الفهرس 
Role of IL-6, TNF-? and VCAM-1 as predictors of renal impairment in cirrhotic patients with spontaneous bacterial peritonitis
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Abstract
Background: SBP is the commonest infection in cirrhosis leading to serious
outcomes including renal impairment (RI) or death. Several mechanisms by
which renal dysfunction occurs in patients with SBP. One of them is systemic
inflammatory response syndrome (SIRS) induced (RI) through release of proinflammatory cytokines e.g; IL-6, TNF-α and VCAM-1 which stimulate release
of nitric oxide (NO) that decreases effective plasma volume with its
consequences including renal perfusion.
Aim: To evaluate the role of IL-6, TNF-α and VCAM-1 as predictors of renal
impairment & outcomes in cirrhotic patients with SBP.
Subjects and methods: This Cross-sectional study was conducted on 90
cirrhotic patients with SBP in Kasr Al-Ainy hospital & NHTMRI. RI is
considered when creatinine >1.3, Accordingly, the studied patients were
divided into group A (n=45) 50% of the patients (no RI) & group B with (RI).
According to the outcome, The patients were divided into group 1(discharge) &
group 2 (death) (n=20) 22.2% of patients. TNF-α, IL-6 & Vcam1 were
measured in the serum by ELISA by (NOVA, Bioneovan Co., China).
Results: RI occurred in 50% of patients. The cytokine levels were high in
11.1%, 8.9% and 6.7% for IL-6, TNF-α and VCAM-1 respectively. We found
no statistically significant difference in cytokines levels between group A & B
or between group 1 & 2. The AUC was 0.5 for the three cytokines with equal
sensitivity and specificity 93% and 97% respectively as predictors of RI.
While the AUC for IL-6, TNF-α & VCAM-1 didn’t exceed 0.6 with specificity
88%, 98% & 93% respectively & with sensitivity 95% for the three cytokines
as predictors for outcomes.
Conclusion: The use of IL-6, TNF-α & VCAM-1 as predictors for renal
impairment & outcomes isn’t recommended as they have poor diagnostic
values.