn 1, A Herber 1, A Boehlig 1, S Boehm 1, J Pratschke 2, T Berg 1, M Schmelzle 2
  • 1Universitätsklinik Leipzig, Sektion Hepatologie, Leipzig, Deutschland
  • 2Charité – Universitätsmedizin Berlin, Department for General, Visceral and Transplantion Surgery, Berlin, Deutschland

Background: Microparticles (MP) are small vesicles (< 1 µm) that are derived from cells after stress or cellular activation. Plasma MP levels have recently been associated with disease severity and outcome of patients with liver failure. We here retrospectively evaluated the prognostic value and clinical relevance of MP levels in the ascites fluid (AF) of patients with decompensated liver cirrhosis.

Material and methods: AF samples of 163 cirrhotic patients (index paracentesis n = 163 were collected between February 2011 and December 2012 and stored at 20 °C. MP were isolated from AF samples of index paracentesis by 2-step ultracentrifugation and identified according to their size using fluorescence activated cell sorting (FACS). MP levels were correlated with clinical and laboratory parameters. Bacterial DNA in ascites was detected by using a quantitative 16S-rRNA gene based PCR method.

Results: MP could be detected in all ascites samples with a median quantification of 281.5 MP/µl (range 17.5 – 32557.1). High ascites MP levels (> 500/µl; n = 103) were associated with a significantly better 30-day survival in decompensated liver cirrhosis, when compared to low ascites MP levels (< 500/µl; n = 60; 94.5% vs. 76%, p = 0.001). At baseline, MP levels correlated with the MELD score (MELD≥20: median 217.11 MP/µl vs. MELD< 20 335.71 MP/µl), INR (r =-0.206, p = 0.019) and thrombocytes (r = 0.295, p = 0.0001) as well as with the administration of beta-blockers (OR 2.115 (1.055 – 4.239) for > 500 MP/µl; p = 0.034).

Conclusion: Ascites levels of cell membrane-derived microparticles are suitable to identify patients with cirrhosis and poor short-term prognosis. We propose ascites MP as an easily detectable biomarker with a considerable impact on patients' management especially with regard to the indication for transplantation. Related pathomechanisms accounting for low-level ascites MP with increasing disease severity might include particle consumption or complex formation and need to be addressed in further studies.