Plasma tumor necrosis factor alpha predicts decreased long-term survival in severe alcoholic hepatitis.
Plasma tumor necrosis factor alpha (TNF alpha), interleukin 1 alpha (IL-1 alpha), and interleukin 1 beta (IL-1 beta) were measured in plasma samples obtained from 23 patients with severe alcoholic hepatitis on admission and after 30 days of hospitalization. Over a 2-year follow-up period, 14 patients died at a mean time of 8 months following discharge. The presence of elevated plasma TNF alpha either at admission or discharge from the hospital was associated with death in 82% (14/17) of patients. By contrast absence of elevated plasma TNF alpha was associated with survival in 100% (6/6). The difference in survival with and without detectable plasma TNF alpha was significant at p = 0.0022. Plasma TNF alpha was not elevated in alcoholic patients without clinically apparent liver disease, with alcoholic cirrhosis, or in nonalcoholic healthy controls. Plasma IL-1 alpha was also significantly increased in alcoholic hepatitis whereas IL-1 beta was not. Neither IL-1 alpha nor beta was correlated with outcome in the alcoholic hepatitis group. It is concluded that the presence of elevated plasma TNF alpha is a significant predictor of decreased long-term survival in patients with severe alcoholic hepatitis.
Laboratory of Metabolism and Molecular Biology, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland 20852.
M E
ME
Felver
E
E
Mezey
M
M
McGuire
M C
MC
Mitchell
H F
HF
Herlong
G A
GA
Veech
R L
RL
Veech
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000401:mortality*; D006519:Hepatitis, Alcoholic / Q000401:mortality*; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha