Serum interleukin-6 level predicts the prognosis for patients with alcohol-related acute-on-chronic liver failure

Hepatol Int. 2023 Oct;17(5):1225-1232. doi: 10.1007/s12072-023-10532-x. Epub 2023 Apr 26.


Aim: Heavy alcohol consumption is the most common etiology of acute-on-chronic liver failure (ACLF) in Japan. In some patients, ACLF is associated with a fatal outcome in less than 6 months. We evaluated the prognosis of patients with alcohol-related ACLF in our cohort and explored the prognostic factors.

Methods: Forty-six patients with alcoholic liver cirrhosis who fulfilled the Japanese diagnostic criteria for ACLF, including those classified as extended and/or probable, were enrolled in this study. Serum concentrations of inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, IL-12p70 and TNFα) were measured. We assessed prognosis and identified factors associated with survival.

Results: During the median 33-day observation period, 19 patients died, and 3 patients underwent living donor liver transplantation. Cumulative survival rates of patients treated without liver transplantation were 69, 48, 41, and 36% at 1, 3, 6, and 12 months, respectively. Eighteen of the 19 deceased patients died within 6 months after ACLF diagnosis. Serum concentrations of inflammatory cytokines were significantly elevated, and patients who underwent liver transplantation or who died within 6 months after admission had significantly higher serum IL-6 levels than the survival group. Multivariate analysis identified IL-6 > 23.3 pg/mL at admission and model for end-stage liver disease (MELD) score ≥ 25 on day 4 of admission as significant independent factors for mortality within 6 months.

Conclusion: Serum IL-6 level and Day-4 MELD were prognostic factors for alcohol-related ACLF. Early liver transplantation is a potential treatment option for patients whose prognosis is expected to be poor.

Keywords: Alcohol disorder; Alcohol liver disease; Human cytokine; IL-10; IL-1β; IL-8; Liver failure; Liver transplantation; MELD; Severe hepatitis; TNF-α.

MeSH terms

  • Acute-On-Chronic Liver Failure*
  • Cytokines
  • End Stage Liver Disease* / complications
  • Ethanol
  • Humans
  • Interleukin-6
  • Liver Transplantation* / adverse effects
  • Living Donors
  • Prognosis
  • Severity of Illness Index


  • Interleukin-6
  • Ethanol
  • Cytokines