@article{3032263,
    title = "Serum zonulin levels in patients with liver cirrhosis: Prognostic
implications",
    author = "Voulgaris, Theodoros A. and Karagiannakis, Dimitrios and Hadziyannis, E. and and Manolakopoulos, Spilios and Karamanolis, Georgios P. and and Papatheodoridis, George and Vlachogiannakos, John",
    journal = "WORLD JOURNAL OF HEPATOLOGY",
    year = "2021",
    volume = "13",
    number = "10",
    pages = "1394-1404",
    publisher = "BAISHIDENG PUBLISHING GROUP INC",
    doi = "10.4254/wjh.v13.i10.1394",
    keywords = "Zonulin; Cirrhosis; Intestinal barrier; Bacterial translocation;
Decompensation; Permeability",
    abstract = "BACKGROUNDIncreased gut permeability and bacterial translocation play an
important role in liver cirrhosis. Zonulin is a recently recognized
protein involved in the disintegration of the intestinal barrier.AIMTo
investigate possible differences in serum zonulin levels among patients
with different cirrhosis stages and their potential prognostic
implications.METHODSConsecutive cirrhotic patients who attended our
liver clinic were included in the study. Serum zonulin levels, clinical,
radiological and biochemical data were collected at baseline. Patients
who accepted participation in a regular surveillance program were
followed-up for at least 12 mo.RESULTSWe enrolled 116 cirrhotics [mean
Child-Turcotte-Pugh (CTP) score: 6.2 & PLUSMN; 1.6; model for end-stage
liver disease score: 11 & PLUSMN; 3.9]. The causes of cirrhosis were
viral hepatitis (39%), alcohol (30%), non-alcoholic fatty liver
disease (17%), and other (14%). At baseline, 53% had decompensated
cirrhosis, 48% had ascites, and 32% had history of hepatic
encephalopathy. Mean zonulin levels were significantly higher in
patients with CTP-B class than CTP-A class (4.2 & PLUSMN; 2.4 ng/dL vs
3.5 & PLUSMN; 0.9 ng/dL, P = 0.038), with than without ascites (P =
0.006), and with than without history of encephalopathy (P = 0.011).
Baseline serum zonulin levels were independently associated with the
probability of decompensation at 1 year (P = 0.039), with an area under
the receiving operating characteristic of 0.723 for predicting hepatic
decompensation. Higher CTP score (P = 0.021) and portal vein diameter (P
= 0.022) were independent predictors of mortality.CONCLUSIONSerum
zonulin levels are higher in patients with more advanced chronic liver
disease and have significant prognostic value in identifying patients
who will develop decompensation."
}