Sphingosine-1-phosphate levels tied to 3-month, 1-year mortality in end-stage liver disease
Prognosis in end-stage liver disease has highly significant association with plasma levels of sphingosine-1-phosphate (S1P), such that patients with low circulating S1P levels have lower 3-month and 1-year survival compared with those who have high S1P levels, a new study shows.
The study included 95 citrated plasma samples from patients who were assessed for orthotopicliver transplantation (OLT). Those who were receiving vitamin K antagonists or rivaroxaban as oral anti-coagulation therapies were excluded.
Hydrophilic interaction chromatography and liquid chromatography-mass spectrometry were used to process and quantify the levels of S1P, sphinganine-1-phosphate (SA1P) and sphingosine (SPH).
At the 3-month and 1-year follow-up, 9.5 (n=9)and 20 percent(n=19) of patients, respectively, died without OLT. Moreover, 10.5 percent (n=10) received OLT within 1 year.
The survival ratespredicted by S1P were 93.8, 83.1 and 57.1 percent for the third, second and first analyte concentration tertiles, respectively. Comparing the first to the second and third tertiles, the hazard ratios (HR) were 2.99 (95 percent CI,1.05 to 8.49; p=0.04)and 8.87 (1.98 to 39.78; p=0.004), respectively.
Survival rates for SA1P were 94.4, 80.2 and 64.5 percent for the third, second and first analyte concentration tertiles respectively. Only the comparison of the first to the third tertile yielded a significant HR (4.50; 1.24 to 16.40; p=0.023). No significant HRs were calculated for SPH.
Moreover, only S1P was the significant predictor of 3-month (HR, 0.94; 0.91 to 0.98; p=0.005) and 1-year (HR, 0.96; 0.94 to 0.99; p=0.002) mortality rates, according to the Cox regression analysis.
Finally, after controlling for platelet counts and haemoglobin and SA1P levels, S1P remained a significant predictor of 3-month (p<0.001) and 1-year (p<0.001) mortality, according to multivariate cox regression analysis.