Neopterin and interleukin‐8 – prognosis in alcohol‐induced cirrhosis

Abstract: Background: Neutrophil cytotoxity and activated macrophages have been implicated in the pathogenesis of alcohol‐induced liver disease. The aim of this study was to relate plasma levels of neopterin, a marker of activation of the cellular immune system, and IL‐8, a neutrophil chemotactic factor, with severity of liver disease and prognosis in patients with alcohol‐induced cirrhosis. Methods: Plasma concentrations of neopterin and IL‐8 were assessed in 81 patients with alcohol‐induced cirrhosis admitted to the Department of Medicine B, Bispebjerg Hospital, Copenhagen, Denmark, and in 16 healthy controls. After a median follow‐up period of 5 years, mortality and death causes were registered. The patients were divided into groups according to the major contributing cause of death: infection, upper gastrointestinal bleeding or hepatic coma. Results: Neopterin and IL‐8 levels were increased in the cirrhosis patients, but not significantly related to Child‐Pugh classification. Five‐year mortality was 67%. High neopterin levels (>upper quartile) were an independent predictor of death (p=0.01, Log rank and p<0.02, Cox). High IL‐8 levels (>upper quartile) were of no significant prognostic value for overall mortality. Causes of death related mortality were as follows (Log rank): Neopterin; p=0.009, p=0.84 and p=0.94, and IL‐8; p=0.36, p=0.002 and p=0.27, respectively, according to infection, bleeding and coma as causes of death. Conclusions: Neopterin and IL‐8 plasma levels are raised in patients with alcohol‐induced cirrhosis, and are predictive of mortality associated with infections and upper gastrointestinal bleeding, respectively.