Implication of inflammation-related cytokines in the natural history of liver cirrhosis.
OBJECTIVE
Increased serum concentrations of pro-inflammatory cytokines have been detected in patients with liver cirrhosis. However, their role in the natural history of cirrhosis and portal hypertension, in the absence of infection, and the prognostic significance of inflammation-related cytokines have not been reported. Our objective was the analysis of the prognostic value of inflammation-related cytokines in cirrhotic patients.


METHODS
Serum concentrations of tumor necrosis factor (TNF-alpha) and its soluble receptors I and II and interleukin 6 (IL-6), as well as mean blood pressure, plasma renin activity, aldosterone, vasopressin and norepinephrine concentrations were determined in 72 cirrhotic patients (Child-Pugh score: A 50%, B 33.3%, C 16.7%), without any evidence of infection, and in 25 healthy controls. Patients were followed up for a median of 35.9 (range 6-60) months.


RESULTS
Increased concentrations of soluble TNF receptors were detected in cirrhotic patients when compared with healthy controls. TNF receptors and IL-6 concentrations were both significantly more elevated in advanced phases of cirrhosis (Child-Pugh score C vs B and vs A). Sixteen patients died as a related consequence of liver cirrhosis. Multivariant analysis demonstrated that Child-Pugh score, mean blood pressure and serum levels of TNF receptor I were associated with mortality.


CONCLUSIONS
In addition to the classic factors implicated in mortality (Child-Pugh score and hemodynamic parameters), alterations in inflammation-related components are of prognostic significance in cirrhotic patients.
Internal Medicine, Hospital Universitario Puerta del Mar, 11009 Cadiz, Spain. joseantonio.giron@uca.es
José A
JA
Girón-González
Carmen
C
Martínez-Sierra
Claudio
C
Rodriguez-Ramos
Manuel A
MA
Macías
Paloma
P
Rendón
Fernando
F
Díaz
Clotilde
C
Fernández-Gutiérrez
Leopoldo
L
Martín-Herrera
D000368:Aged; D016207:Cytokines / Q000097:blood / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate
D016207:Cytokines; D015850:Interleukin-6; D018124:Receptors, Tumor Necrosis Factor