Urinary L-FABP is a promising prognostic biomarker of ACLF and mortality in patients with decompensated cirrhosis

Adrià Juanola, Isabel Graupera, Chiara Elia, Salvatore Piano, Cristina Solé, Marta Carol, Martina Pérez-Guasch, Octavi Bassegoda, Laia Escudé, Ana-Belén Rubio, Marta Cervera, Laura Napoleone, Emma Avitabile, Ann T Ma, Núria Fabrellas, Elisa Pose, Manuel Morales-Ruiz, Wladimiro Jiménez, Ferran Torres, Gonzalo CrespoElsa Solà, Pere Ginès

Research output: Contribution to journalArticleResearchpeer-review


BACKGROUND/AIM: Decompensated cirrhosis (DC) is associated with high mortality, mainly due to development of acute-on-chronic liver failure (ACLF). There is need to identify patients with DC with high risk of mortality and ACLF development. Liver fatty acid-binding protein (L-FABP) is expressed in several organs and correlates with liver and systemic inflammation. Aim of study was to assess prognostic value of L-FABP in patients with DC.

METHODS: Prospective series of 444 patients hospitalized for DC, divided in two cohorts: study cohort (305 patients) and validation cohort (139 patients). L-FABP was measured in urine and plasma samples collected at admission. NGAL was also measured in urine samples for comparison.

RESULTS: Urine but not plasma L-FABP correlated with 3-month survival in univariate analysis. In multivariate analysis, uL-FABP and MELDNa were the only independent predictors of prognosis. Urine L-FABP levels were higher in patients with ACLF than in those without and also predicted the development of ACLF, together with MELD-Na, during follow-up. In patients with ACLF, uL-FABP correlated with liver, coagulation, and circulatory failure. Urine L-FABP levels were also increased in patients with AKI, particularly in those with acute tubular necrosis. The value of uL-FABP in predicting prognosis and ACLF development was confirmed in the validation cohort. Urine NGAL predicted prognosis in univariate but not in multivariate analysis.

CONCLUSIONS: UL-FABP levels are independently associated with 3-month clinical course in patients with DC, in terms of mortality and ACLF development. If confirmed in larger studies, urinary L-FABP appears to be a good biomarker candidate for use in prognosis prediction in DC, together with MELDNa score.

LAY SUMARY: Increased values of liver fatty-acid binding protein (L-FABP), a protein related with lipid metabolism, has been associated with liver-related diseases. The present study analyzed urinary L-FABP (uL-FABP) levels in two independent groups of patients with decompensated cirrhosis (DC) and showed that higher uL-FABP levels correlated with increased mortality and risk of acute-on-chronic liver failure development. Therefore, uL-FABP levels could be useful as a new tool to predict complications in patients with DC.

Original languageEnglish
Pages (from-to)107-114
Number of pages8
JournalJournal of hepatology
Issue number1
Early online date13 Sep 2021
Publication statusPublished - Jan 2022


  • Acute-On-Chronic Liver Failure
  • Cirrhosis
  • Fatty Acid-Binding Proteins
  • L-FABP
  • Liver
  • Mortality
  • Organ Failure


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