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Monday, March 26, 2012

Changes in cytokine levels during admission and mortality in acute alcoholic hepatitis

Cytokine levels are raised in acute alcoholic hepatitis. However, there are disparate results regarding the duration of altered plasma levels, and there are also discrepancies about the relation of changes during the first 15 days after admission with short-term (in-hospital) or long-term mortality.

In 56 patients with acute alcoholic hepatitis we found that IL-8, IL-4, Interferon-γ (IFN-γ), malondialdehyde and C-reactive protein remained higher in patients than in 18 age- and sex-matched controls at admission, at the 7th day and at the 15th day after admission. Moreover, IL-4 levels (and to a lesser extent, IL-10 and IFN-γ ones) increased along the three determinations. However, comparing patients who died during the admission with those who did not, there were no statistically significant differences, but there was a nearly significant trend for MDA (
Z = 1.89; p = 0.059), with higher levels among those who died.

When changes between the first and the second determinations were compared with long-term survival, only IL-8 and IFN-γ showed a relation with mortality.

IFN-γ values increased among those who survived and decreased among those who died (
p = 0.048). IFN-γ values at the first determination also showed a relation with long-term mortality, especially when patients with IFN-γ values in the first quartile were compared with those of the 4th one (log rank = 5.64; p = 0.018; Breslow = 4.64; p = 0.031).

Besides Interferon-γ, only C-reactive protein showed differences between the first and the 4th quartile regarding mortality (Log rank = 4.50;
p = 0.034; Breslow 4.33; p = 0.038).

In contrast with other studies, no relation was found between TNF-α or IL-6 and mortality.

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