Tumour necrosis factor-α and soluble Fas ligand as biomarkers in non-acetaminophen-induced acute liver failure

Abstract

Objectives: Cytokines as prognostic markers in acute liver failure (ALF) have not been evaluated in the Indian subcontinent with hepatitis E as the commonest aetiological agent. We investigated the clinical significance of proinflammatory/apoptotic cytokines soluble Fas ligand (sFasL) and tumour necrosis factor (TNF)-α in ALF of specific aetiology.

Methods: A total of 82 cases, 37 ALF and 45 acute hepatitis (AH), and 60 healthy controls were recruited. Serum levels of sFasL and TNF-α were determined at admission and death/recovery.

Results: Mean sFasL and TNF-α serum levels at admission were significantly higher (p < 0.001) in patients with ALF than AH, but no marked difference was observed between ALF-E (expired, n = 23) and ALF-S (survivors, n = 14), although the former had comparatively higher levels. ALF-E had higher than baseline TNF-α and sFasL concentrations at death, while in the ALF-S group the samples obtained from the patients as soon as they came out of encephalopathy, showed either lower or similar TNF-α and sFasL levels as found at admission.

Conclusion: The high levels of sFasL and TNF-α are associated with ALF. Following the trend of these cytokines can be useful in predicting death and timely referral to a transplant centre.

Keywords::

• Acute liver failure
• TNF
• soluble Fas ligand
• non-acetaminophen
• hepatitis E

Acknowledgements

The study was supported by internal funding at the study centres. There are no conflicts of interest with any of the authors. The study has been presented at American College of Gastroenterology Annual Meeting, 2006, Las Vegas, USA. The manuscript has not been submitted or accepted elsewhere. All authors have contributed to, seen, and approved the final, submitted version of the manuscript.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.