title: Soluble membrane attack complex in ascites in patients with liver cirrhosis without infections.
abstract: OBJECTIVE
  To study complement activation in 46 patients with alcoholic cirrhosis and ascites but no spontaneous bacterial peritonitis (SBP) and 10 healthy controls.
  
  
  METHODS
  Complement activation was determined by the measurement of soluble membrane attack complex (sMAC) concentrations in ascites and plasma. In patients, metabolic liver function was determined by the galactose elimination capacity and the clinical status assessed by the Model of End-Stage Liver Disease and Child-Pugh scores.
  
  
  RESULTS
  Ascites sMAC levels were markedly higher than in the corresponding plasma sample (median (range): 596 (170 - 1519) vs 160 (77 - 848) μg/L; P < 0.01). Ascites sMAC levels correlated positively with liver status. There was no relationship between ascites sMAC and leukocyte count. No relationship between ascites sMAC and blood C-reactive protein, albumin or neutrophile count was found. Plasma sMAC concentrations were slightly higher in patients than in controls [130 μg/L (70 - 204); P = 0.04]. Neither sMAC in ascites nor plasma was related to mortality.
  
  
  CONCLUSIONS
  The increased sMAC concentration in ascites and plasma indicate an activation of the complement system in cirrhosis even in the absence of SBP. This was particularly evident in the peritoneal fluid and most marked in patients with preserved liver status. The high ascites sMAC levels may reflect transudation of membrane attack complexes from the liver. Whether this complement activation has any clinical implications remains to be clarified.
authors.affiliation: Mette Bjerre, Jan Frystyk, Troels K Hansen, Allan Flyvbjerg, The Medical Research Laboratories, Clinical Institute and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus DK-8000, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Bjerre
authors.forename: Peter
authors.initials: P
authors.lastname: Holland-Fischer
authors.forename: Henning
authors.initials: H
authors.lastname: Grønbæk
authors.forename: Jan
authors.initials: J
authors.lastname: Frystyk
authors.forename: Troels K
authors.initials: TK
authors.lastname: Hansen
authors.forename: Hendrik
authors.initials: H
authors.lastname: Vilstrup
authors.forename: Allan
authors.initials: A
authors.lastname: Flyvbjerg