Circulating levels of pentraxin-3 (PTX3) in patients with liver cirrhosis

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BTC: basal total cortisol. Sen: sensitivity. Spe: Specificity. PPV: positive predictive value. NPV: negative predictive value. CP: Child-Pugh. MELD: Model for End-stage Liver Disease. PTC: peak total cortisol. AI: adrenal insufficiency. NAF: normal adrenal function." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jonathan Paz-Delgadillo, Roberto Monreal-Robles, Jesús Z. Villarreal-Pérez, Fernando J. Lavalle-González, Héctor J. Maldonado-Garza, Francisco J. Bosques-Padilla" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jonathan" "apellidos" => "Paz-Delgadillo" ] 1 => array:2 [ "nombre" => "Roberto" "apellidos" => "Monreal-Robles" ] 2 => array:2 [ "nombre" => "Jesús Z." "apellidos" => "Villarreal-Pérez" ] 3 => array:2 [ "nombre" => "Fernando J." "apellidos" => "Lavalle-González" ] 4 => array:2 [ "nombre" => "Héctor J." "apellidos" => "Maldonado-Garza" ] 5 => array:2 [ "nombre" => "Francisco J." 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AIH: autoimmune hepatitis. n: amount of patients." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Roberto Candia, Blanca Norero, Carlos Agüero, Luis Díaz, Juan Pablo Ortega, Rodrigo Wolff, Cristian Hernández-Rocha, Ignacio Duarte, Alejandro Soza, Carlos Benítez, Marco Arrese" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Roberto" "apellidos" => "Candia" ] 1 => array:2 [ "nombre" => "Blanca" "apellidos" => "Norero" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Agüero" ] 3 => array:2 [ "nombre" => "Luis" "apellidos" => "Díaz" ] 4 => array:2 [ "nombre" => "Juan Pablo" "apellidos" => "Ortega" ] 5 => array:2 [ "nombre" => "Rodrigo" "apellidos" => "Wolff" ] 6 => array:2 [ "nombre" => "Cristian" "apellidos" => "Hernández-Rocha" ] 7 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Duarte" ] 8 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Soza" ] 9 => array:2 [ "nombre" => "Carlos" "apellidos" => "Benítez" ] 10 => array:2 [ "nombre" => "Marco" "apellidos" => "Arrese" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304375?idApp=UINPBA00004N" "url" => "/16652681/0000001600000005/v1_201905301208/S1665268119304375/v1_201905301208/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "titulo" => "Circulating levels of pentraxin-3 (PTX3) in patients with liver cirrhosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "780" "paginaFinal" => "787" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jéssica G. Pereira, Telma Erotides Silva, Emília T.O. Bansho, Edelton F. Morato, José T. Pinheiro, Letícia Muraro-Wildner, Maria Luiza Bazzo, Esther Buzaglo Dantas-Corrêa, Leonardo L. Schiavon, Janaína L. Narciso-Schiavon" "autores" => array:10 [ 0 => array:3 [ "nombre" => "Jéssica G." "apellidos" => "Pereira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff1" ] ] ] 1 => array:3 [ "nombre" => "Telma" "apellidos" => "Erotides Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "†" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Emília T.O." "apellidos" => "Bansho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Edelton F." "apellidos" => "Morato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "‡" "identificador" => "aff3" ] ] ] 4 => array:3 [ "nombre" => "José T." 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"apellidos" => "Narciso-Schiavon" "email" => array:1 [ 0 => "janaina.narciso@uol.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Núcleo de Estudos em Gastroenterologia e Hepatologia, Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil" "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Postgraduate Program in Medical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina,Brazil" "etiqueta" => "†" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Center for Assessment of Allergic Type Reactions to Drugs, University Hospital Polydoro Ernani de São Thiago - Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil" "etiqueta" => "‡" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Clinical Analysis Laboratory, University Hospital Polydoro Ernani de São Thiago - Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil" "etiqueta" => "§" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 669 "Ancho" => 957 "Tamanyo" => 38406 ] ] "descripcion" => array:1 [ "en" => "Pentraxin 3 levels according to patient group." ] ] ] "textoCompleto" => "IntroductionLiver cirrhosis is the most advanced stage of chronic liver disease. It is characterized histologically by the presence of regenerative nodules. Its prevalence is estimated at 0.27% in the United States,<a class="elsevierStyleCrossRef" href="#bib0010">1</a> and it is associated with multiple etiologies, most commonly ethanol consumption, chronic viral hepatitis B and C and diabetes mellitus.