Lipocalin2 as a useful biomarker for risk stratification in patients with acute cholangitis: A single-center prospective and observational study

Xin Deng; Jing-Wen Wang; Qiao Wu; Long Pan; Tong Mou; Cheng-You Du

doi:10.1016/j.cca.2022.05.022

Lipocalin2 as a useful biomarker for risk stratification in patients with acute cholangitis: A single-center prospective and observational study

Clin Chim Acta. 2022 Aug 1:533:22-30. doi: 10.1016/j.cca.2022.05.022. Epub 2022 May 28.

Authors

Xin Deng¹, Jing-Wen Wang², Qiao Wu³, Long Pan³, Tong Mou¹, Cheng-You Du⁴

Affiliations

¹ Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China; Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
³ Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China.
⁴ Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China. Electronic address: duchengyou@126.com.

PMID: 35640670
DOI: 10.1016/j.cca.2022.05.022

Abstract

Background: Lipocalin2 (LCN2) is being increasingly used to diagnose and predict severe bacterial infection. We aimed to evaluate the predictive value of serum lipocalin 2 for severity grading of acute cholangitis (AC) on patient admission.

Methods: A total of 108 patients were enrolled in this study. Blood samples were obtained at admission. Receiver operating characteristic (ROC) curves were built to assess the abilities of LCN2 levels to predict moderate/severe (vs. mild) or severe (vs. mild/moderate) AC with traditional markers of inflammation such as white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR). The correlations among the key research indicators were determined using spearman's test. Multivariate analysis was conducted to identify the risk factors for severe AC.

Results: The levels of LCN2 on admission increased significantly with the severity of AC. By analysis of ROC curve of biomarkers for differentiating patients with moderate to severe AC (versus mild AC), the AUC for LCN2 (0.925) was significantly greater than that for other inflammatory markers, and the optimal cut-off value of LCN2 was 262.2 ng/mL, with a sensitivity of 90.8% and specificity of 81.4%. In addition, the AUC for LCN2 (0.912) for severe acute cholangitis was also significantly greater than that for other inflammatory markers, and the optimal cut-off value of LCN2 was 325.7 ng/mL. The sensitivity and specificity were 86.1% and 83.3%, respectively. Furthermore, LCN2 the closest relationships were found between LCN2 and PCT (r = 0.8054, P < 0.001) through Spearman's test. Multivariate analysis showed that LCN2 was the only risk factor predicting severe AC (P < 0.05).

Conclusion: Serum LCN2 concentration on patient admission could better predict severe acute cholangitis than WBC, CRP, PCT and NLR. Serum LCN2 may become a potential biomarker in the risk stratification of acute cholangitis and in indicating the time of biliary drainage.

Keywords: Acute cholangitis; Biomarker; Lipocalin2; Neutrophil-to-lymphocyte ratio.

Publication types

Observational Study

MeSH terms

Biomarkers
C-Reactive Protein* / analysis
Cholangitis* / diagnosis
Humans
Lipocalin-2 / blood*
Procalcitonin
Prospective Studies
ROC Curve
Retrospective Studies
Risk Assessment

Substances

Biomarkers
LCN2 protein, human
Lipocalin-2
Procalcitonin
C-Reactive Protein