Changes of serum cytokine levels in patients with acute on chronic liver failure treated by plasma exchange.
OBJECTIVE
Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) may be useful to bridge patients with AoCLF to liver transplantation or to regenerate their own livers. The aim of this study was to assess the effects of PE on the circulating concentrations of cytokines in patients with AoCLF.


METHODS
One hundred forty-nine patients with AoCLF in 2 groups (PE plus routine-care, n=62; and routine-care, n=87) were enrolled in our study. Fifteen healthy donors were used as the control group. Cytokine levels such as interferon-γ (IFN-γ), interleukin-10 (IL-10), interleukin-4 (IL-4), interleukin-2 (IL-2), and tumor necrosis factor- α (TNF-α) were detected on admission and on days 7, 14, 21, and 30 during hospitalization.


RESULTS
All the detected cytokine values (IFN-γ, IL-10, IL-4, IL-2, and TNF-α) in the patient groups were higher compared with those in the healthy controls (P<0.001). PE was effective to decrease the serum concentration of cytokines: TNF-α dropped from (3.46±1.23) pg/mL to (1.64±0.66) pg/mL (P<0.01), IL-10 from (6.2±2.1) pg/mL to (3.5±1.1) pg/mL (P<0.01), IL-2 from (7.5±4.7) pg/mL to (4.0±2.1) pg/mL (P<0.01), IFN-γ from (27.5±15.8) pg/mL to (15.5±11.8) pg/mL (P<0.01), and IL-4 from (86.7±31.3) pg/mL to (44.7±26.3) pg/mL (P<0.01).


CONCLUSIONS
Cytokines may be important in the pathogenesis of the AoCLF, and PE may represent a reliable hepatic support device for AoCLF.
Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.
Wei-lin
WL
Mao
Yu
Y
Chen
Yue-mei
YM
Chen
Lan-juan
LJ
Li
D016207:Cytokines / Q000097:blood*; D058625:End Stage Liver Disease / Q000097:blood / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D007376:Interleukin-2 / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D017114:Liver Failure, Acute / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D016207:Cytokines; D007376:Interleukin-2; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015847:Interleukin-4; D007371:Interferon-gamma