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=Volume 9 - 2022

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=Background: Bacterial infections are associated with the risk of variceal bleeding through complex pathophysiologic pathways. 
Objectives: 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. 
Methods: Eighty-four (n=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. 
Results: Child-Pugh (CP) score (OR: 1.868; p=0.044), IgM anti-endotoxin antibody levels (OR: 0.954; p=0.016) and TGF-β levels (OR: 0.377; p=0.026) were found to be significant predictors of variceal bleeding. Regression analysis revealed that albumin (OR: 0.0311; p=0.023), CRP (OR: 3.234; p=0.034) and FABP2 levels (OR:1.000, p=0.040), CP score (OR: 2.504; p=0.016), CP creatinine score (OR: 2.366; p=0.008), end-stage liver disease model (MELD), Na (OR: 1.283; p=0.033), portal vein thrombosis (OR: 0.075; p=0.008), hepatocellular carcinoma (OR: 0.060; p=0.003) and encephalopathy (OR: 0.179; p=0.045) were significantly associated with 6-week mortality. 
Conclusions: 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.