Procalcitonin, and cytokines document a dynamic inflammatory state in non-infected cirrhotic patients with ascites

doi:10.3748/wjg.v20.i9.2374

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Mar 7, 2014; 20(9): 2374-2382
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2374

Table 1 Characteristics of the 88 patients studied

Primary liver disease	ETOH	NASH	HCV	Cardiac/miscellaneous	Total
Patients
Ascites (+)	21	0	8	12	41
Ascites (–)	13	11	23	0	47
Age (yr)					54 ± 11
Ascites (+)	50 ± 1	58 ± 5	54 ± 10	55 ± 11
Ascites (–)	48 ± 5	56 ± 8	53 ± 9	56 ± 12
Gender (M/F)					66/22
Ascites (+)	11/9	N/A	14/9	9/8
Ascites (–)	8/3	3/8	4/4	N/A
MELD score					9.6 ± 3.5
Ascites (+)	9.6 ± 2.1	9.3 ± 1.6	10.3 ± 5.0	8.6 ± 2.5
Ascites (–)	9.4 ± 2.2	9.2 ± 2.0	10.0 ± 4.6	8.6 ± 3.1
CTP score					5.6 ± 1.2
Ascites (+)	5.8 ± 1.5	5.3 ± 0.6	5.6 ± 1.5	5.4 ± 0.8
Ascites (–)	5.6 ± 2.0	5.3 ± 0.8	5.6 ± 1.2	5.3 ± 1.2

Data given as mean ± SE. ETOH: Alcohol; NASH: Non-alcoholic steatohepatitis; HCV: Hepatitis C virus; MELD: Model for End-stage Liver Disease; CTP: Childs-Turcotte-Pugh.

Table 2 Biochemical data of the 88 patients

Parameter	Ascitic Group 1(n = 41)	Non-ascitic Group 2(n = 47)	P value
Hemoglobin (g/dL)	10.8 ± 0.4	10.4 ± 1.7	NS
WBC (cells × 10³/μL)	8.3 ± 1.3	6.7 ± 2.8	NS
Platelets (cells × 10³/μL)	132 ± 13	157 ± 66	NS
Prothrombin time (s)	20.5 ± 1.2	17.7 ± 1.1	< 0.05
INR	1.8 ± 0.1	1.5 ± 0.1	< 0.05
BUN (mg/dL)	13.3 ± 7.2	21 ± 4	NS
Creatinine (mg/dL)	1.0 ± 0.7	0.9 ± 0.2	NS
Total bilirubin (mg/dL)	5.9 ± 1.0	4.7 ± 1.9	NS
AST (IU/L)	110 ± 40	98 ± 15	NS
ALT (IU/L)	66 ± 8	210 ± 111	< 0.05
Albumin (g/dL)	2.2 ± 0.1	2.6 ± 0.1	< 0.05
Ascitic fluid WBC (cells × 10³/μL)	417.7 ± 172.5	N/A	N/A
Ascitic fluid PMN (cells × 10³/μL)	196.9 ± 144.2	N/A	N/A
Ascitic fluid albumin (g/dL)	0.90 ± 0.14	N/A	N/A
Ascitic fluid culture	All negative	N/A	N/A

Data given as mean ± SE. INR: International normalized ratio; BUN: Blood urea nitrogen; AST: Aspartate transaminase; ALT: Alanine transaminase; PMN: Polymorphonuclear cells; NS: Non-significant; WBC: White blood cells.

Table 3 Serum and ascitic fluid levels of inflammatory markers in the 88 patients studied

