PD-L1 and the risk of bacterial infection in patients with chronic liver diseases. An international multicohort study.
JHEP Reports, 2025
Juanola A., Mezzano G., Pose E., Moreta M., Incicco S., Gagliardi R., Johansen S., Torp N., Israelsen M., Jiménez-Esquivel N., Castillo-Iturra J., Ribera J., Gratacós-Ginès J., Soria A., Cárdenas A., Pérez-Guasch M., Cervera M., Nadal R., Herms Q., Tonon M., Hansen T., Stankevic E., Huang Y., Vargas V., Zaccherini G., Alessandria C., Uschner F., Beuers U., Francoz C., Mookerjee R., Laleman W., Solé C., Bañares R., Cuyàs B., Ariza X., Coll M., Graupera I., Fabrellas N., Morales-Ruiz M., Thiele M., Krag A., Angeli P., Piano S., Solà E., Ginès P.
| Disease area | Application area | Sample type | Products |
|---|---|---|---|
Infectious Diseases Hepatology | Patient Stratification | Plasma |  Olink Target 96 |
Abstract
Background & Aims
Impaired phagocytic capacity due to PD-1/PD-L1 pathway activation has been proposed to be associated with the development of bacterial infections in patients with liver cirrhosis. Soluble PD-L1 (sPD-L1) is easily measurable in plasma and has been proposed as a biomarker of sepsis. The current study aims to evaluate the role of sPD-L1 as biomarker of bacterial infection development in patients with cirrhosis.
Methods
Plasma samples from 995 patients with chronic liver disease grouped in 3 cohorts were analyzed. An initial cohort of 268 hospitalized patients with acute decompensated cirrhosis, 327 out-patients with non-acute decompensated cirrhosis and finally 400 subjects with high-risk alcohol consumption including all stages of liver fibrosis, from mild/no fibrosis to cirrhosis (F0-F4). Main outcomes of the study were development of bacterial infection and mortality.
Results
Patients who developed bacterial infections had higher levels of sPD-L1 than those who did not [160 (116-221) vs 136 (97-193) pg/mL, respectively, p-value<0.001; HR 1.034 (1.014-1.055)]. Levels of sPD-L1 were associated with bacterial infection development after adjustment for confounding factors. During follow-up, patients who died had higher sPD-L1 levels than survivors, after adjustment for MELD Na [180 (143-267) vs 134 (97-187) pg/mL, respectively; p-value<0.001 [HR 1.066 (1.043-1.089)]. These findings were observed in all cohorts.ConclusionsPlasma levels of sPD-L1 are associated with the risk of bacterial infection development irrespective of the stage of chronic liver disease. Besides, patients with high levels of sPD-L1 have increased mortality. Measurement of sPD-L1 levels may help identify patients at high risk of developing bacterial infections and may be useful for implementation of new preventive strategies.