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Wirtz TH, Reuken PA, Jansen C, Fischer P, Bergmann I, Backhaus C, Emontzpohl C, Reißing J, Brandt EF, Koenen MT, Schneider KM, Schierwagen R, Brol MJ, Chang J, Zimmermann HW, Köse-Vogel N, Eggermann T, Kurth I, Stoppe C, Bucala R, Bernhagen J, Praktiknjo M, Stallmach A, Trautwein C, Trebicka J, Bruns T, Berres ML. Balance between macrophage migration inhibitory factor and sCD74 predicts outcome in patients with acute decompensation of cirrhosis. JHEP Rep 2020; 3:100221. [PMID: 33659891 PMCID: PMC7890204 DOI: 10.1016/j.jhepr.2020.100221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background & Aims Macrophage migration inhibitory factor (MIF) is an inflammatory cytokine and an important regulator of innate immune responses. We hypothesised that serum concentrations of MIF are associated with disease severity and outcome in patients with decompensated cirrhosis and acute-on-chronic liver failure (ACLF). Methods Circulating concentrations of MIF and its soluble receptor CD74 (sCD74) were determined in sera from 292 patients with acute decompensation of cirrhosis defined as new onset or worsening of ascites requiring hospitalisation. Of those, 78 (27%) had ACLF. Short-term mortality was assessed 90 days after inclusion. Results Although serum concentrations of MIF and sCD74 did not correlate with liver function parameters or ACLF, higher MIF (optimum cut-off >2.3 ng/ml) and lower concentrations of sCD74 (optimum cut-off <66.5 ng/ml) both indicated poorer 90-day transplant-free survival in univariate analyses (unadjusted hazard ratio [HR] 2.01 [1.26-3.22]; p = 0.004 for MIF; HR 0.59 [0.38-0.92]; p = 0.02 for sCD74) and after adjustment in multivariable models. Higher MIF concentrations correlated with surrogates of systemic inflammation (white blood cells, p = 0.005; C-reactive protein, p = 0.05) and were independent of genetic MIF promoter polymorphisms. Assessment of MIF plasma concentrations in portal venous blood and matched blood samples from the right atrium in a second cohort of patients undergoing transjugular intrahepatic portosystemic shunt insertion revealed a transhepatic MIF gradient with higher concentrations in the right atrial blood. Conclusions Serum concentrations of MIF and its soluble receptor CD74 predict 90-day transplant-free survival in patients with acute decompensation of cirrhosis. This effect was independent of liver function and genetic predispositions, but rather reflected systemic inflammation. Therefore, MIF and sCD74 represent promising prognostic markers beyond classical scoring systems in patients at risk of ACLF. Lay summary Inflammatory processes contribute to the increased risk of death in patients with cirrhosis and ascites. We show that patients with high serum levels of the inflammatory cytokine macrophage migration inhibitory factor (MIF) alongside low levels of its binding receptor sCD74 in blood indicate an increased mortality risk in patients with ascites. The cirrhotic liver is a relevant source of elevated circulating MIF levels.
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Key Words
- ACLF, acute-on-chronic liver failure
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Acute-on-chronic liver failure
- Biomarker
- CRP, C-reactive protein
- CXCL10, C-X-C motif chemokine
- HCC, hepatocellular carcinoma
- Inflammation
- Liver cirrhosis
- MELD, model for end-stage liver disease
- MIF, macrophage migration inhibitory factor
- SBP, spontaneous bacterial peritonitis
- SDC, stable decompensated cirrhosis
- SHR, subdistribution hazard ratio
- SNP, single nucleotide polymorphism
- Survival
- TIPS, transjugular intrahepatic portosystemic shunt
- UDC, unstable decompensated cirrhosis
- WBC, white blood cell count
- sCD74, soluble receptor CD74
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Affiliation(s)
- Theresa H Wirtz
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp A Reuken
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Petra Fischer
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Irina Bergmann
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Christina Backhaus
- Institute of Human Genetics, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Christoph Emontzpohl
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Mc Govern Medical School, Houston, TX, USA
| | - Johanna Reißing
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Elisa F Brandt
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - M Teresa Koenen
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Kai M Schneider
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Robert Schierwagen
- Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
| | - Maximilian J Brol
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Henning W Zimmermann
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Nilay Köse-Vogel
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Thomas Eggermann
- Institute of Human Genetics, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Ingo Kurth
- Institute of Human Genetics, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Christian Stoppe
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Richard Bucala
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jürgen Bernhagen
- Department of Vascular Biology, Institute for Stroke and Dementia Research (ISD), Ludwig Maximilians-University (LMU), Munich, Germany.,Munich Cluster for Systems Neurology (EXC 2145 SyNergy), Munich, Germany
| | | | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Christian Trautwein
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Jonel Trebicka
- Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
| | - Tony Bruns
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Marie-Luise Berres
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
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