title: Serum endotoxin and inflammatory mediators in patients with cirrhosis and hepatic encephalopathy.
abstract: BACKGROUND
  Recent observations suggest that inflammatory response may be important in the pathogenesis of hepatic encephalopathy. The aim of the study was to measure arterial ammonia, tumour necrosis factor-alpha, Interleukin-6, Interleukin-18, and serum endotoxin levels and their correlation with different grades of hepatic encephalopathy.
  
  
  METHODS
  120 patients with cirrhosis were enrolled: 20 patients each of cirrhosis with grades I, II, III and IV hepatic encephalopathy, cirrhosis with and without minimal hepatic encephalopathy and healthy controls were tested for arterial ammonia, tumour necrosis factor-alpha, Interleukin-6, Interleukin-18 and serum endotoxin levels.
  
  
  RESULTS
  Median arterial ammonia, tumour necrosis factor-alpha, Interleukin-6, Interleukin-18 and serum endotoxin levels were significantly higher in patient with hepatic encephalopathy and minimal hepatic encephalopathy as compared to patients without minimal hepatic encephalopathy and healthy controls. Arterial ammonia (r = 0.72, p = 0.03), tumour necrosis factor alpha (r = 0.87, p = 0.02), Interleukin-6 (r = 0.50, p = 0.05), Interleukin-18 (r = 0.76, p = 0.02) and serum endotoxin (r = 0.91, p = 0.01) correlated with higher grades of hepatic encephalopathy.
  
  
  CONCLUSIONS
  In hepatic encephalopathy arterial ammonia, inflammatory mediators, and serum endotoxin are elevated and correlate with encephalopathy grade.
authors.affiliation: Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
authors.forename: Lokesh
authors.initials: L
authors.lastname: Jain
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.forename: Praveen
authors.initials: P
authors.lastname: Sharma
authors.forename: Siddharth
authors.initials: S
authors.lastname: Srivastava
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000209:etiology* / Q000523:psychology; D006801:Humans; D020382:Interleukin-18 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011581:Psychological Tests; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004731:Endotoxins; D020382:Interleukin-18; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D000641:Ammonia