title: Soluble TNF-alpha-receptors I are prognostic markers in TIPS-treated patients with cirrhosis and portal hypertension.
abstract: BACKGROUND
  TNFα levels are increased in liver cirrhosis even in the absence of infection, most likely owing to a continuous endotoxin influx into the portal blood. Soluble TNFα receptors (sTNFR type I and II) reflect release of the short-lived TNFα, because they are cleaved from the cells after binding of TNFα. The aims were to investigate the circulating levels of soluble TNFR-I and -II in cirrhotic patients receiving TIPS.
  
  
  METHODS
  Forty-nine patients with liver cirrhosis and portal hypertension (12 viral, 37 alcoholic) received TIPS for prevention of re-bleeding (n = 14), therapy-refractory ascites (n = 20), or both (n = 15). Portal and hepatic venous blood was drawn in these patients during the TIPS procedure and during the control catheterization two weeks later. sTNFR-I and sTNFR-II were measured by ELISA, correlated to clinical and biochemical characteristics.
  
  
  RESULTS
  Before TIPS insertion, sTNFR-II levels were lower in portal venous blood than in the hepatic venous blood, as well as in portal venous blood after TIPS insertion. No significant differences were measured in sTNFR-I levels. Hepatic venous levels of sTNFR-I above 4.5 ng/mL (p = 0.036) and sTNFR-II above 7 ng/mL (p = 0.05) after TIPS insertion were associated with decreased survival. A multivariate Cox-regression survival analysis identified the hepatic venous levels of sTNFR-I (p = 0.004) two weeks after TIPS, and Child score (p = 0.002) as independent predictors of mortality, while MELD-score was not.
  
  
  CONCLUSIONS
  Hepatic venous levels of sTNFR-I after TIPS insertion may predict mortality in patients with severe portal hypertension.
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany ; Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jonel
authors.initials: J
authors.lastname: Trebicka
authors.affiliation: Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark ; Department of Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Krag
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gansweid
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schiedermaier
authors.affiliation: Department of Radiology, University of Bonn, Bonn, Germany.
authors.forename: Holger M
authors.initials: HM
authors.lastname: Strunk
authors.affiliation: Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.affiliation: Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Fleming
authors.initials: F
authors.lastname: Bendtsen
authors.affiliation: Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Møller
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Sauerbruch
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Spengler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood*
chemical_list: D015415:Biomarkers; D047888:Receptors, Tumor Necrosis Factor, Type I