Clinical usefulness of serum autotaxin levels for predicting decompensation development and prognosis in patients with compensated cirrhosis

AIM: The progression from compensated to decompensated cirrhosis markedly worsens prognosis. This study investigated the clinical utility of serum autotaxin (ATX) levels as a predictive biomarker for decompensation and mortality, particularly in patients with compensated cirrhosis. METHODS: A total of 210 patients with cirrhosis (165 with compensated cirrhosis) were retrospectively analyzed and classified into three groups based on baseline serum ATX levels: low-, intermediate-, and high-ATX groups. RESULTS: Over a median follow-up of 51.6 months, 43 patients (20.5%) died of liver-related events, and 26 patients (15.8%) with compensated cirrhosis at baseline progressed to decompensation. In both the overall cohort and the compensated cirrhosis subgroup, the high-ATX group had significantly lower cumulative survival rates than the intermediate- and low-ATX groups (p < 0.001 for both). Multivariate analysis identified high serum ATX levels as an independent predictor of mortality (overall cohort: hazard ratio [HR], 1.661; p = 0.039; compensated cirrhosis subgroup: HR, 7.488; p < 0.001). Furthermore, the cumulative incidence of decompensation was highest in the high-ATX group (p < 0.001), and high serum ATX levels were independently associated with an increased risk of decompensation (HR, 5.502; p < 0.001). CONCLUSION: ATX represents a promising non-invasive biomarker for predicting decompensation and poor prognosis in patients with compensated cirrhosis.