Evaluation of the Behavior of Levels of Hmgb1 and Il6 as Predictors of Infection, Acute Kidney Injury and Mortality in Cirrhotic Patients With Variceal Bleeding

Abstract

BACKGROUND: Gastroesophageal varices and associated bleeding are a major cause of morbidity and mortality in cirrhotic patients. OBJECTIVE: To evaluate the potential role of the biomarkers HMGB1 (High Mobility Group Box 1) and IL-6 (Interleukin-6) as predictors of infection, acute kidney injury and mortality in these patients. METHODS: It is a prospective, observational study that included 32 cirrhotic patients with variceal bleeding. RESULTS: The subjects’mean age was 52±5 years and 20 (62.5%) were male. The average MELD was 17.53±5 and the average MELD-Na was 20.63±6.06. Thirty patients (93.3%) patients were Child-Pugh class B or C. Infection was present in 9 subjects (28.1%), acute kidney injury was present in 6 (18.1%) and 4 (12.5%) patients died. The median serum levels of HMGB1 were 1487 pg/mL (0.1 to 8593.1) and the median serum level of IL-6 was 62.1 pg/mL (0.1 to 1102.4). The serum levels of HMGB1 and IL-6 were significantly higher in patients who developed infection, acute kidney injury and death (P<0.05). The Spearman’s correlations for HMGB1 and IL-6 were 0.794 and 0.374 for infection, 0.53 and 0.374 for acute kidney injury and 0.467 and 0.404 for death, respectively. CONCLUSION: Serum levels of HMGB1 and IL-6 were higher in patients with the three studied outcomes. HMGB1 serum levels showed a high correlation with infection and a moderate correlation with acute kidney injury and death, while IL-6 showed a moderate correlation with infection and death and a low correlation with acute kidney injury.

Impact of acute kidney injury on mortality in patients with acute variceal bleeding

“…Recent studies have reported renal impairment in 19%-41% of patients with cirrhosis and AVB [ 14 , 17 – 20 ]. Of these studies, only two small-scale have studies used the new AKI diagnostic criteria [ 14 , 20 ].…”

“…Recent studies have reported renal impairment in 19%-41% of patients with cirrhosis and AVB [ 14 , 17 – 20 ]. Of these studies, only two small-scale have studies used the new AKI diagnostic criteria [ 14 , 20 ]. In the most recent study in China, large-scale retrospective results using ICA criteria were published [ 21 ].…”

Performance of High Mobility Protein Group 1 and Interleukin-6 as Predictors of Outcomes Resulting from Variceal Bleeding in Patients with Advanced Chronic Liver Disease

“…In 2018, Vilela et al conducted a pilot study and demonstrated that serum HMG1 and IL-6 levels were higher in cirrhotic patients with bleeding resulting from the rupture of oesophagogastric varices who developed acute kidney injury and infection and in non-survivors than in patients who did not have these outcomes [10].…”

“…In 2018, Vilela et al conducted a pilot study and evaluated the role of HMG1 and IL-6 as predictors of acute kidney injury, infection and mortality in cirrhotic patients with variceal haemorrhage. The serum levels of HMG1 and IL-6 were higher in patients with these outcomes than in cirrhotic samples that did not present such complications [10]. However, the potential benefit of using these molecules as biomarkers in cirrhotic patients needs to be further studied.…”

“…At the circulatory level, these molecules accentuate systemic vasodilation, including the splanchnic circulation, causing an increase in portal hypertension [6,7]. This property favours studies on these molecules in acute chronic liver failure (ACLF) and bleeding resulting from the rupture of gastroesophageal varices, which can cause ACLF [10,11].…”