Z Gastroenterol 2013; 51 - A60
DOI: 10.1055/s-0033-1347435

Increased gut permeability, elevated endotoxin related products and neutrophil dysfunction in liver cirrhosis

A Horvath 1, B Leber 1, S Lemesch 1, P Stiegler 2, R Stauber 1, P Fickert 1, G Zollner 1, W Spindelböck 1, E Krones 1, F Durchschein 1, P Douschan 1, V Stadlbauer-Köllner 1
  • 1Universitätsklinik für Innere Medizin, Graz, Austria
  • 2Universitätsklinik für Chirurgie, Graz, Austria

Introduction: Infection is the most common precipitant for decompensation in liver cirrhosis. Endotoxin can enter the circulation due to increased gut permeability, and contributes to inadequate activation and dysfunction of the innate immune system in alcoholic cirrhosis. The aim of the study was to assess gut permeability, presence of endotoxin and neutrophil function in patients with liver cirrhosis.

Methods: 40 patients with liver cirrhosis (24 alcoholic, 16 non-alcoholic) and 8 healthy controls were studied. Gut permeability was assessed by differential sugar absorption and determination of diaminooxidase (DAO) serum levels by ELISA. Endotoxin was measured by an adapted limulus amoebocyte lysate assay and ELISA was used to detect lipopolysaccharide binding protein (LBP) and sCD14 levels. Neutrophil phagocytic capacity was determined by FACS analysis.

Results: DAO serum levels, sucrose excretion and lactulose/mannitol ratio in the urine were elevated in patients compared with the control group. For DAO levels a significant association with Child-Pugh-score was found. Age, gender and aetiology had no impact on gut permeability. sCD14 levels were significantly higher in patients compared to controls. LBP did not differ between patients and controls. Age, gender and aetiology did not impact on sCD14 and LBP levels. Free endotoxin could not be detected in any samples. There was a trend to reduced neutrophil phagocytic capacity in patients with liver cirrhosis (significant for those with Child-Pugh score > 7)

Discussion: Gut permeability is increased in liver cirrhosis and might therefore account for translocation of bacterial products into the circulation. Although we could not find free endotoxin in the serum, the increase in sCD14, a mediator in endotoxin clearance, indicates an activation of the immune system in liver cirrhosis due to endotoxin. This is associated with a decrease in neutrophil phagocytic capacity as a possible pathophysiological basis for the increased susceptibility to infections in cirrhosis.