Serum Interleukin-4 and Ascitic CD206 Predict Mortality in Acute Cirrhosis Decompensation and Acute-on-Chronic Liver Failure

Abstract Background & Aim: Acute-on-chronic liver failure (ACLF) is the most severe form of acute decompensation (AD) with intense systemic inflammation and immune dysfunction. IL-4 polarizes macrophages toward the M2 phenotype. CD206 can identify inflammatory peritoneal macrophages in cirrhotic patients and could be linked to prognosis in ACLF. We investigated the predictive value of serum IL-4 and ascitic sCD206 in patients with AD and ACLF and their relation to morbidity and early mortality. Patients and Methods: We included 60 patients with ACLF and AD as well as 30 cirrhotic controls. Clinical data were collected, and survival was followed for 1 and 3 months. Blood samples were analyzed at admission for liver and renal function tests as well as serum IL-4 and ascitic soluble CD206 levels. Correlation with liver function indicators and prognosis was assessed. Results: IL-4 and CD206 were significantly higher in AD and ACLF patients compared to control and were positively correlated with each other’s Child-Pugh score, MELD-Na, and ACLF severity scores. Multivariate regression showed that baseline Child-Pugh score, ascitic sCD206, and serum IL-4 level are the only independent predictors of one-month as well as 3-month mortality. Conclusions: Serum IL-4 and ascitic sCD206 (macrophage markers) could predict early mortality in AD and ACLF. Incorporation of these markers into the traditional liver disease scores can improve their prognostic/predictive performance.