Serum bile acids as marker for acute decompensation and acute‐on‐chronic liver failure in patients with non‐cholestatic cirrhosis

Background & Aims Retention of bile acids ( BA s) plays a central role in hepatic damage and disturbed BA signalling in liver disease. However, there is lack of data regarding the association of BA s with clinical complications, acute decompensation ( AD ) and acute‐on‐chronic liver failure ( ACLF ). Thus, we aimed to evaluate the impact of circulating serum BA s for complications in patients with cirrhosis. Methods One hundred and forty‐three patients with cirrhosis were included in this prospective cohort‐type observational study. Total serum BA s and individual BA composition were assessed in all patients on admission via high‐performance liquid chromatography. Clinical complications with respect to AD , ACLF and 1‐year transplant‐free survival were recorded. Results Total BA s and individual serum BA s were significantly higher in patients with bacterial infection, AD and ACLF ( P <.001) and correlated significantly with model of end‐stage liver disease ( MELD ) and hepatic venous pressure gradient ( P <.001). Total BA s predicted new onset of AD or ACLF during follow‐up ( OR 1.025, 95% CI : 1.012–1.038, P <.001). Best cut‐off predicting new onset of AD / ACLF and survival during course of time was total BA s ≥36.9 μmol/L. Conclusions Serum total and individual BA s are associated with AD and ACLF in patients with cirrhosis. Assessment of total BA s could serve as additional marker for risk stratification in cirrhotic patients with respect to new onset of AD and ACLF .