{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:55:57Z","timestamp":1791482157061,"version":"4.3.4"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background and objectives<\/jats:title>\n Interleukin-6 is a proximal inflammatory cytokine implicated in cirrhosis decompensation, yet its incremental prognostic value over established severity scores remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this prospective, purely observational study (April 2022 to October 2023), 489 consecutive patients hospitalized with cirrhosis at a tertiary hepatology center were enrolled, and serum interleukin-6 was measured at admission.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Median interleukin-6 was 23.8 pg\/mL, in-hospital mortality was 9.0%, and overall mortality was 70.6%. Interleukin-6 independently predicted in-hospital mortality after adjustment for age, sex, and disease severity (adjusted odds ratio 1.34, 95% confidence interval 1.08\u20131.67), supported by Bayesian analysis (posterior probability 99.6%). Adding interleukin-6 to conventional severity scores modestly but significantly improved discrimination for in-hospital mortality, with the combined organ failure score plus interleukin-6 model achieving the highest area under the curve (0.802). The prognostic impact of interleukin-6 was substantially stronger in alcohol-associated liver disease compared with metabolic dysfunction-associated steatotic liver disease. Infection mediated 17.3% of the interleukin-6\u2013mortality association. In sub-cohort analyses, the etiology-specific effect persisted after adjustment for infection and after exclusion of severe alcohol-associated hepatitis; infection mediated 23% of the interleukin-6\u2013mortality association in alcohol-associated liver disease but 2% in metabolic dysfunction-associated steatotic liver disease, and the incremental value of interleukin-6 over MELD-3.0 was confined to alcohol-associated disease and to infected patients. MELD-3.0 remained the dominant prognostic determinant, and interleukin-6's independent prognostic signal attenuated for longer-term outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Admission interleukin-6 did not outperform established severity scores but provided modest, statistically significant incremental discrimination that was confined to the in-hospital window and concentrated in alcohol-associated disease. These findings do not support routine interleukin-6 measurement in unselected admissions but identify alcohol-associated cirrhosis, particularly with infection or intermediate MELD-3.0 scores, as the setting in which interleukin-6-informed risk stratification merits prospective validation and economic evaluation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0360005","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:27:57Z","timestamp":1791480477000},"page":"e0360005","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Admission interleukin-6 as a time-limited, etiology-dependent prognostic signal in hospitalized cirrhosis \u2013 A frequentist and Bayesian cohort study"],"prefix":"10.1371","volume":"21","author":[{"given":"Tharun Tom","family":"Oommen","sequence":"first","affiliation":[{"name":"The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital","place":["Kochi, Kerala, India"],"department":["Department of Clinical and Translational Hepatology"]},{"name":"Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital","place":["Kochi, Kerala, India"],"department":["Department of Gastroenterology and Advanced GI Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9587-336X","authenticated-orcid":true,"given":"Cyriac Abby","family":"Philips","sequence":"additional","affiliation":[{"name":"The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital","place":["Kochi, Kerala, India"],"department":["Department of Clinical and Translational Hepatology"]},{"name":"The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital","place":["Kochi, Kerala, India"],"department":["Clinical Research Division"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arif Hussain","family":"Theruvath","sequence":"additional","affiliation":[{"name":"The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital","place":["Kochi, Kerala, India"],"department":["Clinical Research Division"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5203-7956","authenticated-orcid":true,"given":"Resmi","family":"Ravindran","sequence":"additional","affiliation":[{"name":"The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital","place":["Kochi, Kerala, India"],"department":["Clinical Research Division"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aryalakshmi","family":"Sreemohan","sequence":"additional","affiliation":[{"name":"The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital","place":["Kochi, Kerala, India"],"department":["Clinical Research 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