	Ascites Group 1			Non-ascitic Group 2	Control		P value
	Serum	Ascitic fluid	P value	Serum	NPP	P value	Group 1 (serum) vs Group 2	Group 1 (serum) vs NPP
IL-1A (ng/mL)	0.21 ± 0.08	0.21 ± 0.04	NS	0.17 ± 0.07	0.09 ± 0.01	NS	NS	< 0.05
IL-1B (ng/mL)	6.15 ± 2.83	3.10 ± 0.48	NS	3.56 ± 1.11	2.38 ± 0.62	NS	NS	< 0.05
IL-2 (ng/mL)	5.61 ± 3.49	1.31 ± 0.35	< 0.05	0.96 ± 0.01	1.01 ± 0.40	NS	< 0.05	< 0.05
IL-4 (ng/mL)	2.51 ± 0.79	9.48 ± 1.21	< 0.05	1.25 ± 0.07	1.21 ± 0.39	NS	< 0.05	< 0.05
IL-6 (ng/mL)	94.43 ± 29.58	1240.5 ± 365.64	< 0.05	7.27 ± 1.93	0.64 ± 0.16	< 0.05	< 0.05	< 0.05
IL-8 (ng/mL)	111.83 ± 37.01	335.08 ± 60.0	< 0.05	50.19 ± 18.84	2.22 ± 0.79	< 0.05	< 0.05	< 0.05
IL-10 (ng/mL)	1.47 ± 0.31	57.15 ± 22.32	< 0.05	0.95 ± 0.23	0.62 ± 0.08	< 0.05	NS	< 0.05
MCP-1 (ng/mL)	141.23 ± 23.39	456.35 ± 42.03	< 0.05	200.69 ± 18.19	57.11 ± 12.59	< 0.05	< 0.05	< 0.05
TNF-α (ng/mL)	5.26 ± 1.18	26.32 ± 7.13	< 0.05	9.89 ± 3.54	1.61 ± 0.80	< 0.05	NS	< 0.05
IFNγ (ng/mL)	1.08 ± 0.38	1.61 ± 0.41	NS	0.51 ± 0.04	0.47 ± 0.34	NS	< 0.05	NS
VEGF (ng/mL)	38.31 ± 18.73	234.82 ± 103.11		55.94 ± 11.37	7.14 ± 4.06		NS	< 0.05
EGF (ng/mL)	72.42 ± 14.95	1.78 ± 0.36		45.70 ± 7.38	3.12 ± 0.99		< 0.05	< 0.05

Data given as mean ± SE. IL: Interleukin; MCP: Monocyte chemotactic protein; TNF: Tumor necrosis factor alpha; IFN: Interferon gamma; VEGF: Vascular endothelial growth factor; EGF: Epidermal growth factor; NPP: Normal plasma panel; NS: Non-significant.

Table 4 Serum and ascitic procalcitonin levels segregated by liver disease

	Serum	Ascites	P value
EtOH (ng/mL)	0.38 ± 0.22	0.22 ± 0.13	NS
HCV (ng/mL)	0.44 ± 0.27	0.13 ± 0.12	NS
Cardiac/miscellaneous (ng/mL)	0.95 ± 0.74	0.77 ± 0.07	NS
P value	NS	< 0.05^a

^aP < 0.05 cardiac/misc vs non-cardiac diseases only. Data given as mean ± SE. EtOH: Alcohol; HCV: Hepatitis C virus; NS: Not significant.

Table 5 The serum-ascitic fluid (P-A) gradient for Group 1

Serum-ascitic fluid gradient	Value
IL-1A (ng/mL)	-0.0008 ± 0.097
IL-2 (ng/mL)	4.30 ± 3.53
IL-4 (ng/mL)	-6.96 ± 1.48
IL-6 (ng/mL)	-1146.11 ± 362.15
IL-8 (ng/mL)	-223.24 ± 58.54
IL-10 (ng/mL)	-55.68 ± 22.18
MCP-1 (ng/mL)	-315.13 ± 39.24
TNF-α (ng/mL)	-21.06 ± 7.33
IFNγ (ng/mL)	-0.52 ± 0.48
VEGF (ng/mL)	196.52 ± 105.60
EGF (ng/mL)	70.64 ± 14.74
PCT (ng/mL)	-0.134 ± 0.12

Data given as mean ± SE. IL: Interleukin; MCP: Monocyte chemotactic protein; TNF: Tumor necrosis factor α; IFN: Interferon gamma; VEGF: Vascular endothelial growth factor; EGF: Epidermal growth factor; PCT: Procalcitonin.

Citation: Attar BM, Moore CM, George M, Ion-Nedelcu N, Turbay R, Zachariah A, Ramadori G, Fareed J, Thiel DHV. Procalcitonin, and cytokines document a dynamic inflammatory state in non-infected cirrhotic patients with ascites. World J Gastroenterol 2014; 20(9): 2374-2382
URL: https://www.wjgnet.com/1007-9327/full/v20/i9/2374.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i9.2374