Malnutrition is an independent predictor of immune dysfunction in cirrhotic patients.

Background and Aim: Cirrhosis-associated immune dysfunction (CAID) contributes to the high morbidity and mortality from infections in individuals with cirrhosis. CAID has deficiency not only in quantity of immune cells but also in quality, which cannot simply be explained by portal hypertension and splenic sequestration. Malnutrition is highly prevalent in those with cirrhosis and may be partly responsible for this immune dysfunction. QuantiFERON-monitor (QFM; Qiagen, USA) is a novel immune function assay that measures IFN-gamma production following dual stimulation of both the innate and adaptive immune systems. We aimed to identify whether immune dysfunction in cirrhosis is associated with malnutrition. Method(s): We prospectively measured QFM in 81 cirrhotic patients awaiting liver transplantation at our center as part of the first clinical trials assessing QFM before and after transplantation. Low QFM is suggestive of immunosuppression. Nutritional assessment and measures of muscle function were conducted at the time of QFM measurement to determine the degree of malnutrition and sarcopenia in cirrhotic patients. Nutritional status, as determined by subjective global assessment (SGA), classified patients as "A" (well nourished), "B" (moderately malnourished), or "C" (severely malnourished). Handgrip strength was used as a measure of functional muscle strength and was assessed in kilograms. Groups were compared using the Kruskal-Wallis test and multivariate linear regression with backward regression. Result(s): Of the 81 patients, 57 (70%) were male, and patients had a median age of 54 years. The most common etiology was hepatitis C virus (n = 35), and 29 had hepatocellular carcinoma. Median MELD score was 20, and Child-Pugh score was 10. Fifty-five patients (68%) were malnourished (SGA B + C). The median QFM decreased as malnutrition increased: 211 IU/mL in SGA A (n = 26, 32.1%), 137 IU/mL in SGA B (n = 41, 50.6%), and 26.6 IU/mL in SGA C (n = 14, 17.3%). On univ