Changes of Serum Cytokine Levels in Patients With Acute on Chronic Liver Failure Treated by Plasma Exchange

Background and Aim: Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) may be useful to bridge patients with AoCLF to liver transplantation or to regenerate their own livers. The aim of this study was to assess the effects of PE on the circulating concentrations of cytokines in patients with AoCLF. Methods: One hundred forty-nine patients with AoCLF in 2 groups (PE plus routine-care, n = 62; and routine-care, n = 87) were enrolled in our study. Fifteen healthy donors were used as the control group. Cytokine levels such as interferon-gamma (IFN-gamma), interleukin-10 (IL-10), interleukin-4 (IL-4), interleukin-2 (IL-2), and tumor necrosis factor-alpha (TNF-alpha) were detected on admission and on days 7, 14, 21, and 30 during hospitalization. Results: All the detected cytokine values (IFN-gamma, IL-10, IL-4, IL-2, and TNF-alpha) in the patient groups were higher compared with those in the healthy controls (P < 0.001). PE was effective to decrease the serum concentration of cytokines: TNF-alpha dropped from (3.46 +/- 1.23) pg/mL to (1.64 +/- 0.66) pg/mL (P < 0.01), IL-10 from (6.2 +/- 2.1) pg/mL to (3.5 +/- 1.1) pg/mL (P < 0.01), IL-2 from (7.5 +/- 4.7) pg/mL to (4.0 +/- 2.1) pg/mL (P < 0.01), IFN-gamma from (27.5 +/- 15.8) pg/mL to (15.5 +/- 11.8) pg/mL (P < 0.01), and IL-4 from (86.7 +/- 31.3) pg/mL to (44.7 +/- 26.3) pg/mL (P < 0.01). Conclusions: Cytokines may be important in the pathogenesis of the AoCLF, and PE may represent a reliable hepatic support device for AoCLF.