Published online Aug 14, 2020. doi: 10.3748/wjg.v26.i30.4479
Peer-review started: April 22, 2020
First decision: June 13, 2020
Revised: June 24, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 14, 2020
Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) has a complex and poor prognosis. Interleukin-6 (IL-6) as a pro-inflammatory cytokine is related with severe liver impairment and also plays a role in promoting liver regeneration. Whether serum IL-6 influences HBV-ACLF prognosis has not been studied.
HBV-ACLF is a potentially reversible disease under the condition of intensive care and treatment, therefore, an index used to triage and prognosticate the outcome will promote timely and more appropriate management of the patients.
This study was conducted to determine the impact of serum IL-6 on outcome of patients with HBV-ACLF.
We analyzed 412 HBV-ACLF qualified cases from the dataset of National Twelve Five-Year Science and Technology Major Project of China “Study on HBV-ACLF Treated with Integrated Traditional Chinese Medicine and Western Medicine”. The levels of serum IL-6 at baseline and 4 wk were detected and the impact of IL-6 on short-term mortality of patients with HBV-ACLF were analyzed.
Patients with high IL-6 levels (> 11.8 pg/mL) had a higher mortality within 4 wk than those with low IL-6 levels (≤ 11.8 pg/mL) (24.2% vs 13.2%, P = 0.004; odds ratio [OR] = 2.11, 95% confidence interval [CI]: 1.15-3.90, P = 0.017). The mortality between weeks 5 and 8 in patients with high IL-6 levels at 4 wk was 15.0%, which was significantly higher than the 6.6% mortality rate in patients with low IL-6 levels at 4 wk (hazard ratio = 2.39, 95%CI: 1.05-5.41, P = 0.037). The mortality was 5.0% in patients with high IL-6 levels at baseline and low IL-6 levels at 4 wk, 7.5% in patients with low IL-6 levels both at baseline and at 4 wk, 11.5% in patients with low IL-6 levels at baseline and high IL-6 levels at 4 wk, and 16.7% in patients with high IL-6 levels both at baseline and at 4 wk. The increasing trend of the mortality rate with the dynamic changes of IL-6 was significant (P for trend = 0.023).
Our study demonstrated that a high level of serum IL-6 increases mortality risk in patients with HBV-ACLF.
Our results suggest that IL-6 could be a promising candidate to predict mortality in patients with HBV-ACLF, as well as dynamic changes of IL-6. Further prospective studies are required to validate and confirm the predictive value of IL-6.