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Dysfunction of Circulating Polymorphonuclear Leukocytes and Monocytes in Ambulatory Cirrhotics Predicts Patient Outcome

Sargenti, Konstantina LU ; Johansson, Åsa LU ; Bertilsson, Sara LU ; Mattsby-Baltzer, Inger; Klintman, Daniel LU and Kalaitzakis, Evangelos LU (2016) In Digestive Diseases and Sciences 61(8). p.2294-2302
Abstract

BACKGROUND: Cirrhosis represents a state of functional immune paresis with increased infection risk.

AIMS: To investigate polymorphonuclear (PMN) leukocyte and monocyte function in ambulatory cirrhotics, and their potential relation with cirrhosis etiology or patient outcome.

METHODS: Consecutive ambulatory cirrhotics without current or recent (<1 month) infection or acute decompensation were prospectively enrolled in 2013 and followed for a median time of 20 months until death, transplant or end of 2014. Oxidative burst and phagocytosis of circulating PMNs and monocytes were investigated at baseline and after in vitro Escherichia coli stimulation. Seventeen healthy blood donors served as controls. Baseline clinical and... (More)

BACKGROUND: Cirrhosis represents a state of functional immune paresis with increased infection risk.

AIMS: To investigate polymorphonuclear (PMN) leukocyte and monocyte function in ambulatory cirrhotics, and their potential relation with cirrhosis etiology or patient outcome.

METHODS: Consecutive ambulatory cirrhotics without current or recent (<1 month) infection or acute decompensation were prospectively enrolled in 2013 and followed for a median time of 20 months until death, transplant or end of 2014. Oxidative burst and phagocytosis of circulating PMNs and monocytes were investigated at baseline and after in vitro Escherichia coli stimulation. Seventeen healthy blood donors served as controls. Baseline clinical and laboratory data as well as follow-up data on the development of cirrhosis complications, including acute-on-chronic liver failure (ACLF), and bacterial infections were collected.

RESULTS: Sixty patients were included (70 % male, median age 63 years, 52 % with alcoholic cirrhosis). Compared to controls, cirrhotics showed increased resting and stimulated burst as well as reduced phagocytosis of PMNs, and increased stimulated monocyte burst (p < 0.05 for all). Alcoholic etiology was not related to PMN or monocyte dysfunction (p > 0.05 for all). In Cox regression analysis, increased stimulated monocyte and PMN burst were independent predictors of sepsis, severe sepsis and ACLF occurrence. Also, increased stimulated monocyte burst was associated with worse transplant-free survival (p < 0.05 for all).

CONCLUSIONS: Stimulated PMN and monocyte oxidative burst are increased in ambulatory cirrhotics without acute decompensation. In turn, these changes are associated to sepsis and ACLF occurrence.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Digestive Diseases and Sciences
volume
61
issue
8
pages
2294 - 2302
publisher
Springer
external identifiers
  • Scopus:84961616368
  • WOS:000379787200021
ISSN
1573-2568
DOI
10.1007/s10620-016-4132-3
language
English
LU publication?
yes
id
20a4615f-5fdc-4750-8940-a4b79d185669
date added to LUP
2016-04-11 13:27:07
date last changed
2017-01-10 15:18:30
@article{20a4615f-5fdc-4750-8940-a4b79d185669,
  abstract     = {<p>BACKGROUND: Cirrhosis represents a state of functional immune paresis with increased infection risk.</p><p>AIMS: To investigate polymorphonuclear (PMN) leukocyte and monocyte function in ambulatory cirrhotics, and their potential relation with cirrhosis etiology or patient outcome.</p><p>METHODS: Consecutive ambulatory cirrhotics without current or recent (&lt;1 month) infection or acute decompensation were prospectively enrolled in 2013 and followed for a median time of 20 months until death, transplant or end of 2014. Oxidative burst and phagocytosis of circulating PMNs and monocytes were investigated at baseline and after in vitro Escherichia coli stimulation. Seventeen healthy blood donors served as controls. Baseline clinical and laboratory data as well as follow-up data on the development of cirrhosis complications, including acute-on-chronic liver failure (ACLF), and bacterial infections were collected.</p><p>RESULTS: Sixty patients were included (70 % male, median age 63 years, 52 % with alcoholic cirrhosis). Compared to controls, cirrhotics showed increased resting and stimulated burst as well as reduced phagocytosis of PMNs, and increased stimulated monocyte burst (p &lt; 0.05 for all). Alcoholic etiology was not related to PMN or monocyte dysfunction (p &gt; 0.05 for all). In Cox regression analysis, increased stimulated monocyte and PMN burst were independent predictors of sepsis, severe sepsis and ACLF occurrence. Also, increased stimulated monocyte burst was associated with worse transplant-free survival (p &lt; 0.05 for all).</p><p>CONCLUSIONS: Stimulated PMN and monocyte oxidative burst are increased in ambulatory cirrhotics without acute decompensation. In turn, these changes are associated to sepsis and ACLF occurrence.</p>},
  author       = {Sargenti, Konstantina and Johansson, Åsa and Bertilsson, Sara and Mattsby-Baltzer, Inger and Klintman, Daniel and Kalaitzakis, Evangelos},
  issn         = {1573-2568},
  language     = {eng},
  number       = {8},
  pages        = {2294--2302},
  publisher    = {Springer},
  series       = {Digestive Diseases and Sciences},
  title        = {Dysfunction of Circulating Polymorphonuclear Leukocytes and Monocytes in Ambulatory Cirrhotics Predicts Patient Outcome},
  url          = {http://dx.doi.org/10.1007/s10620-016-4132-3},
  volume       = {61},
  year         = {2016},
}