title: Tumour necrosis factor-alpha and soluble Fas ligand as biomarkers in non-acetaminophen-induced acute liver failure.
abstract: OBJECTIVE
  Cytokines as prognostic markers in acute liver failure (ALF) have not been evaluated in the Indian subcontinent with hepatitis E as the commonest aetiological agent. We investigated the clinical significance of proinflammatory/apoptotic cytokines soluble Fas ligand (sFasL) and tumour necrosis factor (TNF)-alpha in ALF of specific aetiology.
  
  
  METHODS
  A total of 82 cases, 37 ALF and 45 acute hepatitis (AH), and 60 healthy controls were recruited. Serum levels of sFasL and TNF-alpha were determined at admission and death/recovery.
  
  
  RESULTS
  Mean sFasL and TNF-alpha serum levels at admission were significantly higher (p < 0.001) in patients with ALF than AH, but no marked difference was observed between ALF-E (expired, n = 23) and ALF-S (survivors, n = 14), although the former had comparatively higher levels. ALF-E had higher than baseline TNF-alpha and sFasL concentrations at death, while in the ALF-S group the samples obtained from the patients as soon as they came out of encephalopathy, showed either lower or similar TNF-alpha and sFasL levels as found at admission.
  
  
  CONCLUSIONS
  The high levels of sFasL and TNF-alpha are associated with ALF. Following the trend of these cytokines can be useful in predicting death and timely referral to a transplant centre.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Maulana Azad Medical College & Lok Nayak Hospital, University of Delhi, Delhi, India. sdsinghal@gmail.com
authors.forename: Shashideep
authors.initials: S
authors.lastname: Singhal
authors.forename: Anita
authors.initials: A
authors.lastname: Chakravarty
authors.forename: Bhudev C
authors.initials: BC
authors.lastname: Das
authors.forename: Premashis
authors.initials: P
authors.lastname: Kar
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002648:Child; D053222:Fas Ligand Protein / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006505:Hepatitis / Q000097:blood; D006801:Humans; D007194:India; D017114:Liver Failure, Acute / Q000097:blood*; D008297:Male; D012995:Solubility; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D053222:Fas Ligand Protein; D014409:Tumor Necrosis Factor-alpha