Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 8, 2015; 7(16): 1974-1981
Published online Aug 8, 2015. doi: 10.4254/wjh.v7.i16.1974
Role of systemic inflammation in cirrhosis: From pathogenesis to prognosis
Melisa Dirchwolf, Andrés Eduardo Ruf
Melisa Dirchwolf, Hepatopatías Infecciosas, Hospital Francisco J Muñiz, Buenos Aires 1282, Argentina
Andrés Eduardo Ruf, Fundación para la Docencia e Investigación de las Enfermedades del Hígado (FUNDIEH), Buenos Aires 1282, Argentina
Andrés Eduardo Ruf, Liver Transplant Unit, British Hospital of Buenos Aires, Buenos Aires 1280, Argentina
Author contributions: Dirchwolf M was involved in the study design, performed the required research, writing of the draft of the manuscript and approved its final version; Ruf AE was involved in the study design, writing and critical revision of the manuscript and approved its final version.
Conflict-of-interest statement: None of the authors have received fees for serving as a speaker or consultant, nor have they received financial or non-financial support related to this manuscript. The authors have no commercial, personal, political, intellectual, or religious interests to declare.
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: Andrés Eduardo Ruf, MD, Liver Transplant Unit, British Hospital of Buenos Aires, Perdriel 74, Buenos Aires 1280, Argentina. aeruf@hotmail.com
Telephone: +54-011-43096545 Fax: +54-011-43096545
Received: May 15, 2015
Peer-review started: May 16, 2015
First decision: June 3, 2015
Revised: June 15, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: August 8, 2015
Abstract

The natural history of cirrhosis can be divided into an initial stage, known as compensated cirrhosis, and an advanced stage which encompasses both decompensated cirrhosis and acute-on-chronic liver failure (ACLF). The latter syndrome has been recently described as an acute deterioration of liver function in patients with cirrhosis, which is usually triggered by a precipitating event and results in the failure of one or more organs and high short-term mortality rates. Each stage is characterized by distinctive clinical manifestations and prognoses. One of the key elements involved in cirrhosis physiopathology is systemic inflammation, recently described as one of the components in the cirrhosis-associated immune dysfunction syndrome. This syndrome refers to the combination of immune deficiency and exacerbated inflammation that coexist during the course of cirrhosis and relates to the appearance of clinical complications. Since systemic inflammation is often difficult to assess in cirrhosis patients, new objective, reproducible and readily-available markers are needed in order to optimize prognosis and lengthen survival. Thus, surrogate serum markers and clinical parameters of systemic inflammation have been sought to improve disease follow-up and management, especially in decompensated cirrhosis and ACLF. Leukocyte counts (evaluated as total leukocytes, total eosinophils or neutrophil:lymphocyte ratio) and plasma levels of procalcitonin or C-reactive protein have been proposed as prognostic markers, each with advantages and shortcomings. Research and prospective randomized studies that validate these and other markers are clearly warranted.

Keywords: Immune dysfunction, Cirrhosis, Acute-on-chronic liver failure, Prognosis, Systemic inflammation

Core tip: Due to the overwhelming evidence that sustains systemic inflammation influences the natural history of cirrhosis, a review of its current prognostic markers is necessary to highlight their strengths and weaknesses and stimulate further clinical research on this subject.