Abstract
OBJECTIVES: Inflammation may be implicated in the haemodynamic deterioration and in the development of complications in patients with cirrhosis. High-sensitivity C-reactive protein (hsCRP) is a marker of low-grade inflammation, and predicts outcomes in patients at risk of ischaemic heart disease. Proinflammatory cytokines reflect immune activation and have been found to be elevated in cirrhosis. We investigated a possible association between markers of inflammation and splanchnic and systemic haemodynamics, complications and survival in patients with cirrhosis.

METHODS: In 45 stable patients with cirrhosis on the basis of alcohol consumption, we measured hsCRP, as well as monocyte chemoattractant protein-1, tumour necrosis factor-a, interleukin-6, interleukin-8 and vascular endothelial growth factor in patients and in 12 healthy controls. Systemic and splanchnic haemodynamics were investigated in patients.

RESULTS: hsCRP levels were significantly higher in patients compared with controls (P<0.05) and the highest in patients belonging to Child-Pugh class C. hsCRP levels correlated with markers of liver dysfunction and with the hepatic venous pressure gradient (r=0.48, P<0.001). hsCRP values above the median level of 5.3 mg/l were associated with a highly increased mortality (P=0.001). Model for End-Stage Liver Disease score (P=0.01) and hsCRP (P<0.05) provided independent prognostic information. Cytokines had no discernible value in predicting survival.

CONCLUSION: hsCRP is elevated in patients with cirrhosis and is associated with portal hypertension and decreased survival. hsCRP is a promising prognostic marker in cirrhosis, which may improve the selection of candidates for liver transplantation.