Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2018; 10(1): 124-133
Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.124
Toll-like receptor 4 polymorphisms and bacterial infections in patients with cirrhosis and ascites
Edilmar Alvarado-Tapias, Carlos Guarner-Argente, Elida Oblitas, Elisabet Sánchez, Silvia Vidal, Eva Román, Mar Concepción, Maria Poca, Cristina Gely, Oana Pavel, Juan Camilo Nieto, Cándido Juárez, Carlos Guarner, Germán Soriano
Edilmar Alvarado-Tapias, Carlos Guarner-Argente, Elida Oblitas, Elisabet Sánchez, Eva Román, Mar Concepción, Maria Poca, Cristina Gely, Oana Pavel, Carlos Guarner, Germán Soriano, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
Edilmar Alvarado-Tapias, Elisabet Sánchez, Silvia Vidal, Cristina Gely, Juan Camilo Nieto, Carlos Guarner, Germán Soriano, Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
Edilmar Alvarado-Tapias, Elisabet Sánchez, Eva Román, Maria Poca, Carlos Guarner, Germán Soriano, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid 28029, Spain
Silvia Vidal, Juan Camilo Nieto, Cándido Juárez, Department of Immunology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
Eva Román, Escola Universitària d’Infermeria EUI-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
Author contributions: Alvarado-Tapias E, Guarner-Argente C and Soriano G contributed to study concept and design; Alvarado-Tapias E, Poca M, Concepción M, Román E, Pavel O, Guarner-Argente C, Oblitas E, Sánchez E, Vidal S, Nieto JC and Juarez C contributed to acquisition of data; Alvarado-Tapias E, Soriano G and Vidal S contributed to analysis and interpretation of data; Alvarado-Tapias E and Soriano G contributed to drafting of the manuscript; Soriano G, Vidal S, Guarner C and Juarez C contributed to critical revision of the manuscript for important intellectual content; Alvarado-Tapias E, Soriano G and Vidal S contributed to statistical analysis; Soriano G contributed to study supervision.
Supported by (partially) from the Instituto de Salud Carlos III, Madrid, Spain, No. PI0900357; and cofinanced by Fondos FEDER (Fondo Europeo de Desarrollo Regional), “Una manera de hacer Europa”, European Union, and CERCA Programme, Generalitat de Catalunya; Silvia Vidal was supported by Fondo de Investigaciones Sanitarias (FIS) and is a participant in the Program for Stabilization of Investigators of the Direcció d’Estrategia i Coordinació del Departament de Salut, Generalitat de Catalunya; Edilmar Alvarado-Tapias is a recipient of a “Río Hortega” fellowship grant from the Instituto de Salud Carlos III, No. CM16/00133.
Institutional review board statement: This study was approved by the Ethics Committee of Hospital de la Santa Creu i Sant Pau. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edilmar Alvarado-Tapias, MD, Research Fellow, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Barcelona 08025, Spain. ealvaradot@santpau.cat
Telephone: +34-93-5565920 Fax: +34-93-5565608
Received: November 16, 2017
Peer-review started: November 17, 2017
First decision: December 1, 2017
Revised: December 16, 2017
Accepted: December 29, 2017
Article in press: December 29, 2017
Published online: January 27, 2018
Core Tip

Core tip: Patients with cirrhosis present a high incidence of bacterial infections. Toll-like receptor (TLR) 4 genetic polymorphisms, particularly D299G, have been previously associated with an increased predisposition to infection in several populations. In the present study, genetic polymorphisms D299G and/or T399I of TLR4 do not seem to play a relevant role in the predisposition to develop bacterial infections or in the prognosis of cirrhotic patients with ascites. Age, serum creatinine, Child-Pugh score, active alcohol intake, previous hepatic encephalopathy and the presence of hepatocellular carcinoma were independent predictive factors of mortality during follow-up.