Predictive Utility of DASIMAR as a Prognostic Biomarker in Acute-on-chronic Liver Failure (ACLF) (DASIMAR)
The Predictive Utility of the Dimethylarginines and Ischemia Modified Albumin as Prognostic Biomarkers in Patients With Acute-on-chronic Liver Failure
Patients with acute on chronic liver failure have a risk of developing multiorgan failure and a high mortality. The current scoring systems defining the outcome of patients with acute decompensation of cirrhosis fail to identify patients that progress to Acute-on-chronic liver failure (ACLF).
The aim of the study is to evaluate if one can identify these patients early on with the proposed biomarkers: dimethylarginines and ischemia modified albumin.
研究概览
地位
条件
详细说明
Patients with acute-on-chronic liver failure (ACLF) are at risk of multiorgan failure and high mortality. Recent data suggest that patients with decompensated liver cirrhosis have higher ADMA (asymmetrical dimethylarginine) levels compared to compensated cirrhosis and plasma ADMA levels correlate with severity of liver dysfunction and inflammation. There is also an increase in symmetric dimethylarginine (SDMA), a stereo-isomer of ADMA, which is largely excreted by the kidney. Plasma SDMA levels have been shown to be associated with patients
progressing to renal failure. In a pilot study by our group involving 52 patients with acute decompensation of chronic liver disease, we showed an increase in the summed product of ADMA and SDMA, which we termed dimethylarginine score ('DAS'): This was shown to have a good predictive utility for outcome in this small group of patients (AUROC=0.89).
Furthermore, we and others have shown that albumin of patients with advanced liver disease has widespread abnormalities. The amount of albumin that is found to have reduced metal binding capacity as a consequence of oxidative damage is termed Ischemia Modified Albumin (IMA).
Our data shows that patients with ACLF who die have a significantly increased IMA/serum albumin ratio (IMAR). The summation of these two pathologically relevant biomarkers (DAS+IMAR) we termed DASIMAR and found this score to have a better predictive utility than DAS alone (AUROC:0.91).
Primary objective : To identify the patients early on that progress to ACLF which would facilitate a goal directed therapeutic approach.
Secondary objective : Generation of this dataset will further define and enable prognostication of ACLF. If this study reveals a role for these biomarkers in patients with ACLF, commercial development of simple kits may be possible.
研究类型
注册 (预期的)
联系人和位置
学习地点
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London、英国、WC1E 6HX
- 招聘中
- University College London Hospital
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接触:
- Rajeshwar P Mookerjee, BScMRCPPhD
- 电话号码:02076796516
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接触:
- Naina Shah, MBBSMRCP
- 电话号码:02076796516
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
取样方法
研究人群
描述
Inclusion Criteria:
- All patients with an acute clinical decompensation of presumed cirrhosis (elevated bilirubin >85 µmol/L, or/and increasing ascites or/and hepatic encephalopathy < grade 2) related to a clear precipitating event (e.g. infection, bleeding, alcoholic hepatitis, exposure to hepatotoxin)
Exclusion Criteria:
- Admission for reasons other than decompensation of cirrhosis (other co-morbid diseases, especially established cardiovascular or renal disease (U/S).
- Malignancy (extra-hepatic or a hepatocellular carcinoma).
- Patients who have undergone major surgery or have unsolved surgical problems.
- Pregnancy
学习计划
研究是如何设计的?
设计细节
队列和干预
团体/队列 |
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Acute decompensation of cirrhosis
acute decompensation of liver function occuring secondary to precipitating events such as sepsis, GI bleed.
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研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
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Progress to ACLF
大体时间:hours, days
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hours, days
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次要结果测量
结果测量 |
大体时间 |
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Prognosticate ACLF
大体时间:Days
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Days
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合作者和调查者
调查人员
- 首席研究员:Rajeshwar P Mookerjee, BScMRCPPhD、University College London Hospital
研究记录日期
研究主要日期
学习开始
初级完成 (预期的)
研究完成 (预期的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (估计)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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