TIPS insertion leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis.

IF 14 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Molecular Hepatology Pub Date : 2024-11-21 DOI:10.3350/cmh.2024.0587

Anja Tiede, Lena Stockhoff, Zhaoli Liu, Hannah Rieland, Jim B Mauz, Valerie Ohlendorf, Birgit Bremer, Jennifer Witt, Anke Kraft, Markus Cornberg, Jan B Hinrichs, Bernhard C Meyer, Heiner Wedemeyer, Cheng-Jian Xu, Christine S Falk, Benjamin Maasoumy

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引用次数: 0

Abstract

Background and aims: Systemic Inflammation (SI) is considered a key mechanism in disease progression and development of complications in decompensated liver cirrhosis. SI is mainly driven by portal hypertension and bacterial translocation. Transjugular intrahepatic portosystemic shunt (TIPS)-insertion represents an effective treatment for portal hypertension. This study aims to investigate the impact of TIPS-insertion on SI and bacterial translocation.

Methods: We prospectively included 59 cirrhotic patients undergoing TIPS-insertion. Blood samples were collected at TIPS-insertion and follow-up 1, 3, 6, and 12 months (FU) thereafter. At all time points, we performed a comprehensive analysis of SI including 43 soluble inflammatory markers (SIMs), and surrogates of bacterial translocation (sCD14, sCD163). To investigate long-term kinetics of SI, C-reactive protein (CRP) and white blood cells (WBC) were retrospectively analyzed in a cohort of 177 patients up to 3-years after TIPS-insertion.

Results: At TIPS-insertion, 30/43 SIMs, sCD14, and sCD163 measured significantly higher in cirrhotic patients compared to healthy controls. By FU6 25 SIMs and sCD14 measured at significantly lower levels compared to baseline. Interestingly, in patients with TIPS-indication refractory ascites IL-6 decreased to levels documented in earlier stages of cirrhosis. In long-term follow-up, CRP-levels significantly decreased after TIPS-insertion, which translated into improved liver-transplant-free survival in cox regression analysis (HR 0.968, p=0.042). Notably, patients with residual ascites post-TIPS showed significantly higher CRP- and IL-6 levels across all follow-ups compared to patients with resolved ascites.

Conclusions: Decreasing portal hypertension via TIPS-insertion leads to a significant attenuation of SI and bacterial translocation over time.

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插入 TIPS 可持续逆转肝硬化失代偿期患者的全身炎症。

背景和目的：全身炎症（SI）被认为是肝硬化失代偿期疾病进展和并发症发生的关键机制。全身炎症主要由门脉高压和细菌转运引起。经颈静脉肝内门体分流术（TIPS）是治疗门脉高压的有效方法。本研究旨在探讨经颈静脉肝内门体分流术对 SI 和细菌转位的影响：我们前瞻性地纳入了 59 名接受 TIPS 置入术的肝硬化患者。方法：我们前瞻性地纳入了 59 名接受 TIPS 置入术的肝硬化患者，在 TIPS 置入术时采集血样，并在术后 1、3、6 和 12 个月（FU）进行随访。在所有时间点，我们都对 SI 进行了全面分析，包括 43 种可溶性炎症标记物（SIMs）和细菌转运的替代物（sCD14、sCD163）。为了研究 SI 的长期动力学，我们对 177 例患者的队列进行了回顾性分析，分析结果显示，C 反应蛋白（CRP）和白细胞（WBC）在 TIPS 植入术后 3 年内的变化情况：结果：与健康对照组相比，肝硬化患者在植入 TIPS 时的 30/43 SIMs、sCD14 和 sCD163 测量值明显较高。到 FU6 时，25 个 SIMs 和 sCD14 的测量值明显低于基线水平。有趣的是，在有 TIPS 指征的难治性腹水患者中，IL-6 下降到了肝硬化早期的水平。在长期随访中，植入 TIPS 后 CRP 水平明显降低，这在 cox 回归分析中转化为无肝移植生存率的提高（HR 0.968，p=0.042）。值得注意的是，与腹水消退的患者相比，TIPS术后腹水残留的患者在所有随访中的CRP和IL-6水平都明显更高：结论：通过插入 TIPS 降低门静脉高压可显著减轻 SI 和细菌转移。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Molecular Hepatology Medicine-Hepatology

CiteScore

15.60

自引率

9.00%

发文量

审稿时长

10 weeks

期刊介绍： Clinical and Molecular Hepatology is an internationally recognized, peer-reviewed, open-access journal published quarterly in English. Its mission is to disseminate cutting-edge knowledge, trends, and insights into hepatobiliary diseases, fostering an inclusive academic platform for robust debate and discussion among clinical practitioners, translational researchers, and basic scientists. With a multidisciplinary approach, the journal strives to enhance public health, particularly in the resource-limited Asia-Pacific region, which faces significant challenges such as high prevalence of B viral infection and hepatocellular carcinoma. Furthermore, Clinical and Molecular Hepatology prioritizes epidemiological studies of hepatobiliary diseases across diverse regions including East Asia, North Asia, Southeast Asia, Central Asia, South Asia, Southwest Asia, Pacific, Africa, Central Europe, Eastern Europe, Central America, and South America. The journal publishes a wide range of content, including original research papers, meta-analyses, letters to the editor, case reports, reviews, guidelines, editorials, and liver images and pathology, encompassing all facets of hepatology.