Systemic inflammation increases across distinct stages of advanced chronic liver disease and correlates with decompensation and mortality

Abstract

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Reply to: “Presepsin as a biomarker of inflammation and prognosis in decompensated liver disease”

“…1 Although their study cohort was smaller than our study and had no direct measurements of portal hypertension available, these observations are highly valuable, since they confirm the distinct dynamics of certain SI biomarkers across ACLD substages, even in patients without apparent clinical deterioration or infection. Conversely, other biomarkers may not contain clinically relevant information in this particular setting, which is supported by our findings on lipopolysaccharide binding protein (LBP), 2 which has been regarded as a marker of bacterial translocation in ACLD, 6 and predicted mortality in patients with decompensated ACLD admitted to hospital 7 : LBP levels were not significantly different across ACLD sub-stages in our cohort (Fig. 1) and failed to (i) predict first decompensation in compensated ACLD (hazard ratio [HR] 1.13; 95% CI 0.96-1.33; p = 0.149) and (ii) mortality or liver transplantation in decompensated ACLD (HR 1.12; 95% CI 0.96-1.29; p = 0.143).…”

“…To the Editor: We thank Dr. Ferrarese and colleagues for their letter 1 and would like to comment on important aspects related to our recent study. 2 The authors indicate that future validation of our results in patients with acute decompensation (AD) are warranted, since our study cohort includes 'clinically stable' outpatients with advanced chronic liver disease (ACLD). We consider this suggestion highly relevant, however, we would strongly encourage that such future studies also consider the distinct "EASL" stages of decompensation as used in our study, 2 i.e.…”

Patterns of acute decompensation in hospitalized patients with cirrhosis and course of acute‐on‐chronic liver failure

“…Importantly, more pronounced systemic inflammation as indicated by higher CRP levels, an impaired kidney function, lower albumin levels, and a trend to higher clinical scores were the only parameters distinguishing SDC, UDC, and pre‐ACLF at baseline. In line, systemic inflammation, as for example indicated by elevated IL‐6 levels, was a strong predictor of mortality in patients with decompensated cirrhosis 31 and appears to be one of the key contributors to ACLF development in pre‐ACLF patients. Therefore, inflammation may represent an early indicator of ACLF development as well as a potential therapeutic target 32 .…”

Prognostic value of baseline interleukin 6 levels in liver decompensation and survival in HCC patients undergoing radioembolization

“…The same cutoff value for IL6 was also correlated with liver dysfunction. Although most of the evaluated patients had liver functions precluding inclusion to HCC trials, a recent study has shown a cutoff value of 7.0 pg/mL for IL6 is correlated with clinical decompensation in patients with advanced chronic liver disease [ 25 ]. The same study also showed IL6 values are independent predictors of a need for liver transplantation or death.…”