Infection and Alcoholic Liver Disease

Chan, Christine; Levitsky, Josh

doi:10.1016/j.cld.2016.02.014

Cited by 38 publications

(39 citation statements)

References 60 publications

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“…Male sex was a risk factor for readmissions, likely related to the higher prevalence of alcoholic cirrhosis among male individuals. Patients with alcoholic liver disease are prone to infections,17 and patients with cirrhosis and health care‐associated infections have been reported to be at risk for readmission 18. Continued alcohol use also impairs cognitive function and may be associated with poor adherence to follow‐up visits and medication use 19.…”

Section: Discussionmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30‐day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30‐day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30‐day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30‐day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198)

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Section: Discussionmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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“…Alcohol has been shown to reduce CD80 and CD86 expression on DCs and DC costimulatory function . It is likely that reduced expression of HLA‐DR, CD80, and CD86 on various antigen‐presenting cells leads to suboptimal function of pathogen‐specific T cells, which contributes to the discordance between heightened immune activation and increased susceptibility and severity to infections as observed in AH patients …”

Section: Discussionmentioning

confidence: 99%

“…(40) It is likely that reduced expression of HLA-DR, CD80, and CD86 on various antigenpresenting cells leads to suboptimal function of pathogen-specific T cells, which contributes to the discordance between heightened immune activation and increased susceptibility and severity to infections as observed in AH patients. (20,41,42) Both monocytes and CD8 T cells in AH patients expressed significantly higher levels of CD38 (Table 3; Supporting Table S3). CD38 has diverse functions in T-cell activation and proliferation, cytokine release, and monocyte chemotaxis toward sites of inflammation as well as adhesion of T cells and monocytes to endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

“…(6,20) Studies in both humans and animal models have demonstrated that chronic alcohol abuse has a significant impact on T-cell biology including a reduction in count, impairment of development and function, disturbance of the balance between effector and regulatory T-cell types, influence of phenotype and activation, and promotion of cell apoptosis. (6,20) Alcohol abuse also affects multiple aspects of B cellmediated immunity, (6,21,22) leading to reduced numbers and function of B cells while simultaneously increasing production of immunoglobulins. (6,21,22) Particularly, levels of autoantibodies against liverspecific antigens are increased in AH patients and may promote alcohol-related liver damage.…”

mentioning

confidence: 99%

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Alcohol abstinence ameliorates the dysregulated immune profiles in patients with alcoholic hepatitis: A prospective observational study

Amet

Xing

et al. 2017

Hepatology

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Alcoholic hepatitis (AH) develops only in small proportion of heavy drinkers. To better understand the mechanisms underlying this disparity, we conducted a study to define the relationship between AH development and dysregulated immune responses that might be ameliorated by alcohol abstinence. Sixty-eight AH patients, 65 heavy drinking controls without liver disease (HDC), and 20 healthy controls (HC) were enrolled and followed up to 12 months. At the baseline, HDC and HC had no significant differences in their plasma levels of 38 inflammatory cytokines/chemokines measured using multiplex immunoassays. However, compared to HDC, AH patients had higher baseline levels of 11 cytokines/chemokines (TNF-α, IL-6, IL-8, IP10, IL-4, IL-9, IL-10, FGF-2, IL-7, IL-15, and TGF-α), but lower levels of the anti-inflammatory macrophage-derived chemokine (MDC). AH patients also had more activated, yet dysfunctional immune cells as monocytes, T cells, and B cells expressed higher levels of CD38 and CD69, but low levels of HLA-DR, CD80, and CD86 at baseline. In addition, CD4 T cells produced less IFN-γ in response to T cell stimulation. Upregulated IL-6, IL-8, CD38, and CD69 and downregulated MDC, HLA-DR, CD86, and CD80 correlated positively and negatively, respectively, with disease severity. Longitudinal analysis indicated that levels of IL-6, IL-8, CD38, and CD69 were reduced, whereas levels of MDC, HLA-DR, CD80, and CD86 were increased in abstinent AH patients. All of the cellular immune abnormalities were reversed by day 360 in abstinent AH patients; however, plasma levels of TNF-α, IL-8, IL-10, FGF-2, and IL-7 remained higher. Conclusion: AH patients were in a highly immune-dysregulated state, whereas HDC showed little evidence of immune activation. Alcohol abstinence reversed most, but not all, of the immunological abnormalities.

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“…Despite contradictory evidence, there is previous literature showing that alcohol-related liver disease and alcohol consumption, particularly alcoholic hepatitis, are associated with increased rates of infection and antibiotic resistance, which could partly explain our high rate of MDR infections. 3 Additionally, the emergence and identification of 1 case of PDR-bacteria is alarming and can have serious clinical consequences.…”

Section: Another Clinical Unmet Need In Liver Patients: Multidrug Resmentioning

confidence: 99%

Another clinical unmet need in liver patients: Multidrug resistant bacteria in decompensated cirrhosis

Morais

Liberal

Santos

et al. 2019

Journal of Hepatology

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Infection and Alcoholic Liver Disease

Cited by 38 publications

References 60 publications

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Alcohol abstinence ameliorates the dysregulated immune profiles in patients with alcoholic hepatitis: A prospective observational study

Another clinical unmet need in liver patients: Multidrug resistant bacteria in decompensated cirrhosis

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