PLASMA TUMOR NECROSIS FACTOR-ALPHA PREDICTS DECREASED LONG-TERM SURVIVAL IN SEVERE ALCOHOLIC HEPATITIS

Plasma tumor necrosis factor α (TNF α), interleukin 1 α (IL‐1α), and interleukin 1 β (IL‐1β) were measured in plasma samples obtained from 23 patients with severe alcoholic hepatitis on admission and after 30 days of hospitalization. Over a 2‐year follow‐up period, 14 patients died at a mean time of 8 months following discharge. The presence of elevated plasma TNF α either at admission or discharge from the hospital was associated with death in 82% (14/17) of patients. By contrast absence of elevated plasma TNF α was associated with survival in 100% (6/6). The difference in survival with and without detectable plasma TNF α was significant at p= 0.0022. Plasma TNF α was not elevated in alcoholic patients without clinically apparent liver disease, with alcoholic cirrhosis, or in nonalcoholic healthy controls. Plasma IL‐1a was also significantly increased in alcoholic hepatitis whereas IL‐1β was not. Neither IL‐1α nor β was correlated with outcome in the alcoholic hepatitis group. It is concluded that the presence of elevated plasma TNF α is a significant predictor of decreased long‐term survival in patients with severe alcoholic hepatitis. Copyright © 1990, Wiley Blackwell. All rights reserved