Lipopolysaccharide binding protein in cirrhotic patients with severe sepsis.
BACKGROUND
Lipopolysaccharide binding protein (LBP) is an acute-phase protein produced by the liver. It has been shown that LBP plays an important role in the inflammatory response to sepsis. LBP has also been shown to protect animals from endotoxin challenge by facilitating the removal of endotoxin from the blood circulation. Cirrhotic patients are susceptible to bacterial infection. It is unknown whether pre-existing liver dysfunction impacts the LBP levels and thus the prognosis in severe sepsis.


METHODS
We evaluated the serum LBP, inflammatory cytokines, and the relationship between LBP concentrations, functional liver reserve and outcomes in 58 critically ill cirrhotic patients with severe sepsis.


RESULTS
The serum LBP levels were significantly higher in 28-day survivors, while the interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were significantly higher in non-survivors. We analyzed the receiver operating characteristic (ROC) curve to determine the cut-off point for LBP to predict 28-day mortality. The cumulative rates at 28 days were 58.3% versus 16.7% for the high LBP group (>46 ng/mL) and low LBP group (<46 ng/mL) (p < 0.001). The high-LBP group had significantly lower INR, Child-Pugh, Model for End-stage Liver Disease (MELD) scores and TNF-α level. Meanwhile, the LBP levels were inversely correlated with INR, and Child-Pugh, MELD and sequential organ failure assessment (SOFA) scores.


CONCLUSIONS
The concentration of LBP is associated inversely with disease severity scores and outcomes in critically ill cirrhotic patients with severe sepsis.
Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Yi-Yuan
YY
Chen
Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Jau-Min
JM
Lien
Department of Internal Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Yun-Shing
YS
Peng
Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Yung-Chang
YC
Chen
Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Ya-Chung
YC
Tian
Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Ji-Tseng
JT
Fang
Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Hsing-Chih
HC
Huang
Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Pang-Chi
PC
Chen
Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Chih-Wei
CW
Yang
Division of Gastroenterology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC.
Cheng-Shyong
CS
Wu
Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Chang Gung University, College of Medicine, Tao-Yuan, Taiwan, ROC. Electronic address: mhtsai@cgmh.org.tw.
Ming-Hung
MH
Tsai
D000209:Acute-Phase Proteins; D000368:Aged; D002352:Carrier Proteins / Q000097:blood*; D016638:Critical Illness; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood*; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008875:Middle Aged; D018805:Sepsis / Q000150:complications*; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D002352:Carrier Proteins; D016207:Cytokines; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein
lipopolysaccharide binding protein; liver cirrhosis; severe sepsis