<a class="elsevierStyleCrossRefs" href="#bib0010">1,2</a> In-hospital mortality for disease decompensation is 9.1% in South Korea<a class="elsevierStyleCrossRef" href="#bib0020">3</a> and is 25.0% after 30 days of admission in Brazil.<a class="elsevierStyleCrossRef" href="#bib0025">4</a> Identifying patients with worse prognosis would facilitate early management of potentially severe cases. Several prognostic markers have been studied to identify mortality associated with decompensated cirrhosis, including the Model for End-Stage Liver Disease (MELD) score and its derivatives, Acute-on-Chronic Liver Failure (ACLF) score, Interleukins 2, 6 and 8 (IL-2, IL-6 and IL-8, respectively), C-reactive protein (CRP) and even total leukocyte count.Pentraxins are proteins formed by 5 monomers that form a ring in radial symmetry. They are a class of pattern recognition receptors. Among pentraxins, the main ones are pentraxin-3, CRP and serum amyloid P component. PTX3 is a long-chain pentraxin considered an acute phase marker produced mainly by endothelial and vascular smooth muscle cells at the site of inflammation. It is also produced by macrophages, fibroblasts, neutrophils, epithelial cells, dendritic cells and other cell types both near and far from the inflammation site,<a class="elsevierStyleCrossRefs" href="#bib0030">5,6</a> Pentraxin production is influenced by certain inflammatory stimuli such as interleukin 1 beta (IL-1β) and tumor necrosis factor alfa (TNF-α).<a class="elsevierStyleCrossRef" href="#bib0040">7</a> It differs considerably from CRP in terms of expression patterns by affected organs. In particular, this is a short pentraxin mainly produced in the liver in response to IL-6.<a class="elsevierStyleCrossRef" href="#bib0045">8</a>PTX3 has been recognized as an independent marker of inflammation associated with various disorders<a class="elsevierStyleCrossRefs" href="#bib0045">8,9</a> such as atherosclerosis, cancer, respiratory diseases and central nervous system diseases in which increased levels are related to the risk of the disease or its progression.<a class="elsevierStyleCrossRef" href="#bib0055">10</a> However, according to our knowledge there are no studies that analyze its role in liver cirrhosis.The aim of this study is to describe PTX3 levels in ambulatory patients and hospitalized patients with liver cirrhosis and their association with disease prognosis.Material and MethodsSampleThis is a prospective cohort study with consecutive inclusion of patients with liver cirrhosis treated at the hepa-tology ambulatory department and admitted to the emergency service of a tertiary hospital in southern Brazil between January 2011 and January 2014 because of disease decompensation. Patients were excluded from the study because of insufficient clinical and laboratory data in the medical records, hepatocellular carcinoma that did not meet Milan criteria and refusal to participate in the study.During routine outpatient or emergency admission, subjects were asked to participate and sign the free and informed consent form. A family member or guardian would authorize data collection if the patient had encepha-lopathy grades III or IV. Clinical and laboratory variables were collected from interviews and from the medical records. The following clinical variables were studied: age, sex, skin color, etiology of cirrhosis and presence of ascites. Laboratory variables collected on admission included serum creatinine, MELD, Child-Pugh and Chronic Liver Failure - Sequential Organ Failure Assessment (CLIF-SOFA) scores, total leukocyte count, serum sodium, platelet count, international normalized ratio (INR), albumin, CRP and total bilirubin.The diagnosis of cirrhosis was established either histo-logically when liver biopsy was available or by a combination of clinical, imaging and laboratory data in patients with evidence of portal hypertension.PTX3 assays were performed by Enzyme-Linked Im-munosorbent Assay with serum samples collected on admission or at an outpatient visit and stored in a freezer at -80 °C (ELISA; R&D Systems - Minneapolis, MN).MethodsPatients were followed during hospitalization and 90-day mortality was assessed by telephone in case of discharge. The 90-day mortality rates did not include patients who underwent liver transplantation (because they were excluded from the study).Individuals with suspected bacterial infection at admission underwent clinical examination to confirm the diagnosis and establish the primary source of infection. The diagnosis of infection was performed according to the criteria of the Center for Disease Control.<a class="elsevierStyleCrossRef" href="#bib0060">11</a> Diagnostic paracentesis was performed for all patients with ascites present at admission. Hepatic encephalopathy was graded according to the criteria of West-Haven.