Longitudinal monocyte Human leukocyte antigen‐DR expression is a prognostic marker in critically ill patients with decompensated liver cirrhosis

Berres, Marie‐Luise; Schnyder, Barbara; Yagmur, Eray; Inglis, Brett; Stanzel, S.; Tischendorf, Jens J. W.; Koch, Alexander; Winograd, Ron; Wasmuth, Hermann E.

doi:10.1111/j.1478-3231.2008.01870.x

Cited by 63 publications

(53 citation statements)

References 27 publications

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“…A bilirubin level of >3.2 mg/dl and platelet count of <98 000/mm 3 significantly increase the likelihood of SBP,53 and each model for end-stage liver disease (MELD) point increases the risk of SBP by about 11% 54. However, circulating mononuclear cells also present with alterations in Toll-like receptor (TLR)55 and HLA expression56 57 as well as reduced chemotactic, opsonic, phagocytic and killing capacity 58 59. Furthermore, genetic variants influencing host defence mechanisms such as CARD15/NOD231 60 and TLR261 have been reported to be associated with an enhanced probability of acquiring SBP.…”

Section: Epidemiology and Prognosis Of Sbpmentioning

confidence: 99%

Spontaneous bacterial peritonitis: recent guidelines and beyond

Wiest

Krag

Gerbes

2011

Gut

333

298

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Section: Epidemiology and Prognosis Of Sbpmentioning

confidence: 99%

Spontaneous bacterial peritonitis: recent guidelines and beyond

Wiest

Krag

Gerbes

2011

Gut

333

298

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“…The poorer outcome in the patients whose CRP levels failed to improve leads us to hypothesise inability to resolve inflammation may be pathophysiologically important in this syndrome. It has recently been shown that decreased HLA-DR expression [45] and a further decrease over three days is noted in non-survivors, whereas survivors showed increased or at least unchanged HLA-DR levels [46]. …”

Section: Discussionmentioning

confidence: 99%

Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure: a prospective cohort study

et al. 2012

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IntroductionAcute deterioration of cirrhosis is associated with high mortality rates particularly in the patients who develop organ failure (OF), a condition that is referred to as acute-on-chronic liver failure (ACLF), which is currently not completely defined. This study aimed to determine the role of predisposing factors, the nature of the precipitating illness and inflammatory response in the progression to OF according to the PIRO (predisposition, injury, response, organ failure) concept to define the risk of in-hospital mortality.MethodsA total of 477 patients admitted with acute deterioration of cirrhosis following a defined precipitant over a 5.5-year period were prospectively studied. Baseline clinical, demographic and biochemical data were recorded for all patients and extended serial data from the group that progressed to OF were analysed to define the role of PIRO in determining in-hospital mortality.ResultsOne hundred and fifty-nine (33%) patients developed OF, of whom 93 patients died (58%) compared with 25/318 (8%) deaths in the non-OF group (P < 0.0001). Progression to OF was associated with more severe underlying liver disease and inflammation. In the OF group, previous hospitalisation (P of PIRO); severity of inflammation and lack of its resolution (R of PIRO); and severity of organ failure (O of PIRO) were associated with significantly greater risk of death. In the patients who recovered from OF, mortality at three years was almost universal.ConclusionsThe results of this prospective study shows that the occurrence of OF alters the natural history of cirrhosis. A classification based on the PIRO concept may allow categorization of patients into distinct pathophysiologic and prognostic groups and allow a multidimensional definition of ACLF.

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“…For example, a genetically dependent increased production of IL-10 is strongly associates with active lesions of cutaneous leishmaniasis (213). IL-10 also plays a decisive role in the formation of immune paralysis, a temporary immunodeficiency occurring after trauma, major surgery, burns, or shock, and which has a high risk of bacterial/mycological infections with lethal outcomes (214)(215)(216)(217)(218)(219). It seems that macrophagederived IL-10 is also jointly responsible for age-associated immune deficiency (220).…”

Section: Role Of Il-10 In Immune-mediated Diseasesmentioning

confidence: 99%