Plasma Interleukin-10: A Likely Predictive Marker for Hepatitis B VirusRelated Acute-on-Chronic Liver Failure

Background: The pathogenesis of HBV-related acute-on-chronic liver failure (HBV-ACLF) is mainly based on a heightened immune-inflammatory reaction; however, the intimate underlying mechanism remains unclear. Objectives: The aim of the study was to explore potential key immune molecular targets that could serve as early predictive markers for HBV-ACLF. Patients and Methods: Twenty-seven patients with acute exacerbation of chronic hepatitis B (CHB) (defined by: alanine transaminase >= 20 ULN, total bilirubin >= 5 ULN, 40% < prothrombin time activity <= 60%) and without cirrhosis were divided into18 cases which did not progress to HBV-ACLF (defined by: prothrombin time activity <40% and development within four weeks of hepatic encephalopathy and/ or ascites) and nine cases that developed HBV-ACLF. Nine healthy people defined the normal control group (NC). Interleukin-iii (IL-beta), IL-2, IL-4, IL-6, IL-8, IL-i0, IL-12p70,TNF-alpha and IFN-gamma protein levels were assayed by Cytometric Bead Array (CRA) in blood plasma. The ELISA method was applied to confirm IL-10 detection using the CBA method. Results: IL-4, IL42p7o and IFN-gamma were undetectable; IL-1 beta, IL-6, IL-8, IL-10 and TNF-alpha levels were significantly higher than in NC. Moreover, cytokines reached the highest levels in acute exacerbation of CHB, with the exception of IL-2 and IL-8. When comparing the HBV-ACLF patients prior to and at the time of ACLF diagnosis, IL-10 was the only cytokine that exhibited a significant decrease (P = 0.008). IL-10 concentrations were positively correlated to ALT levels (r=0.711, P < 0.001). Conclusions: The assessment of plasma IL-10 levels in chronic hepatitis B acute exacerbation may provide an early predictive marker for progression to HBV-ACLF.