Macrophage activation is a prognostic parameter for variceal bleeding and overall survival in patients with liver cirrhosis

Background and Aims:

Soluble CD 163 (sCD163) is shed in the blood circulation by activated macrophages, correlates strongly with the hepatic venous pressure gradient (HVPG) and is thereby a good indicator for portal hypertension. It is unknown if sCD163 correlates with the risk of variceal bleeding and overall survival (OS) in patients with liver cirrhosis. We performed a prospective study to investigate if sCD163 serum levels correlate with the risk of variceal bleeding and with OS in cirrhotic patients.

Methods:

Patients with liver cirrhosis were prospectively enrolled and followed until death or last contact. At the day of inclusion into the study blood samples were taken and the sCD163 serum levels were assessed by ELISA (Enzyme-linked immunosorbent assay). The time until the end points death and variceal bleeding were assessed and the risks of death or variceal bleeding were calculated with uni- and multivariate Cox regression analyses.

Results:

High sCD163 levels (>4100ng/l) corresponding to a HVPG >10mmHg were associated with variceal bleeding and death independently from the MELD (model of end stage liver disease) score, age and sex.

Furthermore, high sCD163 levels were independent from the variceal stage associated with gastrointestinal bleeding.

Conclusions:

The sCD163 serum level is a new independent non-invasive risk factor for death and variceal bleeding in cirrhotic patients.