title: Admission levels and early changes in serum interleukin-10 are predictive of poor outcome in acute liver failure and decompensated cirrhosis.
abstract: OBJECTIVE
  Immunoparesis contributes to prognosis in acute liver failure (ALF) and decompensated cirrhosis, a phenomenon thought to be mediated by the anti-inflammatory cytokine interleukin (IL)-10. We investigated the prognostic value of admission IL-10 levels and their evolution during the early phase of treatment in intensive care, in comparison to the pro-inflammatory cytokines IL-6 and tumour necrosis factor (TNF)-alpha.
  
  
  METHODS
  We measured these cytokines within 48 h of admission in 51 ALF and 39 decompensated cirrhosis patients admitted to intensive care, and obtained follow-up measurement a median of 2 days later in 35 patients.
  
  
  RESULTS
  Levels of all cytokines were higher in those with a poor outcome. IL-10 performed as well as TNF-alpha and IL-6 in the whole cohort (area under receiver operator curve 0.73 vs 0.66 and 0.72). However IL-10 outperfomed pro-inflammatory cytokines in the subgroups with ALF (0.80 vs 0.63 and 0.70) and acetaminophen-induced ALF (0.92 vs 0.67 and 0.81). Levels of all cytokines rose significantly in non-surviving patients (n=15); IL-10 by a factor of 2, TNF-alpha by 2.6 and IL-6 by 1.13. No significant changes were seen in the surviving patients. In ALF, IL-10 was an independent predictor of outcome in multivariate analysis.
  
  
  CONCLUSIONS
  The magnitude of the compensatory anti-inflammatory response at admission, and its development during the early phase of treatment, predicts outcome as well as the pro-inflammatory response in acute hepatic syndromes and supports a vital role for this immunological phenomenon in the outcome of these patients.
authors.affiliation: Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, UK. philaberry@hotmail.com
authors.forename: P A
authors.initials: PA
authors.lastname: Berry
authors.forename: C G
authors.initials: CG
authors.lastname: Antoniades
authors.forename: M J
authors.initials: MJ
authors.lastname: Hussain
authors.forename: M J W
authors.initials: MJ
authors.lastname: McPhail
authors.forename: W
authors.initials: W
authors.lastname: Bernal
authors.forename: D
authors.initials: D
authors.lastname: Vergani
authors.forename: J A
authors.initials: JA
authors.lastname: Wendon
mesh_terms: D015331:Cohort Studies; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000276:immunology*; D017114:Liver Failure, Acute / Q000276:immunology*; D010343:Patient Admission; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D006684:HLA-DR Antigens; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10