Soluble Cluster of Differentiation 14 as a Prognostic Marker in Decompensated Cirrhosis With Water Retention

Aim In patients with decompensated liver cirrhosis, water retention often leads to complications such as acute kidney injury and poor prognosis. Soluble CD14 (sCD14), a marker of bacterial translocation, may have clinical relevance in this setting. Therefore, we aimed to investigate the prognostic value of sCD14 in patients with decompensated liver cirrhosis and water retention, and to determine its association with diuretic responsiveness, acute kidney injury development, and short‐term mortality. Methods We retrospectively analyzed 134 patients with decompensated liver cirrhosis and refractory fluid retention treated with tolvaptan. Associations between serum sCD14 levels and diuretic response, acute kidney injury development, and liver‐related mortality were evaluated. sCD14 was compared with other bacterial translocation markers (soluble CD163 and mannose receptor) in a subset excluding patients with advanced hepatocellular carcinoma. Results Lower sCD14 levels were associated with improved short‐ and long‐term diuretic responses and a lower acute kidney injury incidence. Patients with sCD14 ≤ 2340 pg/mL had significantly better liver‐related survival than those with higher levels (median survival time: 24.5 vs. 4.8 months, respectively; p < 0.01). In the multivariate analysis, sCD14 > 2340 pg/mL independently predicted liver‐related mortality (hazard ratio = 2.71, p < 0.01). Compared with sCD163 and mannose receptor, sCD14 demonstrated superior prognostic value. Concomitant rifaximin use was significantly associated with lower sCD14 levels. Conclusions sCD14 is a potential biomarker for predicting prognosis, diuretic response, and acute kidney injury development in patients with decompensated liver cirrhosis and water retention. Its predictive capacity surpasses that of other bacterial translocation markers and may be influenced by administering therapeutic interventions, including rifaximin.