Interrelation of inflammation and oxidative stress in liver cirrhosis

Abstract

Recently, the trend of research has been focused on the role of hematological indicators in assessing the activities of various diseases. The aim of the present study was to determine the usefulness of such hematological indicators for assessment of the relationship between inflammation and oxidative stress in order to provide new predictive tools for a non-invasive investigation of disease outcome for liver cirrhosis patients. A total of 35 subjects with compensated or decompensated liver cirrhosis and 10 age-matched healthy volunteers were included in this study. The patients were divided into two groups: Group 1, patients with toxic metabolic cirrhosis due to ethanol consumption; group 2, patients with liver cirrhosis following hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Using hematological data obtained after the complete counting of peripheral blood cells, the monocyte/lymphocyte (MLR), neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) ratios as well as systemic immune inflammation biomarkers were determined. The erythrocyte sedimentation ratio (ESR), C-reactive protein (CRP), fibrinogen and biochemical parameters related to liver function were also registered. Thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCARB), and total antioxidant capacity (TAC) were also investigated in the peripheral blood samples of healthy subjects and liver cirrhosis patients. The results revealed that NLR, MLR and PLR were significantly increased in group 2. PLR was significantly increased in group 1 compared with that noted in the control group. TBARS and PCARB were increased in patients from group 1 compared to patients from group 2 and the control group. However, no difference in TAC was found between the liver cirrhosis groups and the control. We showed that the pro-inflammatory status of liver cirrhosis patients can be easily appreciated by NLR, MLR but not PLR. However, the increase in these ratios was not significantly associated with a decrease in the antioxidant capacity and an augmentation of oxidative stress markers for the patients diagnosed with cirrhosis included in the two groups of study.

Keywords: inflammation; liver cirrhosis; monocyte/lymphocyte ratio; neutrophil/lymphocyte ratio; oxidative stress; platelet/lymphocyte ratio.

Figure 1

Bar plot (mean ± SEM) of NLR in the liver cirrhosis patients from group 1 and 2 compared with the control group. One-way ANOVA test, ^**P<0.01, ^***P<0.001. NLR, neutrophil/lymphocyte ratio.

Figure 2

ROC diagram of NLR in the liver cirrhosis patients from group 1 and 2 compared with the control group. ROC, receiver operator characteristic analysis; NLR, neutrophil/lymphocyte ratio; AUC, area under the curve; CI, confidence interval.

Figure 3

Bar plot (mean ± SEM) of MLR in the liver cirrhosis patients from group 1 and 2 compared with the control group. One-way ANOVA test, ^**P<0.01. MLR, monocyte/lymphocyte ratio.

Figure 4

ROC diagram of MLR in the liver cirrhosis patients from group 1 and 2 compared with the control group. ROC, receiver operator characteristic analysis; MLR, monocyte/lymphocyte ratio; AUC, area under the curve; CI, confidence interval.

Figure 5

Bar plot (mean ± SEM) of PLR in the liver cirrhosis patients from group 1 and 2 compared with the control group. One-way ANOVA test, ^*P<0.05, ^**P<0.01. PLR, platelet/lymphocyte ratio.

Figure 6

ROC diagram of in the liver cirrhosis patients from group 1 and 2 compared with the control group. ROC, receiver operator characteristic analysis; PLR, platelet/lymphocyte ratio; AUC, area under the curve; CI, confidence interval.

Figure 7

Bar plot (mean ± SEM) of lipid peroxidation level in plasma in the healthy controls vs. liver cirrhosis group 1 and 2. One-way ANOVA with Tukey's multiple comparison test, ^*P<0.05, ^**P<0.01. TBARS, thiobarbituric acid reactive substances.

Figure 8

Bar plot (mean ± SEM) of protein carbonyl levels in the plasma of patients with liver cirrhosis from groups 1 and 2. Mann-Whitney test, ^*P<0.05. PCARB, protein carbonyl content.

Figure 9

Bar plot (mean ± SEM) of plasma total antioxidant capacity in healthy controls vs. liver cirrhosis group 1 and 2. One-way ANOVA with Bonferroni's multiple comparison test, P>0.05; no significant differences were noted.