title: Prognostic potential of hepatocyte volume and cytokine expression in cirrhotic portal hypertension.
abstract: BACKGROUND
  Differentiating the prognosis of Child-Pugh A and B patients is difficult, particularly following an acute variceal hemorrhage. We have examined the prognostic significance of hepatocyte volume (HV) and the expression of selected cytokines controlling liver repair and regeneration.
  
  
  METHODS
  Forty Child-Pugh A and B cirrhotic patients surviving a first acute variceal hemorrhage were recruited prospectively. Hematological, biochemical, neurological, hemodynamic, radio-nuclear and histological assessments were carried out following recovery (at 3 weeks). Fibrosis (%) and HV were calculated using histological morphometry and radio-nuclear liver volume assessment. Immunohistochemistry was used in liver biopsy specimens to assess markers of proliferation (PCNA) and the expression of mitogens (TGF-alpha, TGF-beta(1)) or their receptors (C-met and EGFR).
  
  
  RESULTS
  In total, 27 patients died during the follow-up period. HV was predictive of survival in Child-Pugh grade A patients (chi(2) = 10.5, P = 0.0012), but percentage fibrosis and regeneration factor expression were not predictive in either Child-Pugh A or B patients. Cox regression modeling with Child-Pugh grade demonstrated HV to be an independent predictor of survival (chi(2) = 7.1, P = 0.02).
  
  
  CONCLUSIONS
  HV predicts survival independently in cirrhotic portal hypertension, and may help to differentiate prognosis in those at the more favorable end of the disease spectrum. Liver cytokine expression 3 weeks following an acute variceal bleed did not appear useful in determining prognosis.
authors.affiliation: Department of Surgery, University of Liverpool, Liverpool, UK.
authors.forename: Saboor
authors.initials: S
authors.lastname: Khan
authors.forename: Andrew
authors.initials: A
authors.lastname: Dodson
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.forename: Anthony
authors.initials: A
authors.lastname: Kawesha
authors.forename: J Steven
authors.initials: JS
authors.lastname: Grime
authors.forename: Mair
authors.initials: M
authors.lastname: Critchley
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
mesh_terms: D000328:Adult; D002452:Cell Count; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D022781:Hepatocytes / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D016207:Cytokines