Tumor necrosis factor-α and interleukin-6 in cirrhotic patients with spontaneous bacterial peritonitis

Abstract

AIM:To evaluate the role of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in cirrhotic patients who have hepatic and renal impairment with spontaneous bacterial peritonitis (SBP). METHODS:We prospectively studied 120 cirrhotic patients with SBP and 80 cirrhotic patients with sterile ascitic fluid. They included 144 males and 56 females with ages ranging between 34 and 62 years. The diagnosis of cirrhosis was established by clinical and laboratory criteria that did not require histological confirmation. The severity of underlying liver disease was evaluated using Pugh's modification of Child's criteria (Child-Pugh scores). Ascitic fluid was sent to the laboratory for cell count, culture, sensitivity testing, and measurement of chemical elements (i.e. , albumin, glucose). Specimens were inoculated into aerobic and anaerobic blood culture bottles. Serum and ascitic fluid were also collected in sterile tubes at study entry (before the initiation of antibiotic treatment) and 48 h later. Assays for TNF-α and IL-6 in the serum and ascitic fluid were performed with an immunoenzymometric assay using manufacture's instructions. RESULTS:Cytokine levels in serum and ascitic fluid were significantly higher in the patients with SBP.(plasma TNF-α: 135.35 ng/mL ± 11.21 ng/mL vs 92.86 ng/mL ± 17.56 ng/mL, P < 0.001; plasma IL-6: 32.30 pg/mL ± 7.07 pg/mL vs 12.11 pg/mL ± 6.53 pg/mL, P < 0.001; ascitic fluid TNF-α: 647.54 ± 107.11 ng/mL vs 238.43 ng/mL ± 65.42 ng/mL, P < 0.001); ascitic fluid IL-6: 132.84 ng/mL ± 34.13 vs 40.41 ± 12.85 pg/mL, P < 0.001). About 48 (40%) cirrhotic patients with SBP developed renal and hepatic impairment and showed significantly higher plasma and ascitic fluid cytokine levels at diagnosis of infection. [(plasma TNF-α: 176.58 ± 17.84 vs 135.35 ± 11.21 ng/mL) (P < 0.001) and (IL-6: 57.83 ± 7.85 vs 32.30 ± 7.07 pg/mL) (P < 0.001); ascitic fluid TNF-α: 958.39 ± 135.72 vs 647.54 ± 107.11 ng/mL, (P < 0.001), ascitic fluid vs 132.84 ± 34.13 pg/mL, (P < 0.001)]. Twenty nine patients (60.4%) with SBP and renal impairment died whereas, only four patients (5.55%) with SBP but without renal impairment died from gastrointestinal hemorrhage (P < 0.0005).CONCLUSION: It appears that TNF-α production may enhance liver cell injury and lead to renal impairment. This correlated well with the poor prognosis and significantly increased mortality associated with SBP in cirrhotic patients.

Impaired neutrophil extracellular traps and inflammatory responses in the peritoneal fluid of patients with liver cirrhosis

“…Furthermore, recently the same group have also reported that levels of resistin produced by neutrophils, positively correlates with IL-6 levels, contributing to the impaired function of neutrophils. 18 Suliman et al 23 also observed higher levels of IL-6 in both serum and AF from patients with SBP vs patients with ASC, in contrast to our results they also found elevated levels of TNF-α in their patients, although it is noteworthy that they measured the cytokine concentrations by a different method (ie ELISA).…”

Serum interleukin-6 in the diagnosis of bacterial infection in cirrhotic patients

“…[ 33 ] Finally, several studies also analyzed the correlation between IL-6 level and the severity or the prognosis of bacterial infection. [ 11 , 12 ] The results confirmed the values of IL-6 as a prognostic biomarker. However, this issue was not considered in this study due to insufficient data.…”

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

“…Over-expression of IL-6 reflects hepatic dysfunction and varices bleeding with mortality, as well as correlates p-STAT3 expression. A study published in 2012 evaluated the role of TNF-α and IL-6 in cirrhotic patients who had hepatic and renal impairment with spontaneous bacterial peritonitis (22) . Approximately 40% (n=48) of cirrhotic patients with SBP developed renal and hepatic impairment and showed significantly higher plasma and ascitic fluid cytokine levels upon the diagnosis of infection (22) .…”

“…A study published in 2012 evaluated the role of TNF-α and IL-6 in cirrhotic patients who had hepatic and renal impairment with spontaneous bacterial peritonitis (22) . Approximately 40% (n=48) of cirrhotic patients with SBP developed renal and hepatic impairment and showed significantly higher plasma and ascitic fluid cytokine levels upon the diagnosis of infection (22) . In contrast, Elsing et al (23) did not find higher levels of IL-6 in patients with acute decompensation compared with non-decompensated patients.…”