title: Elevated soluble tumor necrosis factor receptor 75 concentrations identify patients with liver cirrhosis at risk of death.
abstract: OBJECTIVE
  Elevated levels of the soluble 75-kd receptor for tumor necrosis factor-alpha (sTNF-R 75) are better predictors of mortality in cirrhosis than the Child-Turcotte-Pugh (CTP) score. Thus, we compared sTNF-R 75 with the Model for End-Stage Liver Disease (MELD), CTP, and the sTNF-R 75/55 ratio.
  
  
  METHODS
  Ninety-two patients with liver cirrhosis (mean age, 55 years; range, 19-76 years; male, 66%; CTP stage C, 41%) were included in our prospective single-center survival study. The study setting was a tertiary care university clinic. Soluble TNF-R levels were determined, and the primary end point was death.
  
  
  RESULTS
  During > or =730 days, 44 patients died. Multivariate Cox regression analysis revealed sTNF-R 75 (> or =14 ng/mL) as an independent predictor of mortality (hazard ratio, 2.53; P = .006). By receiver operating characteristic, MELD and sTNF-R 75 were more accurate in predicting 6-, 15-, and 24-month mortality than CTP and sTNF-R 75/55. This was significant for 6 months (MELD, 0.78; sTNF-R 75, 0.75 vs sTNF-R 75/55, 0.60). In patients with high MELD scores (> or =15), survival was further reduced if sTNF-R 75 values were elevated (P = .035).
  
  
  CONCLUSIONS
  Elevated sTNF-R 75 levels independently predicted mortality and improved MELD on the basis of evaluation of prognosis, especially in patients with high MELD scores. Thus, sTNF-R 75 levels might be a useful cytokine-based prognostic marker in patients with liver cirrhosis.
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Bonn, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Grünhage
authors.forename: Bettina
authors.initials: B
authors.lastname: Rezori
authors.forename: Markus
authors.initials: M
authors.lastname: Neef
authors.forename: Frank
authors.initials: F
authors.lastname: Lammert
authors.forename: Tilman
authors.initials: T
authors.lastname: Sauerbruch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Spengler
authors.forename: Christoph
authors.initials: C
authors.lastname: Reichel
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008103:Liver Cirrhosis / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept