Soluble TNF-Alpha-Receptors I Are Prognostic Markers in TIPS-Treated Patients with Cirrhosis and Portal HypertensionReport as inadecuate




Soluble TNF-Alpha-Receptors I Are Prognostic Markers in TIPS-Treated Patients with Cirrhosis and Portal Hypertension - Download this document for free, or read online. Document in PDF available to download.

Background

TNFα levels are increased in liver cirrhosis even in the absence of infection, most likely owing to a continuous endotoxin influx into the portal blood. Soluble TNFα receptors sTNFR type I and II reflect release of the short-lived TNFα, because they are cleaved from the cells after binding of TNFα. The aims were to investigate the circulating levels of soluble TNFR-I and -II in cirrhotic patients receiving TIPS.

Methods

Forty-nine patients with liver cirrhosis and portal hypertension 12 viral, 37 alcoholic received TIPS for prevention of re-bleeding n = 14, therapy-refractory ascites n = 20, or both n = 15. Portal and hepatic venous blood was drawn in these patients during the TIPS procedure and during the control catheterization two weeks later. sTNFR-I and sTNFR-II were measured by ELISA, correlated to clinical and biochemical characteristics.

Results

Before TIPS insertion, sTNFR-II levels were lower in portal venous blood than in the hepatic venous blood, as well as in portal venous blood after TIPS insertion. No significant differences were measured in sTNFR-I levels. Hepatic venous levels of sTNFR-I above 4.5 ng-mL p = 0.036 and sTNFR-II above 7 ng-mL p = 0.05 after TIPS insertion were associated with decreased survival. A multivariate Cox-regression survival analysis identified the hepatic venous levels of sTNFR-I p = 0.004 two weeks after TIPS, and Child score p = 0.002 as independent predictors of mortality, while MELD-score was not.

Conclusion

Hepatic venous levels of sTNFR-I after TIPS insertion may predict mortality in patients with severe portal hypertension.



Author: Jonel Trebicka , Aleksander Krag, Stefan Gansweid, Peter Schiedermaier, Holger M. Strunk, Rolf Fimmers, Christian P. Strassburg,

Source: http://plos.srce.hr/



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