Phenotype-Specific Dose-Response Patterns of Systemic Inflammation With Hepatic Decompensation in Cirrhosis: A...

Area of Science:

• Hepatology
• Inflammation research
• Clinical biochemistry

Background:

• Systemic inflammation is linked to liver decompensation in cirrhosis.
• The relationship between inflammation and specific decompensation phenotypes requires clarification.

Purpose of the Study:

• To evaluate the association between an inflammation burden index (IBI) and cirrhosis severity.
• To investigate the dose-response patterns of IBI across different decompensation phenotypes (ascites, spontaneous bacterial peritonitis).

Main Methods:

• Developed an IBI integrating IL-6, hs-CRP, neutrophil-to-lymphocyte ratio, and procalcitonin.
• Analyzed IBI association with Child-Turcotte-Pugh (CTP) score, MELD score, ascites, and SBP in 463 cirrhosis patients.
• Utilized restricted cubic splines for dose-response analysis and assessed IBI-sarcopenia interaction.

Main Results:

• High IBI correlated with worse CTP and MELD scores, and increased risk of ascites and SBP.
• Dose-response patterns varied by phenotype: monotonic for CTP, MELD, SBP; inverted-U for ascites, particularly in advanced disease (CTP C).
• Ascites in high-IBI patients showed an immunoparalysis profile; IBI-sarcopenia interaction was supra-additive for ascites.

Conclusions:

• The association between inflammation burden and cirrhosis decompensation is specific to the clinical phenotype.
• The inverted-U pattern for ascites may represent an artifact of advanced disease rather than a biological threshold.
• Findings necessitate prospective validation to confirm the descriptive results.