Admission levels and early changes in serum interleukin-10 are predictive of poor outcome in acute liver failure and decompensated cirrhosis

被引:76
作者
Berry, P. A. [1 ]
Antoniades, C. G. [1 ]
Hussain, M. J. [1 ]
McPhail, M. J. W. [1 ]
Bernal, W. [1 ]
Vergani, D. [1 ]
Wendon, J. A. [1 ]
机构
[1] Kings Coll Hosp London, Inst Liver Studies, London SE5 9RS, England
关键词
anti-inflammatory response; cytokine; immunoparesis; multiple organ failure; systemic inflammatory response; HLA-DR EXPRESSION; FULMINANT HEPATIC-FAILURE; SEPTIC SHOCK; ANTIINFLAMMATORY RESPONSE; ACUTE-PANCREATITIS; PLASMA CYTOKINE; SEVERE SEPSIS; PROGNOSIS; MORTALITY; MONOCYTES;
D O I
10.1111/j.1478-3231.2010.02219.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Backround & Aim: Immunoparesis contributes to prognosis in acute liver failure (ALF) and decompensated cirrhosis, a phenomenon thought to be mediated by the anti-inflammatory cytokine interleukin (IL)-10. We investigated the prognostic value of admission IL-10 levels and their evolution during the early phase of treatment in intensive care, in comparison to the pro-inflammatory cytokines IL-6 and tumour necrosis factor (TNF)-alpha. Methods: We measured these cytokines within 48 h of admission in 51 ALF and 39 decompensated cirrhosis patients admitted to intensive care, and obtained follow-up measurement a median of 2 days later in 35 patients. Results: Levels of all cytokines were higher in those with a poor outcome. IL-10 performed as well as TNF-alpha and IL-6 in the whole cohort (area under receiver operator curve 0.73 vs 0.66 and 0.72). However IL-10 outperfomed pro-inflammatory cytokines in the subgroups with ALF (0.80 vs 0.63 and 0.70) and acetaminophen-induced ALF (0.92 vs 0.67 and 0.81). Levels of all cytokines rose significantly in non-surviving patients (n = 15); IL-10 by a factor of 2, TNF-alpha by 2.6 and IL-6 by 1.13. No significant changes were seen in the surviving patients. In ALF, IL-10 was an independent predictor of outcome in multivariate analysis. Conclusion: The magnitude of the compensatory anti-inflammatory response at admission, and its development during the early phase of treatment, predicts outcome as well as the pro-inflammatory response in acute hepatic syndromes and supports a vital role for this immunological phenomenon in the outcome of these patients.
引用
收藏
页码:733 / 740
页数:8
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