Elevated soluble tumour necrosis factor receptor serum concentrations and short-term mortality in liver cirrhosis without acute infections

Background: Serum concentrations of the soluble 75-kDa tumour necrosis fact or receptor (sTNF-R 75) are elevated in patients with severe liver disease and may be linked to mortality as well as to prognostic markers related to clinical outcome and metabolic functions in patients with liver cirrhosis. Patients and Methods: We prospectively studied the relation of sTNF-R 75 to Child-Pugh score points and serum markers of bile acid (total serum bile a cids and 7 alpha-hydroxycholesterol), lignocaine (lignocaine metabolite (ME GX) liver function test results) and albumin metabolism (albumin and prealb umin) in 10 healthy individuals and 30 patients with cirrhosis, all free of acute infections. In patients with cirrhosis mortality was recorded for 15 months. Results: Soluble TNF-R 75 concentrations correlated with Child-Pug h score points (r = 0.440, p = 0.015), MEGX test results (rs = -0.604, p < 0.001) and prealbumin (rs = -0.527, p < 0.001) in cirrhosis. Nonsurviving p atients had almost threefold higher median sTNF-R 75 concentrations (29 ng/ ml) than survivors (11 ng/ml) (p = 0.003), Soluble TNF-R 75 serum concentra tions with an optimal cut off > 14 ng/ml were significantly more accurate i n predicting patient mortality than Child-Pugh score points in a receiver-o perator characteristic curve analysis. Conclusion: Soluble TNF-R 75 serum c oncentrations appear to be a promising new risk factor for mortality in pat ients with cirrhosis without acute infections, Copyright (C) 2000 S. Karger AG, Basel.