Elevated soluble tumour necrosis factor receptor serum concentrations and short-term mortality in liver cirrhosis without acute infections.
BACKGROUND
Serum concentrations of the soluble 75-kDa tumour necrosis factor receptor (sTNF-R 75) are elevated in patients with severe liver disease and may be linked to mortality as well as to prognostic markers related to clinical outcome and metabolic functions in patients with liver cirrhosis.


METHODS
We prospectively studied the relation of sTNF-R 75 to Child-Pugh score points and serum markers of bile acid (total serum bile acids and 7alpha-hydroxycholesterol), lignocaine (lignocaine metabolite (MEGX) liver function test results) and albumin metabolism (albumin and prealbumin) in 10 healthy individuals and 30 patients with cirrhosis, all free of acute infections. In patients with cirrhosis mortality was recorded for 15 months.


RESULTS
Soluble TNF-R 75 concentrations correlated with Child-Pugh score points (r = 0.440, p = 0.015), MEGX test results (r(S) = -0.604, p < 0.001) and prealbumin (r(S) = -0. 527, p < 0.001) in cirrhosis. Nonsurviving patients had almost threefold higher median sTNF-R 75 concentrations (29 ng/ml) than survivors (11 ng/ml) (p = 0.003). Soluble TNF-R 75 serum concentrations with an optimal cut off > 14 ng/ml were significantly more accurate in predicting patient mortality than Child-Pugh score points in a receiver-operator characteristic curve analysis.


CONCLUSIONS
Soluble TNF-R 75 serum concentrations appear to be a promising new risk factor for mortality in patients with cirrhosis without acute infections.
Reichel
C
C
Department of General Internal Medicine, University of Bonn, Germany. C.Reichel@uni-bonn.de
Sudhop
T
T
Braun
B
B
Kreuzer
K A
KA
Hahn
C
C
Look
M P
MP
von Bergmann
K
K
Sauerbruch
T
T
Spengler
U
U
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D016019:Survival Analysis
D015415:Biomarkers; D018124:Receptors, Tumor Necrosis Factor