title: Sequential changes in plasma cytokine and endotoxin levels in cirrhotic patients with bacterial infection.
abstract: To delineate the clinical roles of plasma cytokine or endotoxin levels in the natural course of infection in patients with decompensated cirrhosis, 66 cirrhotic patients were studied within a 1.5-year period. Plasma levels of tumour necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, IL-8 and endotoxin were determined on days 1, 4 and 7 after admission when hospital infection was suspected and 4 months later. A total of 24 patients (36.4%) were proven to be infected during hospitalization (group A), while 42 others were not infected (group B). Fever occurred in a very high proportion (22/24) of group A patients. Baseline levels of TNF-alpha (37.7+/-15.2 compared with 8.7+/-1.2 pg/ml; P<0.01) and IL-6 (180.5+/-20.5 compared with 24.6+/-7.5 pg/ml; P<0.0001) were higher in group A patients, while IL-1beta, IL-8 and endotoxin levels were not significantly different between the two groups. For patients with hospital infection, IL-6 levels determined during the episode were significantly higher than baseline levels. Using IL-6 >80 pg/ml as a baseline cut-off level to diagnose bacterial infection, the sensitivity, specificity and accuracy were 87.5, 100 and 95.5% respectively. The one-year cumulative probability of mortality (61.1% compared with 23.7%; P<0.001) and of bacterial re-infection (72.2% compared with 18.4%; P<0.0001) was higher in group A than in group B. Plasma TNF-alpha and IL-6 levels determined at 4 months were not different between the two groups. In conclusion, fever or elevated plasma IL-6 levels in patients with decompensated cirrhosis calls for early antibiotic treatment to prevent life-threatening bacterial infection. Bacterial infection is likely to recur in those patients with increased IL-6 levels, while severe episodes of infection occur in patients with increased TNF-alpha levels.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China. sswang@vghtpe.gov.tw
authors.forename: S S
authors.initials: SS
authors.lastname: Wang
authors.forename: F Y
authors.initials: FY
authors.lastname: Lee
authors.forename: C C
authors.initials: CC
authors.lastname: Chan
authors.forename: R H
authors.initials: RH
authors.lastname: Lu
authors.forename: Y
authors.initials: Y
authors.lastname: Chao
authors.forename: H C
authors.initials: HC
authors.lastname: Lin
authors.forename: S L
authors.initials: SL
authors.lastname: Wu
authors.forename: Y T
authors.initials: YT
authors.lastname: Tsai
authors.forename: S D
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000097:blood* / Q000150:complications; D015415:Biomarkers / Q000097:blood; D004731:Endotoxins / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007378:Interleukins / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000097:blood* / Q000150:complications; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D015415:Biomarkers; D004731:Endotoxins; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha