Portal hypertension as a trigger for the acute chronic liver failure development in decompensated alcoholic liver cirrhosis

The aim of the study was to assess the effect of the portal hypertension (PH) severity on the systemic inflammation development and the acute chronic liver failure (ACLF) incidence in patients with acute decompensation of alcoholic liver cirrhosis (ALC). Materials and methods. We examined 119 decompensated ALC patients: with mild symptoms of PH (group I, n = 43-36.1%) and with severe symptoms of PH (group II, n = 76-63.9%). We determined cytokines TNF-α, IL-1β, IL-4, IL-6, IL-8 and the marker of hepatocytic apoptosis - fragments of cytokeratin-18 (FCK-18) by ELISA. The presence and degree of ACLF were determined using an online calculator https://www.clifresearch.com/ToolsCalculators.aspx. Results. In patients of group II, the indicators of hepatocellular inflammation were significantly higher - alanine aminotransferase, aspartate aminotransferase, FCK-18; higher systemic inflammation markers - leukocytes, C-reactive protein, TNF-α, IL-6, IL-8, below IL-4; were worse markers of hepatocellular failure - albumin, cholesterol, international normalized ratio and markers of extrahepatic organ failure - renal, cerebral, circulatory, coagulation. In patients of group II, ACLF developed significantly more often - in 32.9%, the ACLF index was higher - 56.1 ± 6.9 points and short-term mortality rate was higher - 21.1% than those in patients of group II - 18.6%, 49.5 ± 3.6 and 4.6% (p<0.05), respectively. Conclusion. The progression of portal hypertension in decompensated alcoholic liver cirrhosis was accompanied by a significant increase in the incidence of ACLF and short-term mortality.

alcoholic liver cirrhosis, portal hypertension, acute on chronic liver failure, cytokines, hepatocytic apoptosis, short-term mortality

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