Neutrophil activation in chronic liver disease

Objective To assess the relationship between neutrophil activation and indices of disease severity in patients with chronic liver disease. Methods: Plasma neutrophil elastase was measured by radioimmunoassay as a marker of neutrophil activation, and disease severity assessed by standard clinical, biochemical, haematological and histological techniques. Patients: Eighty-eight patients with chronic liver disease were studied. Thirty-nine had alcohol-induced liver disease (ALD), 18 autoimmune chronic hepatitis, 13 cryptogenic cirrhosis, seven primary biliary cirrhosis, six primary sclerosing cholangitis, three haemochromatosis and two secondary biliary cirrhosis. Seventy three patients were cirrhotic and 15 were non-cirrhotic, confirmed by biopsy. Results: Levels of neutrophil elastase were raised in Childs C cirrhotic patients with ALD compared with Childs A or B patients with ALD (P<0.01), Childs A or B patients with non-ALD (P<0.01), and Childs C patients with non-ALD (P=0.02). In patients with ALD, neutrophil elastase correlated with prothrombin time (r = 0.679, P=0.001), bilirubin (r = 0.587, P<0.001), Child-Pugh score (r = 0.546, P< 0.001) and inversely with serum albumin (r = -0.511, P<0.001). In patients with non-ALD, there were no correlations with these measurements or with transaminase levels. Conclusion: Neutrophil activation, as measured by plasma neutrophil elastase, is a marker of disease severity in patients with alcohol-induced chronic liver damage, but not in those with other causes of liver disease.