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. 2021 Dec 24:2021:1795851.
doi: 10.1155/2021/1795851. eCollection 2021.

Role of High-Density Lipoprotein Cholesterol (HDL-C) as a Clinical Predictor of Decompensation in Patients with Chronic Liver Disease (CLD)

Harshavardhan Rao B  1 , Priya Nair  1 , Anoop K Koshy  1 , S Krishnapriya  2 , C R Greeshma  3 , Rama P Venu  1
Affiliations

Role of High-Density Lipoprotein Cholesterol (HDL-C) as a Clinical Predictor of Decompensation in Patients with Chronic Liver Disease (CLD)

Harshavardhan Rao B et al. Int J Hepatol. .

Abstract

Introduction: Systemic inflammation triggered by bacterial products like lipopolysaccharides (LPS) in the circulation is an important factor leading to decompensation in patients with chronic liver disease (CLD). High-density lipoprotein cholesterol (HDL-C) has a significant role in innate immune response to LPS in the circulation and could therefore increase the risk for decompensation in patients with CLD. In this study, we have explored the role of HDL-C as a prognostic marker for decompensation.

Methods: This was a prospective, observational, cohort study where consecutive patients with CLD were included. Patients with cholestatic liver disease and hepatocellular carcinoma were excluded. Fasting lipids were measured in all patients at the time of recruitment. Each patient was carefully followed up for development of decompensation events such as new-onset/worsening ascites, hepatic encephalopathy, or variceal bleed during follow-up.

Results: A total of 170 patients were included (mean age 60 ± 11.5 years, M : F = 6 : 1). At the end of follow-up, 97/170 patients (57%) had decompensation events. Mean HDL-C levels were significantly lower among patients with decompensation (27.5 ± 15 mg/dL vs. 43.5 ± 13.9 mg/dL; p value 0.004). Using ROC analysis, cut-off for HDL-C of 36.4 mg/dL was identified. On multivariate analysis, HDL-C (OR = 6.072; 95% CI 2.39-15.39) was found to have an independent association with risk of decompensation.

Conclusions: HDL-C level (<36.4 mg/dL) is a reliable marker for risk of decompensation and can be a useful addition to existing prognostic scoring systems in CLD. It can be a valuable tool to streamline treatment protocols and prioritise liver transplantation.

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Conflict of interest statement

There are no conflicts of interest to report.

Figures

Figure 1
Figure 1
Association of HDL-C with decompensation events on follow-up in patients with CLD. (a) Comparison of mean HDL-C levels between patients with decompensation and those with stable decompensated disease. (b) Association of HDL − C < 36.4 mg/dL with risk of decompensation events on follow-up. ∗Abbreviations: CLD: chronic liver disease; HDL-C: high-density lipoprotein cholesterol.
Figure 2
Figure 2
HDL-C levels showing a significant linear inverse correlation with markers of systemic inflammation: (a) correlation of HDL-C levels with CRP values (p value 0.001). (b) Correlation of HDL-C levels with NLR (p value 0.011). ∗Abbreviations: HDL-C: high-density lipoprotein cholesterol; CRP: C-reactive protein; NLR: neutrophil-lymphocyte ratio.
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