Characterization of inflammatory response in hepatorenal syndrome: Relationship with kidney outcome and survival.

Abstract

BACKGROUND:

Several lines of evidence indicate that decompensated cirrhosis is characterized by the presence of systemic inflammation. Hepatorenal syndrome (HRS-AKI) is a unique type of renal failure that occurs at late stages of cirrhosis. However, confirmation of the presence and significance of such inflammatory response in HRS-AKI is lacking.

AIM AND METHODS:

To characterize the systemic inflammatory response, as estimated by measuring a large number of cytokines, in 161 patients hospitalized for an acute decompensation of cirrhosis: 44 patients without acute kidney injury (AKI), 63 patients with hypovolaemia-induced AKI and 58 patients with HRS-AKI.

RESULTS:

HRS-AKI was characterized by an altered cytokine profile compared to the other two groups, particularly IL-6, IL-8, TNF-α, VCAM-1, fractalkine and MIP-1α. The inflammatory response was not related to presence of bacterial infection, concomitant acute-on-chronic liver failure or severity of renal dysfunction. Patients who responded to terlipressin and albumin had only a decrease in TNF-α and RANTES after treatment without changes in other cytokines. Interestingly, patients with persistent HRS-AKI had higher levels of IP-10 and VCAM-1 compared to those with resolution of HRS-AKI. VCAM-1 was also an independent predictor of 3-month mortality. A systems biology analysis approach showed that the inflammatory status of HRS-AKI was similar to that of chronic nonhepatic inflammatory conditions, such as lupus erythematosus or inflammatory bowel disease.

CONCLUSION:

Hepatorenal syndrome is characterized by a marked systemic inflammatory state, reminiscent of that of nonhepatic inflammatory diseases, that correlates with patient outcomes.

• Authors: Cristina Solé, Elsa Solà, Patricia Huelin, Marta Carol, Rebeca Moreira, Unai Cereijo, José-Manuel Mas, Isabel Graupera, Elisa Pose, Laura Napoleone, Gloria dePrada, Adrià Juanola, Núria Fabrellas, Ferran Torres, Manuel Morales-Ruiz, Judith Farrés, Wladimiro Jiménez, Pere Ginès
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 39 Issue 7 Pg. 1246-1255 (07 2019) ISSN: 1478-3231 [Electronic] United States
• PMID: 30597709 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 The Authors. Liver International Published by John Wiley & Sons Ltd.

Chemical References

• Albumins
• Biomarkers
• Cytokines
• Vasoconstrictor Agents
• Terlipressin

Topics

• Acute Kidney Injury (etiology, mortality, therapy)
• Acute-On-Chronic Liver Failure (complications, therapy)
• Aged
• Albumins (therapeutic use)
• Biomarkers (blood)
• Cytokines (blood)
• Female
• Hepatorenal Syndrome (etiology, mortality, therapy)
• Humans
• Inflammation (pathology)
• Kidney (physiopathology)
• Liver (physiopathology)
• Liver Cirrhosis (complications, therapy)
• Liver Transplantation
• Male
• Middle Aged
• Prospective Studies
• Severity of Illness Index
• Spain
• Survival Analysis
• Terlipressin (therapeutic use)
• Vasoconstrictor Agents (therapeutic use)