AUTHOR=Triantos Christos , Kalafateli Maria , Assimakopoulos Stelios F. , Karaivazoglou Katerina , Mantaka Aikaterini , Aggeletopoulou Ioanna , Spantidea Panagiota I. , Tsiaoussis Georgios , Rodi Maria , Kranidioti Hariklia , Goukos Dimitrios , Manolakopoulos Spilios , Gogos Charalambos , Samonakis Dimitrios N. , Daikos Georgios L. , Mouzaki Athanasia , Thomopoulos Konstantinos 

TITLE=Endotoxin Translocation and Gut Barrier Dysfunction Are Related to Variceal Bleeding in Patients With Liver Cirrhosis

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.836306

DOI=10.3389/fmed.2022.836306

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>Bacterial infections are associated with the risk of variceal bleeding through complex pathophysiologic pathways.</p></sec><sec><title>Objectives</title><p>The primary objective of the present case-control study was to investigate the role of bacterial translocation and intestinal barrier dysfunction in the pathogenesis of variceal bleeding. A secondary objective was to determine independent predictors of key outcomes in variceal bleeding, including bleeding-related mortality.</p></sec><sec><title>Methods</title><p>Eighty-four (<italic>n</italic> = 84) consecutive patients participated in the study, 41 patients with acute variceal bleeding and 43 patients with stable cirrhosis, and were followed up for 6 weeks. Peripheral blood samples were collected at patient admission and before any therapeutic intervention.</p></sec><sec><title>Results</title><p>Child-Pugh (CP) score (OR: 1.868; <italic>p</italic> = 0.044), IgM anti-endotoxin antibody levels (OR: 0.954; <italic>p</italic> = 0.016) and TGF-β levels (OR: 0.377; <italic>p</italic> = 0.026) were found to be significant predictors of variceal bleeding. Regression analysis revealed that albumin (OR: 0.0311; <italic>p</italic> = 0.023), CRP (OR: 3.234; <italic>p</italic> = 0.034) and FABP2 levels (OR:1.000, <italic>p</italic> = 0.040), CP score (OR: 2.504; <italic>p</italic> = 0.016), CP creatinine score (OR: 2.366; <italic>p</italic> = 0.008), end-stage liver disease model (MELD), Na (OR: 1.283; <italic>p</italic> = 0.033), portal vein thrombosis (OR: 0.075; <italic>p</italic> = 0.008), hepatocellular carcinoma (OR: 0.060; <italic>p</italic> = 0.003) and encephalopathy (OR: 0.179; <italic>p</italic> = 0.045) were significantly associated with 6-week mortality.</p></sec><sec><title>Conclusions</title><p>Bacterial translocation and gut barrier impairment are directly related to the risk of variceal bleeding. Microbiota-modulating interventions and anti-endotoxin agents may be promising strategies to prevent variceal bleeding.</p></sec>