title: Serum pentraxin-3 and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) predict severity of infections in acute decompensated cirrhotic patients.
abstract: BACKGROUND
  Pentraxin-3 (PTX3) and soluble tumor necrosis factor (TNF)-like weak inducer of apoptosis (sTWEAK) are new candidate prognostic markers for comorbidities and mortality in various inflammatory diseases. Acute decompensation of cirrhosis is characterized by acute exacerbation of chronic systemic inflammation. Recently, increased circulating PTX3levels have been reported in nonalcoholic steatohepatitis patients and positively correlated with disease severity. This study aims to explore serum PTX3/sTWEAK levels and their relationship with clinical outcomes in cirrhotic patients with acute decompensation.
  
  
  METHODS
  We analyzed serum PTX3/sTWEAK levels in relation to inhospital and 3-month new clinical events and survivals in cirrhotic patients with acute decompensation.
  
  
  RESULTS
  During admission, serum PTX3/sTWEAK levels were significantly higher in acute decompensated cirrhotic patients than controls and positively correlated with protein-energy wasting (PEW), new infections, long hospital stays, high medical costs, and high mortality. During a 3-month follow-up, acute decompensated cirrhotic patients with high serum PTX3/sTWEAK levels had more episodes of unplanned readmission and high 3-month mortality. On multivariate analysis, high PTX3/sTWEAK levels and PEW were independent risk factors for high mortality.
  
  
  CONCLUSIONS
  High serum PTX3/sTWEAK levels and PEW are common in cirrhotic patients with acute decompensation. As compared with low serum PTX3and sTWEAK cases, cirrhotic patients with high serum PTX3/sTWEAK levels a have higher probability of new severe infections, severe sepsis, septic shock, type 1 hepatorenal syndrome, in-hospital, and 3-month follow-up mortalities. Therefore, high serum PTX3/sTWEAK levels on hospital admission predict disease severity and case fatality in cirrhotic patients with acute decompensation.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Fan
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address: yangyy@vghtpe.gov.tw.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Yang
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Oral Biology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Alan
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Kuei-Chuan
authors.initials: KC
authors.lastname: Lee
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yun-Cheng
authors.initials: YC
authors.lastname: Hsieh
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chang-Phone
authors.initials: CP
authors.lastname: Fung
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Hui-Chi
authors.initials: HC
authors.lastname: Hsu
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: hclin@vghtpe.gov.tw.
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
mesh_terms: D001424:Bacterial Infections / Q000097:blood* / Q000382:microbiology / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D000074049:Cytokine TWEAK / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000382:microbiology / Q000473:pathology; D018836:Inflammation Mediators / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000382:microbiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000683:Serum Amyloid P-Component / Q000032:analysis*; D012772:Shock, Septic / Q000097:blood / Q000382:microbiology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D000099153:Pentraxins
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D000074049:Cytokine TWEAK; D018836:Inflammation Mediators; D000683:Serum Amyloid P-Component; D014409:Tumor Necrosis Factor-alpha; D000099153:Pentraxins; C109743:TNFSF12 protein, human
keywords: pentraxin-3; protein-energy wasting; soluble TNF-like weak inducer of apoptosis