Prognostic Analysis Of Lipopolysaccharide-binding Protein And Soluble CD14 In Liver Cirrhosis With Systemic Inflammatory Response Syndrome

Objective:To investigate the changes and the prognostic value of lipopolysaccha-ride-binding protein and soluble CD 14 in liver cirrhosis with systemic inflammatory response syndrome.Methods:We measured the concentrations of lipopolysaccharides,lipopolysaccha-rides-binding protein,soluble CD 14 in 23 cirrhotic patients with systemic inflammatory response syndrome,23 cirrhotic patients without systemic inflammatory response syndrome and 11 volunteers.Also we collected their essential history,in-hospital outcome and biological parameters including white blood cell,platelet,total bilirubin, albumin,ALT,AST,PT,INR,Scr,BUN,CRP to access the Child-Pugh grading and model for end-stage liver disease scoring.All analysis was performed using the SPSS16.0.Results:1.Compared to the cirrhosis without SIRS group,the cirrhosis with SIRS group had higher in-hospital mortality(34.8%vs.4.3%,P＜0.05),significantly higher sCD 14 concentration(1354.97±277.64μg/L vs.855.8±191.1μg/L,P＜0.01),higher CRP level(33.8mg/L vs.7.6mg/L,P＜0.05).The MELD score increased as well.No statistic significances ware found in LPS and LBP level.2.Compared to survivors in cirrhotic patients with SIRS,non-survivors had higher sCD 14 concentration(1589.4±205.35 vs.1229.95±227.81μg/L,P0.01),higher MELD score(24±15 vs.11±7,P＜0.05).In the three sCD14 concentration group which are under 1000,1000-1500,over 1500μg/L,the in-hospital mortality rate significantly increased(0%vs.33.3%vs.83.3%,χ2=10.817,P＜0.01).sCD14 positively correlated with in-hospital fatality rate(r=0.661,P＜0.01).No statistic significance was found in LPS and LBP level. 3.In MELD≥18 group,the in hospital mortality of cirrhotic patients with SIRS significantly increased(71.4%vs.18.8%,χ2 = 5.902,P＜0.05 )and sCD14 was higher than that ofR＜18 group as well(1581.32±219.01 vs.1255.95±243.93μg/L,P＜0.01).4.The AUC of sCD14 and MELD for predicting fatal outcome in SIRS patients was 0.9 and 0.808,both P value are under 0.05.Conclusion:1.Liver cirrhosis Patients with SIRS had higher in-hospital mortality and higher sCD14 concentration.2.sCD14 may well predict the in-hospital mortality prognosis of liver cirrhosis with SIRS.When the concentration of sCD14 is over 1500μg/L,the mortality is higher. LBP and CRP have little value in this aspect.3.MELD is a prognostic predictor for in-hospital mortality in liver cirrhosis with systemic inflammatory response syndrome.When the score is over 18,the outcome is poor.