Exploring the Relationship Between NOD2 Risk Variants and First Decompensation Events in Cirrhotic Patients With Varices.

IF 6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Liver International Pub Date : 2024-10-29 DOI:10.1111/liv.16143

Henrik Karbannek, Matthias C Reichert, Robin Greinert, Alexander Zipprich, Frank Lammert, Cristina Ripoll

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Abstract

Background and aims: NOD2 mutations are associated with impaired gut mucosal barrier function. According to the systemic inflammation hypothesis, bacterial translocation is central in the development of decompensation. The aim was to evaluate whether the presence of NOD2 variants is associated with the development of first decompensation.

Method: Secondary analysis of prospectively collected consecutive patients with compensated cirrhosis, who were screened between 2014 and 2018. Patients with and without NOD2 variants were compared and stratified analysis according to the presence of varices was performed.

Results: 360 patients [239 (66%) men, median age 61 (53-69) years, 70 (19%) with NOD2 variants, 90 (25%) with varices] were followed for a median of 9 (4-16) months. Similar baseline characteristics were observed across NOD2 status groups, except for beta-blocker use (45% vs. 32% amongst variant carriers vs. non-carriers, p = 0.05). During follow-up, 34 patients (12%) developed their first decompensation, with no differences according to NOD2 status [HR 1.75 (95% CI 0.84-3.67)]. On multivariate analysis, only MELD remained an independent predictor of decompensation. Amongst patients with varices (n = 90), 18 (24.4%) carried a NOD2 variants, with a higher incidence of first decompensation [HR 3.00 (95% CI 1.08-8.32)], primarily due to ascites [HR 3.32 (95% CI 1.07-10.32)]. In this subgroup, MELD [HR 1.18 (95% CI 1.06-1.32)] and NOD2 variants [HR 2.91 (95% CI 0.95-8.89)] were determined to be independent predictors of decompensation.

Conclusions: The presence of NOD2 risk variants leads to a greater incidence of first decompensation only in compensated patients with varices.

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探究肝硬化静脉曲张患者中 NOD2 风险变异与首次失代偿事件之间的关系

背景和目的：NOD2 基因突变与肠道粘膜屏障功能受损有关。根据全身炎症假说，细菌转运是失代偿发生的核心。目的是评估 NOD2 变异的存在是否与首次失代偿的发生有关：对前瞻性收集的连续代偿期肝硬化患者进行二次分析，这些患者在 2014 年至 2018 年间接受了筛查。对存在和不存在NOD2变体的患者进行了比较，并根据是否存在静脉曲张进行了分层分析：对360名患者[239人（66%）男性，中位年龄61（53-69）岁，70人（19%）有NOD2变异，90人（25%）有静脉曲张]进行了中位9（4-16）个月的随访。各 NOD2 状态组的基线特征相似，但使用β-受体阻滞剂的情况除外（变异型携带者与非携带者的比例分别为 45% 和 32%，P = 0.05）。在随访期间，34 名患者（12%）首次出现失代偿，NOD2 状态无差异[HR 1.75 (95% CI 0.84-3.67)]。在多变量分析中，只有 MELD 仍是失代偿的独立预测因素。在静脉曲张患者（n = 90）中，18 例（24.4%）携带 NOD2 变体，首次失代偿的发生率较高[HR 3.00 (95% CI 1.08-8.32)]，主要原因是腹水[HR 3.32 (95% CI 1.07-10.32)]。在该亚组中，MELD[HR 1.18 (95% CI 1.06-1.32)]和NOD2变异[HR 2.91 (95% CI 0.95-8.89)]被确定为失代偿的独立预测因素：结论：NOD2风险变体的存在仅导致代偿期静脉曲张患者首次失代偿的发生率升高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.