Toll-like receptor 4 polymorphisms and bacterial infections in patients with cirrhosis and ascites

Edilmar Alvarado-Tapias, Carlos Guarner-Argente, Elida Oblitas, Elisabet Sánchez, Silvia Vidal, Eva Román, Mar Concepción, Maria Poca, Cristina Gely, Oana Pavel, Juan Camilo Nieto, Cándido Juárez, Carlos Guarner, Germán Soriano

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Abstract

© The Author(s) 2018. AIM To assess the relationship between the presence of toll-like receptor 4 (TLR4) polymorphisms and bacterial infections in cirrhotic patients with ascites. METHODS We prospectively included consecutive patients with cirrhosis and ascites hospitalized during a 6-year period. Patients with human immunodeficiency virus (HIV) infection or any other immunodeficiency, patients with advanced hepatocellular carcinoma (beyond Milan' s criteria) or any other condition determining poor short-term prognosis, and patients with a permanent urinary catheter were excluded. The presence of D299G and/or T399I TLR4 polymorphisms was determined by sequencing and related to the incidence and probability of bacterial infections, other complications of cirrhosis, hepatocellular carcinoma, and mortality during follow-up. A multivariate analysis to identify predictive variables of mortality in the whole series was performed. RESULTS We included 258 patients: 28 (10.8%) were carriers of D299G and/or T399I TLR4 polymorphisms (polymorphism group) and 230 patients were not (wildtype group). The probability of developing any bacterial infection at one-year follow-up was 78% in the polymorphism group and 69% in the wild-type group (P = 0.54). The one-year probability of presenting infections caused by gram-negative bacilli (51% vs 44%, P = 0.68), infections caused by gram-positive cocci (49% vs 40%, P = 0.53), and spontaneous bacterial peritonitis (29% vs 34%, respectively, P = 0.99) did not differ between the two groups. The oneyear probability of transplant-free survival was 55% in the polymorphism group and 66% in the wild-type group (P = 0.15). Multivariate analysis confirmed that age, Child-Pugh score, active alcohol intake, previous hepatic encephalopathy, hepatocellular carcinoma and serum creatinine were associated with a higher risk of CONCLUSION Genetic polymorphisms D299G and/or T399I of TLR4 do not seem to play a relevant role in the predisposition of cirrhotic patients with ascites to bacterial infections.
Original languageEnglish
Pages (from-to)124-133
JournalWorld Journal of Hepatology
Volume10
Issue number1
DOIs
Publication statusPublished - 27 Jan 2018

Keywords

  • Ascites
  • Bacterial infections
  • Cirrhosis
  • Genetic polymorphisms
  • Toll-like receptor 4

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    Alvarado-Tapias, E., Guarner-Argente, C., Oblitas, E., Sánchez, E., Vidal, S., Román, E., Concepción, M., Poca, M., Gely, C., Pavel, O., Nieto, J. C., Juárez, C., Guarner, C., & Soriano, G. (2018). Toll-like receptor 4 polymorphisms and bacterial infections in patients with cirrhosis and ascites. World Journal of Hepatology, 10(1), 124-133. https://doi.org/10.4254/wjh.v10.i1.124