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SummaryBackgroundProbiotics may correct intestinal dysbiosis and proinflammatory conditions in patients with liver cirrhosis.AimTo test the effects of a multispecies probiotic on innate immune function, bacterial translocation and gut permeability.MethodsIn a randomised, double blind, placebo‐controlled study, stable cirrhotic out‐patients either received a daily dose of a probiotic powder containing eight different bacterial strains (Ecologic Barrier, Winclove, Amsterdam, The Netherlands) (n = 44) or a placebo (n = 36) for 6 months and were followed up for another 6 months.ResultsWe found a significant but subclinical increase in neutrophil resting burst (2.6–3.2%, P = 0.0134) and neopterin levels (7.7–8.4 nmol/L, P = 0.001) with probiotics but not with placebo. Probiotic supplementation did not have a significant influence on neutrophil phagocytosis, endotoxin load, gut permeability or inflammatory markers. Ten severe infections occurred in total; one during intervention in the placebo group, and five and four after the intervention has ended in the probiotic and placebo group, respectively. Liver function showed some improvement with probiotics but not with placebo.ConclusionsProbiotic supplementation significantly increased serum neopterin levels and the production of reactive oxygen species by neutrophils. These findings might explain the beneficial effects of probiotics on immune function. Furthermore, probiotic supplementation may be a well‐tolerated method to maintain or even improve liver function in stable cirrhosis. However, its influence on gut barrier function and bacterial translocation in cirrhotic patients is minimal.

In patients at risk for PH and/or with unexplained dyspnea, CART analysis detects prognostic thresholds at a resting mPAP of 17 mm Hg and 26 mm Hg, and values between 20 mm Hg and 25 mm Hg represent an independent predictor of poor survival. Clinical trial registered with www.clinicaltrials.gov (NCT 01607502).

Stable cirrhosis 228 patients enrolled at Medical University of Graz Acute decompensation 280 patients enrolled in CANONIC cohort including 107 patients with ACLF Measurement of HDL-related biomarkers (HDL-C, apoA-I) at baseline Highlights HDL levels are profoundly decreased in chronic liver failure. HDL-related biomarkers (HDL-C, apoA-I) are robust predictors of disease progression and survival. The prognostic value of single HDL-related biomarkers is very similar to that of the composite scores. HDL-related biomarkers correlated inversely with markers of inflammation.

COPD is frequently associated with mild to moderate pulmonary hypertension (PH). However, a small subset of patients develops severe PH, which is currently haemodynamically defined as mean pulmonary arterial pressure (mPAP) ⩾35 mmHg, or mPAP ⩾25 mmHg in combination with cardiac index <2.0 L•min −1 •m −2 [1, 2]. These cut-offs are, however, arbitrary and mainly based on expert opinion. In this study we aimed to determine prognostically relevant haemodynamic thresholds for severe PH in COPD by using an unbiased approach.We retrospectively analysed COPD patients with at least 1-year follow-up who underwent right heart catheterisation (RHC) and clinical evaluation at our clinic due to suspected PH between 2003 and 2018. RHC was performed in the supine position, with a mid-thoracic zero reference level, as previously described [3]. All data were included into a prospective local database (GRAPHIC (GRAz Pulmonary Hypertension In COPD) registry). Patients undergoing lung transplantation at any time (n=3) were excluded from this analysis. We performed Cox regression analysis, adjusting for age, sex and forced expiratory volume in 1 s (FEV 1 ) with the primary outcome all-cause mortality. For identification of the best prognostic cut-offs, we searched for the lowest p-values. Continuous baseline characteristics of the groups according to the best cut-off were compared using independent t-tests or Mann-Whitney U-test, as appropriate. Continuous variables are described as mean±SD or median (interquartile range), as appropriate. The study was approved by the institutional ethics board (EK: 32-180 ex 19/20) of the Medical University Graz.We included 139 COPD patients (age 68 (62-73) years; 55.4% male; mPAP 35 (27-43) mmHg; pulmonary vascular resistance (PVR) 4.3 (2.9-7.3) WU; FEV 1 56±20% predicted). 72 patients (52%) died during a follow-up of 8.0 (3.8-11.7) years, with a median time to death of 3.0 (1.3-5.2) years. 61 (44%) patients received any PAH drug at any time-point.Out of the examined haemodynamic parameters, after adjustment for age, sex and FEV 1 , PVR (HR 1.09, 95% CI 1.02-1.16; p=0.007) and mPAP (HR 1.03, 95% CI 1.01-1.05; p=0.001) were associated with survival, while pulmonary arterial wedge pressure (PAWP) and cardiac index were not ( p=0.696 and p=0.171). Among all haemodynamic parameters, PVR >5.0 WU was the best prognostic cut-off (HR 2.59, 95% CI 1.58-4.27; p<0.001) (figure 1a). Patients with PVR >5.0 WU were more frequently males ( p<0.001) and had a lower 6-min walk distance (254±112 versus 333±117 m; p<0.001), lower peak oxygen uptake (41±13 versus 61±23% predicted; p<0.001) and higher N-terminal pro brain natriuretic peptide (2288 (694-3634) versus 442 (160-1126) pg•mL −1 ; p<0.001) as compared to patients with PVR ⩽5.0 WU.For mPAP, the p-values for potential cut-off scores showed two equivalent minimal levels, the first at 33 mmHg (HR 2.26, 95% CI 1.37-3.71; p=0.001) (figure 1b) and the second at 45 mmHg (HR 2.44, 95% CI 1.43-4.16; p=0.001). Out of the patients with mPAP ⩾33 mmHg, n=28 (36%) and n=49 ...