Brief Article
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World J Hepatol. Feb 27, 2014; 6(2): 85-91
Published online Feb 27, 2014. doi: 10.4254/wjh.v6.i2.85
Disease dependent qualitative and quantitative differences in the inflammatory response to ascites occurring in cirrhotics
Bashar M Attar, Magdalena George, Nicolae Ion-Nedelcu, Guilliano Ramadori, David H Van Thiel
Bashar M Attar, Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Chicago, IL 60612, United States
Bashar M Attar, Magdalena George, David H Van Thiel, Rush University Medical Center, Chicago, IL 60612, United States
Nicolae Ion-Nedelcu, Victor Babes Infectious and Tropical Disease Clinic, 70346 Bucharest, Romania
Guilliano Ramadori, Department of Gastroenterology and Endocrinology, August Georg University, 3400 Gottingen, Germany
Author contributions: Attar BM contributed to literature search, patient identification, and manuscript writing; Van Thiel DH contributed to study hypothesis, data collectionand manuscript writing; all the authors participated in study design and data analysis.
Correspondence to: Bashar M Attar, MD, PhD, AGAF, FACP, FACG, FASGE, Professor, Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, 1901 W. Harrison Street, Cook County-Admin. bldg, Suite 1450, Chicago, IL 60612, United States.
Telephone: +1-312-8647213 Fax: +1-312-8649214
Received: July 4, 2013
Revised: November 25, 2013
Accepted: January 13, 2014
Published online: February 27, 2014

AIM: To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis (SBP).

METHODS: A total of 57 consecutive patients with ascites requiring a large volume paracentesis were studied. Their age, gender, specific underlying disease conditions were recorded after a review of their clinical records. Each underwent a routine assessment prior to their paracentesis consisting of a complete blood count, complete metabolic profile and prothrombin time/international normalized ratio (INR) determination. The ascitic fluid was cultured and a complete cell count and albumin determination was obtained on the fluid. In addition, blood and ascitic fluid was assessed for the levels of interleukin interleukin (IL)-1A, IL-1B, IL-2, IL-4, IL-8, IL-10, monocyte chemotactic protein (MCP)-1, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) utilizing the Randox Biochip platforms (Boston, MA). A serum-ascites gradient, for each cytokine and growth factor was calculated. The results are reported as mean ± SEM between disease groups with statistical analysis consisting of the student t-test (two tailed) with a P value of 0.05 defining significance.

RESULTS: No clinically important demographic or biochemical differences between the 4 groups studied were evident. In contrast, marked difference in the cytokine and growth factors levels and pattern were evident between the 4 disease groups. Individuals with alcoholic cirrhosis had the highest levels of IL-1A, IL-1B, IL-4, IFNγ. Those with malignant disease had the highest levels of IL-2. Those with hepatitis C virus (HCV) associated cirrhosis had the highest value for IL-6, IL-8, IL-10, MCP-1 and VEGF. Those with cardiac disease had the highest level of TNF-α and EGF. The calculated serum- ascites gradients for the cardiac and malignant disease groups had a greater frequency of negative values signifying greater levels of IL-8, IL-10 and MCP-1 in ascites than did those with alcohol or HCV disease.

CONCLUSION: These data document important differences in the cytokine and growth factor levels in plasma, ascitic fluid and the calculated plasma - ascites fluid gradients in cirrhotics requiring a large volume paracentesis. These differences may be important in determining the risk for bacterial peritonitis.

Keywords: Ascites, Cirrhosis, Growth factors, Inflammation, Procalcitonin

Core tip: Previous studies have examined factors relative to the pathogenesis of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis of the liver. This study was designed to examine the role of cytokines in decompensated cirrhotics requiring a large-volume paracentesis for ascites management and to compare the biomarker responses present in both the plasma and ascitic fluid of cirrhotics of differing etiologies. Factors likely to represent protective cytokines associated with a reduced risk for SBP include epidermal growth factor, tumor necrosis factor-α, interleukin (IL)-1A, IL-8, and IL-10. Those are more likely to be associated with potential for SBP include: IL-1B, IL-4, monocyte chemotactic protein -1, and interfero-γ.