Grünhage F, Rezori B, Neef M, Lammert F, Sauerbruch T, Spengler U, Reichel C. Elevated soluble tumor necrosis factor receptor 75 concentrations identify patients with liver cirrhosis at risk of death.
Clin Gastroenterol Hepatol 2008;
6:1255-62. [PMID:
18995216 DOI:
10.1016/j.cgh.2008.06.018]
[Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 06/17/2008] [Accepted: 06/23/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS
Elevated levels of the soluble 75-kd receptor for tumor necrosis factor-alpha (sTNF-R 75) are better predictors of mortality in cirrhosis than the Child-Turcotte-Pugh (CTP) score. Thus, we compared sTNF-R 75 with the Model for End-Stage Liver Disease (MELD), CTP, and the sTNF-R 75/55 ratio.
METHODS
Ninety-two patients with liver cirrhosis (mean age, 55 years; range, 19-76 years; male, 66%; CTP stage C, 41%) were included in our prospective single-center survival study. The study setting was a tertiary care university clinic. Soluble TNF-R levels were determined, and the primary end point was death.
RESULTS
During > or =730 days, 44 patients died. Multivariate Cox regression analysis revealed sTNF-R 75 (> or =14 ng/mL) as an independent predictor of mortality (hazard ratio, 2.53; P = .006). By receiver operating characteristic, MELD and sTNF-R 75 were more accurate in predicting 6-, 15-, and 24-month mortality than CTP and sTNF-R 75/55. This was significant for 6 months (MELD, 0.78; sTNF-R 75, 0.75 vs sTNF-R 75/55, 0.60). In patients with high MELD scores (> or =15), survival was further reduced if sTNF-R 75 values were elevated (P = .035).
CONCLUSIONS
Elevated sTNF-R 75 levels independently predicted mortality and improved MELD on the basis of evaluation of prognosis, especially in patients with high MELD scores. Thus, sTNF-R 75 levels might be a useful cytokine-based prognostic marker in patients with liver cirrhosis.
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