Lipoprotein-related biomarkers HDL-C and apoA-I predict infection risk in patients with liver cirrhosis
Abstract
Infections are major drivers of decompensation and mortality in cirrhosis. High-density lipoprotein (HDL) and its major protein component apolipoprotein A-I (apoA-I) exhibit immune-modulatory properties, yet their role in predicting infection risk in cirrhosis remains poorly defined. This single-centre cohort study evaluated baseline HDL cholesterol (HDL-C) and apoA-I in 311 patients with cirrhosis (training: n = 225; temporal validation: n = 86). The primary endpoint was infection requiring antibiotic therapy within 12 months. Cox regression, C-indices and censoring-adjusted time-dependent ROC analyses assessed prognostic performance. Infections occurred in 24% of the training and 31% of the validation cohort. Lower HDL-C and apoA-I levels were significantly associated with infection risk in both cohorts. In the training cohort, both biomarkers improved discrimination when added to MELD. The biomarker models achieved higher C-indices and numerically higher 12-month AUCs than MELD and Child-Pugh alone. Discrimination attenuated in the validation cohort, where the biomarker-based models performed comparably to the established MELD and Child-Pugh scores. Training-derived exploratory cut-offs of HDL-C < 40.4 mg/dL and apoA-I < 98.5 mg/dL identified groups with higher infection risk. Occurrence of infection signaled a clear transition towards an unfavorable clinical trajectory, with a mortality rate of 41% during follow-up. These findings support HDL-C and apoA-I as candidate prognostic biomarkers of infection susceptibility. External validation and prospective assessment of clinical utility are needed; causal and therapeutic implications require dedicated investigation.
Related
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- Risk Factors for Metastatic Infectious Complications in Patients with Catheter-Related Bloodstream Infection
- Incidence and predictors of acute decompensation in adult patients with cirrhosis: a retrospective cohort study at the University of Gondar comprehensive Specialized Hospitals, Northwest Ethiopia, 2025
- The Pros & Cons of Measuring Plasma Ammonia in the Management of Patients With Cirrhosis: An ISHEN Debate
BibTeX
@article{rainer2026lipoproteinrelated,
title = {{Lipoprotein-related biomarkers HDL-C and apoA-I predict infection risk in patients with liver cirrhosis}},
author = {Florian Rainer and Markus Trieb and Angela Horvath and Philipp Douschan and Hubert Scharnagl and Ákos Heinemann and Gunther Marsche and Vanessa Stadlbauer and Rudolf E. Stauber},
journal = {Scientific Reports},
year = {2026},
month = oct,
doi = {10.1038/s41598-026-74841-5},
url = {https://www.nature.com/articles/s41598-026-74841-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Lipoprotein-related biomarkers HDL-C and apoA-I predict infection risk in patients with liver cirrhosis
AU - Florian Rainer
AU - Markus Trieb
AU - Angela Horvath
AU - Philipp Douschan
AU - Hubert Scharnagl
AU - Ákos Heinemann
AU - Gunther Marsche
AU - Vanessa Stadlbauer
AU - Rudolf E. Stauber
PY - 2026
DA - 2026/10/11
JO - Scientific Reports
DO - 10.1038/s41598-026-74841-5
UR - https://www.nature.com/articles/s41598-026-74841-5
AB - Infections are major drivers of decompensation and mortality in cirrhosis. High-density lipoprotein (HDL) and its major protein component apolipoprotein A-I (apoA-I) exhibit immune-modulatory properties, yet their role in predicting infection risk in cirrhosis remains poorly defined. This single-centre cohort study evaluated baseline HDL cholesterol (HDL-C) and apoA-I in 311 patients with cirrhosis (training: n = 225; temporal validation: n = 86). The primary endpoint was infection requiring antibiotic therapy within 12 months. Cox regression, C-indices and censoring-adjusted time-dependent ROC analyses assessed prognostic performance. Infections occurred in 24% of the training and 31% of the validation cohort. Lower HDL-C and apoA-I levels were significantly associated with infection risk in both cohorts. In the training cohort, both biomarkers improved discrimination when added to MELD. The biomarker models achieved higher C-indices and numerically higher 12-month AUCs than MELD and Child-Pugh alone. Discrimination attenuated in the validation cohort, where the biomarker-based models performed comparably to the established MELD and Child-Pugh scores. Training-derived exploratory cut-offs of HDL-C < 40.4 mg/dL and apoA-I < 98.5 mg/dL identified groups with higher infection risk. Occurrence of infection signaled a clear transition towards an unfavorable clinical trajectory, with a mortality rate of 41% during follow-up. These findings support HDL-C and apoA-I as candidate prognostic biomarkers of infection susceptibility. External validation and prospective assessment of clinical utility are needed; causal and therapeutic implications require dedicated investigation.
SN - 2045-2322
ER -