Mannose-binding lectin deficiency confers risk for bacterial infections in a large Hungarian cohort of patients with liver cirrhosis.
OBJECTIVE
Mannose-binding lectin (MBL) is a serum lectin synthesized by the liver and involved in innate host defense. MBL deficiency increases the risk of various infectious diseases mostly in immune-deficient conditions. Bacterial infections are a significant cause of morbidity and mortality in liver cirrhosis due to the relative immuncompromised state.


METHODS
Sera of 929 patients with various chronic liver diseases [autoimmune liver diseases (ALD), 406; viral hepatitis C (HCV), 185; and liver cirrhosis (LC) with various etiologies, 338] and 296 healthy controls (HC) were assayed for MBL concentration. Furthermore, a follow-up, observational study was conducted to assess MBL level as a risk factor for clinically significant bacterial infections in cirrhotic patients.


RESULTS
MBL level and the prevalence of absolute MBL deficiency (<100 ng/ml) was not significantly different between patients and controls (ALD: 14.5%, HCV: 11.9%, LC: 10.7%, HC: 15.6%). In cirrhotic patients, the risk for infection was significantly higher among MBL deficient subjects as compared to non-deficient ones (50.0% vs. 31.8%, p=0.039). In a logistic regression analysis, MBL deficiency was an independent risk factor for infections (OR: 2.14 95% CI: 1.03-4.45, p=0.04) after adjusting for Child-Pugh score, co-morbidities, gender, and age. In a Kaplan-Meier analysis, MBL deficiency was associated with a shorter time to develop the first infectious complication (median days: 579 vs. 944, pBreslow=0.016, pLogRank=0.027) and was identified as an independent predictor in a multivariate Cox-regression analysis (p=0.003, OR: 2.33, 95% CI: 1.34-4.03).


CONCLUSIONS
MBL deficiency is associated with a higher probability and shorter time of developing infections in liver cirrhosis, further supporting the impact of the MBL molecule on the host defense.
Altorjay
Istvan
I
2nd Department of Medicine, University of Debrecen, Debrecen, Hungary.
Vitalis
Zsuzsanna
Z
Tornai
Istvan
I
Palatka
Karoly
K
Kacska
Sandor
S
Farkas
Gyula
G
Udvardy
Miklos
M
Harsfalvi
Jolan
J
Dinya
Tamas
T
Orosz
Peter
P
Lombay
Bela
B
Par
Gabriella
G
Par
Alajos
A
Csak
Timea
T
Osztovits
Janos
J
Szalay
Ferenc
F
Csepregi
Antal
A
Lakatos
Peter Laszlo
PL
Papp
Maria
M
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000097:blood* / Q000209:etiology* / Q000276:immunology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006814:Hungary; D007113:Immunity, Innate; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications* / Q000276:immunology; D008107:Liver Diseases / Q000097:blood / Q000150:complications / Q000276:immunology; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood / Q000172:deficiency* / Q000276:immunology; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors
D037601:Mannose-Binding Lectin