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HepatologyVolume 27, Issue 5 p. 1227-1232 Original ArticleFree Access Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: Relationship with the development of renal impairment and mortality Miguel Navasa, Corresponding Author Miguel Navasa Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaMiquel Navasa, Liver Unit, Hospital Clínic i Provincial, Villarroel 170, 08036 Barcelona, Spain===Search for more papers by this authorAntonio Follo, Antonio Follo Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorXavier Filella, Xavier Filella Biochemistry Laboratory, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorWladimiro Jiménez, Wladimiro Jiménez Hormonal Laboratory, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorAnna Francitorra, Anna Francitorra Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorRamón Planas, Ramón Planas Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, SpainSearch for more papers by this authorAntoni Rimola, Antoni Rimola Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorVicente Arroyo, Vicente Arroyo Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorJoan Rodés, Joan Rodés Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this author Miguel Navasa, Corresponding Author Miguel Navasa Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaMiquel Navasa, Liver Unit, Hospital Clínic i Provincial, Villarroel 170, 08036 Barcelona, Spain===Search for more papers by this authorAntonio Follo, Antonio Follo Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorXavier Filella, Xavier Filella Biochemistry Laboratory, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorWladimiro Jiménez, Wladimiro Jiménez Hormonal Laboratory, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorAnna Francitorra, Anna Francitorra Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorRamón Planas, Ramón Planas Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, SpainSearch for more papers by this authorAntoni Rimola, Antoni Rimola Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorVicente Arroyo, Vicente Arroyo Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this authorJoan Rodés, Joan Rodés Liver Unit, Department of Internal Medicine, Hospital Clínic i Provincial, University of BarcelonaSearch for more papers by this author First published: 30 December 2003 https://doi.org/10.1002/hep.510270507Citations: 331AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Spontaneous bacterial peritonitis (SBP) is associated with an important production of inflammatory mediators. However, it is unknown whether there is a relationship between the abdominal production of these mediators and the development of renal impairment, one of the most important prognostic parameters in spontaneous bacterial peritonitis. We studied 52 cirrhotic patients at diagnosis and resolution of the infection, by measuring endotoxin, tumor necrosis factor (TNF), and interleukin-6 (IL-6) levels in plasma and ascitic fluid. Thirteen patients (25%) developed renal impairment. Patients developing renal impairment showed significantly higher plasma and ascitic fluid cytokine levels at diagnosis of infection than patients who did not (plasma TNF-α: 96.0 ± 38.7 vs. 39.1 ± 3.6 pg/mL, P = .0209; ascitic fluid TNF-α: 474.5 ± 118.1 vs. 160.8 ± 42.7 pg/mL, P = .0173; plasma IL-6: 6,635 ± 2,897 vs. 458 ± 109 pg/mL, P = .0004; ascitic fluid IL-6: 182,559 ± 47,328 vs. 39,250 ± 10,803 pg/mL, P = .0001). Independent predictors of development of renal impairment at diagnosis were: renal failure (blood urea nitrogen > 30 mg/dL or serum creatinine > 1.5 mg/dL) (P < .001), IL-6 levels in ascitic fluid (P < .001), and mean arterial pressure (P < .05). Ten of the 13 (77%) patients who developed renal impairment died during hospitalization, but only 2 of the 39 (5%) patients who did not (P= .0001). In addition, renal failure at diagnosis of the infection was the only independent predictor of hospital mortality (P < .001). 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