title: High-sensitivity C-reactive protein levels predict survival and are related to haemodynamics in alcoholic cirrhosis.
abstract: OBJECTIVE
  Inflammation may be implicated in the haemodynamic deterioration and in the development of complications in patients with cirrhosis. High-sensitivity C-reactive protein (hsCRP) is a marker of low-grade inflammation, and predicts outcomes in patients at risk of ischaemic heart disease. Proinflammatory cytokines reflect immune activation and have been found to be elevated in cirrhosis. We investigated a possible association between markers of inflammation and splanchnic and systemic haemodynamics, complications and survival in patients with cirrhosis.
  
  
  METHODS
  In 45 stable patients with cirrhosis on the basis of alcohol consumption, we measured hsCRP, as well as monocyte chemoattractant protein-1, tumour necrosis factor-α, interleukin-6, interleukin-8 and vascular endothelial growth factor in patients and in 12 healthy controls. Systemic and splanchnic haemodynamics were investigated in patients.
  
  
  RESULTS
  hsCRP levels were significantly higher in patients compared with controls (P<0.05) and the highest in patients belonging to Child-Pugh class C. hsCRP levels correlated with markers of liver dysfunction and with the hepatic venous pressure gradient (r=0.48, P<0.001). hsCRP values above the median level of 5.3 mg/l were associated with a highly increased mortality (P=0.001). Model for End-Stage Liver Disease score (P=0.01) and hsCRP (P<0.05) provided independent prognostic information. Cytokines had no discernible value in predicting survival.
  
  
  CONCLUSIONS
  hsCRP is elevated in patients with cirrhosis and is associated with portal hypertension and decreased survival. hsCRP is a promising prognostic marker in cirrhosis, which may improve the selection of candidates for liver transplantation.
authors.affiliation: Department of Gastroenterology, Hvidovre Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. c.o.mortensen@gmail.com
authors.forename: Christian
authors.initials: C
authors.lastname: Mortensen
authors.forename: Ove
authors.initials: O
authors.lastname: Andersen
authors.forename: Aleksander
authors.initials: A
authors.lastname: Krag
authors.forename: Flemming
authors.initials: F
authors.lastname: Bendtsen
authors.forename: Søren
authors.initials: S
authors.lastname: Møller
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D013152:Splanchnic Circulation / Q000502:physiology; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D016207:Cytokines; D002097:C-Reactive Protein