6 research outputs found
Ascites’ neutrophil function is significantly impaired in patients with decompensated cirrhosis but can be restored by autologous plasma incubation
Systemic immune cell dysfunction is a typical feature of liver diseases and
increases the risk of bacterial infection, especially spontaneous bacterial
peritonitis. We evaluated functional properties of neutrophil granulocytes in
blood and ascites of patients both with and without decompensated cirrhosis.
We collected blood and ascites samples from 63 patients with cirrhosis and
eight without cirrhosis. Phagocytosis activity (PA) and oxidative burst
activity (OBA) were evaluated after ex vivo stimulation with E. coli, while
fluorescence signals were measured by flow cytometry. Ascites’ neutrophil
function tests were repeated after incubation with autologous plasma. Ascites’
neutrophils showed an impaired PA and OBA (median blood PA 98.1% (86.8–99.8)
vs. ascites’ PA 50.5% (0.4–97.3), p < 0.0001; median blood OBA 98.7%
(27.5–100) vs. ascites’ OBA 27.5% (0.3–96.7), p < 0.0001). Patients with non-
cirrhotic ascites showed higher PA but equally suppressed OBA. Ascites’
neutrophil function could be partially restored after incubation with
autologous plasma (median increase PA: 22.5% (−49.7 – +93.2), p = 0.002; OBA:
22.8% (−10.4 – +48.8), p = 0.002). Ascites’ neutrophils of patients with
cirrhosis are functionally impaired, but could be partially restored after
incubation with plasma. Further investigations are needed to identify the
factors in ascites that are associated with neutrophils’ function
a cohort study
Background Microparticles (MPs) are small (<1 μm) cell membrane-derived
vesicles that are formed in response to cellular activation or early stages of
apoptosis. Increased plasma MP levels have been associated with liver disease
severity. Here we investigated the clinical impact of ascites MPs in patients
with decompensated liver cirrhosis. Methods Ascites and blood samples of 163
patients with cirrhosis (ascites n = 163, blood n = 31) were collected between
February 2011 and December 2012. MPs were obtained from ascites and from blood
by two-step ultracentrifugation and quantified by flow cytometry. Quantitative
absolute MP levels were correlated with clinical and laboratory baseline
parameters as well as patient outcomes. Ascites microparticles were stained
with antibodies against CD66b (neutrophils) and CD3 (lymphocytes) in a
subgroup of 60 matched patients. Results MPs were detected in all ascites and
blood samples. Absolute ascites MP levels correlated with blood levels (r =
0.444, p = 0.011). Low ascites MP levels (<488.4 MP/μL) were associated with a
poor 30-day survival probability (488.4 MP/μL 94.7%,
log rank p = 0.001) and such patients had a higher relative amount of ascites
microparticles derived from neutrophils and lymphocytes. Low levels of ascites
MPs, high MELD score and antibiotic treatment were independent risk factors
for death within 30 days. Conclusions Ascites MP levels predict short-term
survival along with the liver function in patients with decompensated
cirrhosis. Further studies which evaluate ascites MPs as disease specific
biomarker with a validation cohort and which investigate its underlying
mechanisms are needed. Neutrophils and lymphocytes contributed more frequently
to the release of microparticles in patients with low ascites levels, possibly
indicating an immune activation in this cohort
Prevalence of Pruritus and Association with Anxiety and Depression in Patients with Nonalcoholic Fatty Liver Disease
Patient-reported outcomes are important in nonalcoholic fatty liver disease (NAFLD). Pruritus is of special interest for evolving therapies with farnesoid X receptor (FXR) agonists. The aim of this study was to investigate the prevalence of pruritus in a real-life NAFLD cohort and analyze associations with anxiety and depression. Pruritus was assessed using a visual analogue- (VAS) and 5-D itch-scale (5-D). Anxiety and depression were evaluated by Beck’s-Depression-Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS-A, HADS-D). An optimal logistic regression model was found with a stepwise procedure to investigate variables associated with pruritus. In total, 123 NAFLD patients were recruited. VAS and 5-D were highly correlated (Spearman’s correlation coefficient 0.89). Moderate/severe pruritus was reported in 19% (VAS) and 21% (5-D) of patients. Anxiety and depression were present in 12% and 4% (HADS-A and HADS-D, respectively) and 12% (BDI) of cases. There was a significant association between VAS and BDI (p = 0.019). The final multivariate model for 5-D included diabetes mellitus (OR 4.51; p = 0.01), BDI (OR 5.98; p = 0.024), and HADS-A (OR 7.75; p = 0.011). One-fifth of NAFLD patients reported moderate or severe pruritus. 5-D was significantly associated with diabetes mellitus, depression, and anxiety. These findings should be tested in larger populations and considered in candidates for treatment with FXR agonists