Digestive Diseases and Sciences

, Volume 61, Issue 8, pp 2294–2302 | Cite as

Dysfunction of Circulating Polymorphonuclear Leukocytes and Monocytes in Ambulatory Cirrhotics Predicts Patient Outcome

  • Konstantina Sargenti
  • Åsa Johansson
  • Sara Bertilsson
  • Inger Mattsby-Baltzer
  • Daniel Klintman
  • Evangelos Kalaitzakis
Original Article



Cirrhosis represents a state of functional immune paresis with increased infection risk.


To investigate polymorphonuclear (PMN) leukocyte and monocyte function in ambulatory cirrhotics, and their potential relation with cirrhosis etiology or patient outcome.


Consecutive ambulatory cirrhotics without current or recent (<1 month) infection or acute decompensation were prospectively enrolled in 2013 and followed for a median time of 20 months until death, transplant or end of 2014. Oxidative burst and phagocytosis of circulating PMNs and monocytes were investigated at baseline and after in vitro Escherichia coli stimulation. Seventeen healthy blood donors served as controls. Baseline clinical and laboratory data as well as follow-up data on the development of cirrhosis complications, including acute-on-chronic liver failure (ACLF), and bacterial infections were collected.


Sixty patients were included (70 % male, median age 63 years, 52 % with alcoholic cirrhosis). Compared to controls, cirrhotics showed increased resting and stimulated burst as well as reduced phagocytosis of PMNs, and increased stimulated monocyte burst (p < 0.05 for all). Alcoholic etiology was not related to PMN or monocyte dysfunction (p > 0.05 for all). In Cox regression analysis, increased stimulated monocyte and PMN burst were independent predictors of sepsis, severe sepsis and ACLF occurrence. Also, increased stimulated monocyte burst was associated with worse transplant-free survival (p < 0.05 for all).


Stimulated PMN and monocyte oxidative burst are increased in ambulatory cirrhotics without acute decompensation. In turn, these changes are associated to sepsis and ACLF occurrence.


Liver cirrhosis Bacterial infection Polymorphonuclear leucocytes Monocytes Outcome 



Acute-on-chronic liver failure


Alcoholic liver disease


Alcohol use disorders identification test


Area under the ROC curve


Confidence interval


Hazard ratio


Median fluorescence intensity




Polymorphonuclear leukocytes


Receiver operating characteristics


Reactive oxygen species


Tumor necrosis alpha


Financial support

This study was supported by a grant from the Region Skåne (Government), the Swedish Society of Medicine, and the Royal Physiographic Society in Lund, Sweden. The work was independent of these grants.

Compliance with ethical standards

Conflict of interest


Supplementary material

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Konstantina Sargenti
    • 1
  • Åsa Johansson
    • 2
    • 3
  • Sara Bertilsson
    • 1
  • Inger Mattsby-Baltzer
    • 4
  • Daniel Klintman
    • 1
  • Evangelos Kalaitzakis
    • 1
    • 5
  1. 1.Department of Gastroenterology, Skåne University HospitalUniversity of LundLundSweden
  2. 2.Department of Haematology, Skåne University HospitalUniversity of LundLundSweden
  3. 3.Clinical Immunology and Transfusion Medicine, University and Regional Laboratories Region SkåneSkåne University HospitalLundSweden
  4. 4.Department of Microbiology, Sahlgrenska University HospitalUniversity of GothenburgGothenburgSweden
  5. 5.Digestive Disease Center, Copenhagen University Hospital/HerlevUniversity of CopenhagenCopenhagenDenmark

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