Plasma Tumor Necrosis Factor α Predicts Decreased Long‐Term Survival in Severe Alcoholic Hepatitis

Abstract

Plasma tumor necrosis factor .alpha. (TNF .alpha.), interleukin 1 .alpha. (IL-1.alpha.), and interleukin 1 .beta. (IL-1.beta.) were measured in plasma samples obtained from 23 patients with severe alcoholic hepatitis on admission and after 30 days of hospitalization. Over a 2-year follow-up period, 14 patients died at a mean time of 8 months following discharge. The presence of elevated plasma TNF .alpha. either at admission or discharge from the hospital was associated with death in 82% (14/17) of patients. By contrast absence of elevated plasma TNF .alpha. was associated with survival in 100% (6/6). The difference in survival with and without detectable plasma TNF .alpha. was significant at p = 0.0022. Plasma TNF .alpha. was not elevated in alcoholic patients without clinically apparent liver disease, with alcoholic cirrhosis, or in nonalcoholic healthy controls. Plasma IL-1 .alpha. was also significantly increased in alcoholic hepatitis whereas IL-1 .beta. was not. Neither IL-1 .alpha. nor .beta. was correlated with outcome in the alcoholic hepatitis group. It is concluded that the presence of elevated plasma TNF .alpha. is a significant predictor of decreased long-term survival in patients with severe alcoholic hepatitis.