{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:21:13Z","timestamp":1770751273220,"version":"3.50.0"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,11,28]],"date-time":"2016-11-28T00:00:00Z","timestamp":1480291200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000589","name":"Chief Scientist Office","doi-asserted-by":"publisher","award":["CSO ETM\/191"],"award-info":[{"award-number":["CSO ETM\/191"]}],"id":[{"id":"10.13039\/501100000589","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Acute liver failure (<jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content>) is associated with significant morbidity and mortality. Studies have implicated the immune response, especially monocyte\/macrophages as being important in dictating outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate changes in the circulating monocytes and other immune cells serially in patients with <jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content>, relate these with cytokine concentrations, monocyte gene expression and patient outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a prospective case\u2013control study in the Scottish Liver Transplant Unit, Royal Infirmary Edinburgh, 35 consecutive patients admitted with paracetamol\u2010induced liver failure (<jats:styled-content style=\"fixed-case\">POD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content>), 10 patients with non\u2010paracetamol causes of <jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content> and 16 controls were recruited. The peripheral blood monocyte phenotype was analysed by flow cytometry, circulating cytokines quantified by protein array and monocyte gene expression array performed and related to outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>On admission, patients with worst outcomes after <jats:styled-content style=\"fixed-case\">POD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content> had a significant monocytopenia, characterised by reduced classical and expanded intermediate monocyte population. This was associated with reduced circulating lymphocytes and natural killer cells, peripheral cytokine patterns suggestive of a \u2018cytokine storm\u2019 and increased concentrations of cytokines associated with monocyte egress from the bone marrow. Gene expression array did not differentiate patient outcome. At day 4, there was no significant difference in monocyte, lymphocyte or natural killer cells between survivors and the patients with adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Severe paracetamol liver failure is associated with profound changes in the peripheral blood compartment, particularly in monocytes, related with worse outcomes. This is not seen in patients with non\u2010paracetamol\u2010induced liver failure. Significant monocytopenia on admission may allow earlier clarification of prognosis, and it highlights a potential target for therapeutic intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13878","type":"journal-article","created":{"date-parts":[[2016,11,29]],"date-time":"2016-11-29T02:06:41Z","timestamp":1480385201000},"page":"443-454","source":"Crossref","is-referenced-by-count":28,"title":["Patients with the worst outcomes after paracetamol (acetaminophen)\u2010induced liver failure have an early monocytopenia"],"prefix":"10.1111","volume":"45","author":[{"given":"J. K.","family":"Moore","sequence":"first","affiliation":[{"name":"MRC Centre for Regenerative Medicine University of Edinburgh Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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