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.