Elevated Soluble Tumor Necrosis Factor Receptor 75 Concentrations Identify Patients With Liver Cirrhosis at Risk of Death

Background & Aims

Elevated levels of the soluble 75-kd receptor for tumor necrosis factor–alpha (sTNF-R 75) are better predictors of mortality in cirrhosis than the Child-Turcotte-Pugh (CTP) score. Thus, we compared sTNF-R 75 with the Model for End-Stage Liver Disease (MELD), CTP, and the sTNF-R 75/55 ratio.

Methods

Ninety-two patients with liver cirrhosis (mean age, 55 years; range, 19–76 years; male, 66%; CTP stage C, 41%) were included in our prospective single-center survival study. The study setting was a tertiary care university clinic. Soluble TNF-R levels were determined, and the primary end point was death.

Results

During ≥730 days, 44 patients died. Multivariate Cox regression analysis revealed sTNF-R 75 (≥14 ng/mL) as an independent predictor of mortality (hazard ratio, 2.53; P = .006). By receiver operating characteristic, MELD and sTNF-R 75 were more accurate in predicting 6-, 15-, and 24-month mortality than CTP and sTNF-R 75/55. This was significant for 6 months (MELD, 0.78; sTNF-R 75, 0.75 vs sTNF-R 75/55, 0.60). In patients with high MELD scores (≥15), survival was further reduced if sTNF-R 75 values were elevated (P = .035).

Conclusions

Elevated sTNF-R 75 levels independently predicted mortality and improved MELD on the basis of evaluation of prognosis, especially in patients with high MELD scores. Thus, sTNF-R 75 levels might be a useful cytokine-based prognostic marker in patients with liver cirrhosis.

Abbreviations used in this paper: AUC, area under the curve, CI, confidence interval, CTP, Child-Turcotte-Pugh, CV, coefficient of variation, INR, international normalized ratio, MELD, Model for End-Stage Liver Disease, NMR, nuclear magnetic resonance, NYHA, New York Heart Association, ROC, receiver operating characteristic, sTNF-R, soluble tumor necrosis factor–alpha receptor, TNF-α, tumor necrosis factor–alpha