Ascitic Interleukin 6 Is Associated with Poor Outcome and Spontaneous Bacterial Peritonitis: A Validation in Critically Ill Patients with Decompensated Cirrhosis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Laboratory Analyses and Clinical Scores
2.3. Microbiological Analyses and Evidence of Infection
2.4. Data Collection
2.5. Statistical Analysis and Primary Endpoint
3. Results
3.1. Patients’ Characteristics and Laboratory Analyses
3.2. Levels of Ascitic Interleukin 6 in Infectious Diseases
3.3. Prognostic Accuracy of Ascitic Interleukin 6
3.4. Correlation Analyses
3.5. Diagnostic Accuracy of Ascitic Interleukin 6
3.6. Association of Ascitic Interleukin 6 with Renal Impairment
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Result |
---|---|
Male sex, n/total (%) | 43/64 (67%) |
Age, years | 61 (52–67) |
Body weight, kg | 79 (65–87) |
Body height, cm | 175 (167–180) |
BMI | 25.7 (22.9–27.9) |
APACHE II | 23 (17–28) |
SOFA | 10 (8–15) |
MELD | 27 (23–32) |
CTP | 11 (10–12) |
CTP C, n/total (%) | 55/64 (86%) |
No ACLF—Grade 0, n/total (%) | 9/64 (14%) |
ACLF, n/total (%) | 55/64 (86%) |
ACLF Grade I, n/total (%) | 16/55 (29%) |
ACLF Grade II, n/total (%) | 19/55 (35%) |
ACLF Grade III, n/total (%) | 20/55 (36%) |
CLIF-C OF, n = 55 | 11 (10–12) |
CLIF-C ACLF, n = 55 | 55 (48–61) |
Etiology of cirrhosis, n/total (%) | Alcoholic 48/64 (75%) |
Viral 4/64 (6%) | |
Autoimmune 2/64 (3%) | |
Cryptogenic/NASH 10/64 (16%) (histological criteria of NASH 6/10) | |
Primary admission diagnoses, n/total (%) | Sepsis 26/64 (41%) |
Acute kidney failure/HRS 18/64 (28%) | |
Hepatic encephalopathy 11/64 (17%) | |
Gastrointestinal bleeding 9/64 (14%) | |
Infection on ICU admission, n/total (%) | 53/64 (83%) |
No infection on ICU admission, n/total (%) | 11/64 (17%) |
Length of ICU stay, days | 13 (6–24) |
28-days mortality, n/total /%) | 28/64 (44%) |
3-month mortality, n/total (%) | 39/64 (61%) |
ICU mortality, n/total (%) | 34/64 (53%) |
Clinical cause of death, n/total (%) | Sepsis, Pneumonia 30/39 (77%) |
Gastrointestinal bleeding 5/39 (13%) | |
Cardiocirculatory failure 4/39 (10%) | |
Dialysis during ICU, n /total (%) | 36/64 (56%) |
Creatinine, mg/dL | 1.8 (1.4–2.7) |
Bilirubin, mg/dL | 5.4 (2.0–14.9) |
INR | 1.7 (1.5–2.1) |
MAP, mmHg | 73 (68–81) |
Use of vasopressors, n/total (%) | 31/64 (48%) |
PaO2, mmHg | 87 (75–100) |
FiO2, % | 30 (30–40) |
Mechanical ventilation, n/total (%) | 24/64 (38%) |
HE, n/total (%) | 34/64 (53%) |
WBC, 109 cells/L | 10.7 (8.0–13.6) |
Classification | Percentage (Fraction) | IL-6ascites, pg/mL | p-Value | |
---|---|---|---|---|
No infection | 17% (11/64) | 1031 (694–1713) | <0.001 | |
Infection | 83% (53/64) | 8607 (4282–25,249) | ||
No SBP | 70% (45/64) | 4275 (1169–8526) | <0.001 | |
SBP | 30% (19/64) | 24,453 (12,329–63,836) | ||
Community-acquired SBP | 32% (6/19) | 17,159 (10,703–39,539) | 0.323 | |
Nosocomial SBP | 68% (13/19) | 38,679 (11,425–78,809) | ||
CNNA | 47% (9/19) | 12,528 (6321–21,198) | 0.008 | |
Culture-positive SBP | 53% (10/19) | 61,155 (28,003–84,643) | ||
Single-infections | Urinary tract | 11% (7/53) | 2107 (1453–4123) | |
Respiratory | 30% (19/53) | 7045 (2149–9419) | ||
SBP | 11% (7/53) | 33,228 (12,329–63,839) | ||
Bacteremia | 5% (3/3) | 9624 (1725–10,558) | ||
Co- infections | Pneumonia + Urinary tract | 5% (3/53) | 6690 (4289–16,958) | |
Pneumonia + SBP | 14% (9/53) | 16,375 (11,425–77,525) | ||
Urinary tract + SBP | 6% (4/53) | 34,375 (8497–73,592) | ||
Pneumonia + Bacteremia | 1% (1/53) | 9591 |
Spearmans Coefficient rs | Linear Regression R2 | p-Value | |
---|---|---|---|
CRP, mg/dL | 0.453 | 0.055 | <0.001 |
PCT, ng/mL | 0.445 | 0.019 | <0.001 |
IL-6serum, pg/mL | 0.658 | 0.150 | <0.001 |
APACHE-II | 0.494 | 0.236 | <0.001 |
SOFA | 0.570 | 0.281 | <0.001 |
MELD | 0.434 | 0.287 | <0.001 |
CTP | 0.160 | 0.167 | 0.207 |
ACLF-Grade | 0.375 | 0.108 | 0.002 |
CLIF-OF | 0.330 | 0.234 | 0.014 |
CLIF-ACLF | 0.381 | 0.202 | 0.004 |
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Share and Cite
Mayr, U.; Lukas, M.; Elnegouly, M.; Vogt, C.; Bauer, U.; Ulrich, J.; Schmid, R.M.; Huber, W.; Lahmer, T. Ascitic Interleukin 6 Is Associated with Poor Outcome and Spontaneous Bacterial Peritonitis: A Validation in Critically Ill Patients with Decompensated Cirrhosis. J. Clin. Med. 2020, 9, 2865. https://doi.org/10.3390/jcm9092865
Mayr U, Lukas M, Elnegouly M, Vogt C, Bauer U, Ulrich J, Schmid RM, Huber W, Lahmer T. Ascitic Interleukin 6 Is Associated with Poor Outcome and Spontaneous Bacterial Peritonitis: A Validation in Critically Ill Patients with Decompensated Cirrhosis. Journal of Clinical Medicine. 2020; 9(9):2865. https://doi.org/10.3390/jcm9092865
Chicago/Turabian StyleMayr, Ulrich, Marina Lukas, Mayada Elnegouly, Christine Vogt, Ulrike Bauer, Joerg Ulrich, Roland M. Schmid, Wolfgang Huber, and Tobias Lahmer. 2020. "Ascitic Interleukin 6 Is Associated with Poor Outcome and Spontaneous Bacterial Peritonitis: A Validation in Critically Ill Patients with Decompensated Cirrhosis" Journal of Clinical Medicine 9, no. 9: 2865. https://doi.org/10.3390/jcm9092865