Wasmuth HE et al. (2005) Patients with acute on chronic liver failure display 'sepsis-like' immune paralysis. J Hepatol 42: 195–201

Patients with liver cirrhosis are at increased risk of infections, and there is evidence that depression of cellular immunity is responsible. Wasmuth and colleagues have investigated this by analyzing functional immune parameters in patients with acute liver failure and decompensated cirrhosis (acute-on-chronic liver failure [ACLF]), using patients with severe sepsis, or with non-decompensated cirrhosis, as controls.

At the time of admission to the medical intensive care unit, the degree of cellular immune depression was similar in patients with ACLF (n = 27) and severe sepsis (n = 31); patients in these groups had significantly lower monocyte surface HLA-DR expression and ex vivo lipopolysaccharide-induced tumour necrosis factor (TNF)-α production than those with stable liver cirrhosis (n = 24). Serum levels of interleukin-6, however, were significantly higher in patients with sepsis than in those with ACLF, suggesting that different mechanisms were responsible for the immune depression seen in the two groups. A subgroup analysis showed that the etiology of liver cirrhosis was not related to the observed immune dysfunction in the ACLF group.

Wasmuth et al. conclude that patients with ACLF displayed a 'sepsis-like' cellular immune depression. They propose that immune-enhancing therapies should be developed to reduce infectious morbidity in these patients.