Transferrin: a predictor of survival in early stage liver cirrhosis

Background and aims:

The best available prognostic model to predict survival in patients with liver cirrhosis is the Model for End-stage Liver Disease (MELD). Additional parameters have been proposed to improve the prognostic accuracy of the model and transferrin was recently identified as a predictor of survival in patients with advanced and decompensated cirrhosis. The aim of this study was to understand if altered iron metabolism in liver cirrhosis is a consequence of inflammation and impaired liver function or an independent predictor of survival.

Methods:

Clinical, demographic and biochemical data was retrospectively analyzed from a cohort of 995 patients with liver cirrhosis (age ≥18 years) who presented from 01/08/2004 to 31/12/2014 at the University Hospital of Innsbruck. Patients with hepatocellular carcinoma, extrahepatic malignancy at diagnosis or a follow-up time < 6 months (unless death occurred within 6 months) were excluded.

Results:

During a median follow-up of 3.13 years, 193 deaths occurred and 234 patients underwent liver transplantation. Median transplant-free follow-up was 2.17 years. Multivariate Cox regression analysis was carried out in search for predictors of survival in this cohort. In a model including C-reactive protein, ferritin, transferrin, transferrin saturation and MELD, only transferrin and MELD remained as independent predictors of transplant-free survival. ROC curve analysis showed that a transferrin concentration of 180 mg/dl is at the highest prognostic accuracy to predict 3-months and 1-year survival. When patient subgroups with MELD ≥15 and < 15 were analyzed, transferrin remained significantly associated with transplant-free survival in the subgroup with a MELD score < 15.

Conclusion:

Our study shows that the association of transferrin with survival is independent of MELD score even at early stages of liver cirrhosis. This finding can improve the prognostic evaluation in patients with liver cirrhosis and suggests that interventions targeted at iron handling might improve outcome.

No conflict of interest has been declared by the author(s).