<a class="elsevierStyleCrossRef" href="#bib0065">12</a> If present, the precipitating factor was investigated and lactulose was administered with dose adjustment as needed.The severity of liver disease was estimated by Child-Pugh<a class="elsevierStyleCrossRef" href="#bib0070">13</a> and MELD scores<a class="elsevierStyleCrossRef" href="#bib0075">14</a> calculated based on laboratory tests performed on admission. ACLF and CLIF-SOFA were defined as proposed by the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF).<a class="elsevierStyleCrossRef" href="#bib0080">15</a>Statistical analysisNumerical variables with normal distribution were expressed as the mean and standard deviation (SD) and were compared using Student's t test. Numerical variables with non-normal distribution were expressed as medians and compared using the Mann-Whitney test. The normality of variable distribution was determined by the Kolmorogov-Smirnov test. Qualitative variables were represented by frequency (%) and chi-square test or Fisher's exact test were used when needed for analysis. Bivariate analyses were performed to compare cirrhotic individuals from outpatient visits with hospitalized patients. Bivariate analysis was performed to compare the mean levels of PTX3 in terms of the presence of cirrhosis complications at time of admission. Spearman correlation analysis was performed to compare the values of serum PTX3 to the laboratory variables and prognostic markers MELD, Child-Pugh and CLIF-SOFA. A cutoff point for the PTX3 was determined by Receiver Operating Characteristic (ROC) curve. Survival probability was calculated using Kaplan-Meier method and differences in survival between groups were compared using the log-rank test.All tests were performed using the Statistical Package for the Social Sciences, version 22.0 (IBM SPSS statistics, Chicago, Illinois, USA). P values lower than 0.05 were considered statistically significant.The study protocol was in accordance with the ethical principles of the Declaration of Helsinki and was approved by the local research ethics committee under the number 252709.RESULTSCasuistry analysisBetween January 2011 and January 2014, studied patients included 32 healthy controls, 29 subjects with liver cirrhosis treated at the hepatology ambulatory department and 130 cirrhotic patients admitted to the hospital for disease decompensation. <a class="elsevierStyleCrossRef" href="#t0010">Table 1</a> shows the demographic and epi-demiological characteristics of patients included in the study. The mean age of the controls was 41.8 ± 15.4 years and 78.0% were male. Individuals with cirrhosis had a mean age of 54.1 ± 11.7 years, 73.8% were male, 35.6% were Child-Pugh class C and the mean MELD score was 15.0 ± 6.2. Only seven patients underwent needle biopsy of the liver to diagnose cirrhosis. The etiology of cirrhosis was related to alcohol in 35.0%, alcohol and hepatitis C virus (HCV) in 22.5% and HCV only in 16.9%.<elsevierMultimedia ident="t0010"></elsevierMultimedia>Comparative analysis of outpatient and hospitalized patients with liver cirrhosisOutpatients and hospitalized patients with liver cirrhosis had similar clinical characteristics except for skin color, in which there was a higher proportion of individuals with white skin color among outpatients (50.0% vs. 71.3%; p = 0.025). These characteristics are shown in <a class="elsevierStyleCrossRef" href="#t0010">table 1</a>. When comparing PTX3 levels between groups, it was observed that the cirrhotic outpatients had higher means compared to healthy controls (2.6 vs. 1.1 ng/mL; p < 0.001). Hospitalized cirrhotic patients had higher means compared both to healthy controls (3.8 vs. 1.1 ng/mL; p < 0.001) and to cirrhotic outpatients (3.8 vs. 2.6 ng/mL; p < 0.001) as can be seen in <a class="elsevierStyleCrossRef" href="#f0010">figure 1</a>.<elsevierMultimedia ident="f0010"></elsevierMultimedia>Correlation analysis of PTX3 with variables of interestThere was a positive correlation between serum levels of PTX3 and creatinine (r = 0.220; p = 0.012), MELD (r = 0.279; p = 0.001), Child-Pugh score (r = 0.224; p = 0.010) and CLIF-SOFA score (r = 0.225; p = 0.010). There was no correlation between PTX3 levels and total leukocyte count, serum sodium, platelet count, INR, albumin, CRP and total bilirubin.Comparative analysis of serum PTX3 levels according to complications on admissionWhen comparing PTX3 levels in terms of the presence or absence of ACLF (<a class="elsevierStyleCrossRef" href="#f0015">Figure 2</a>), it was observed that patients with ACLF showed higher PTX3 medians than those without ACLF (8.0 vs. 3.1 ng/mL; p < 0.001). When comparing PTX3 levels according to MELD score (<a class="elsevierStyleCrossRef" href="#f0020">Figure 3</a>), it was observed that patients with MELD higher than 20 had higher median PTX3 levels compared to others (6.7 vs. 3.4 ng/mL; p = 0.002).<elsevierMultimedia ident="f0015"></elsevierMultimedia><elsevierMultimedia ident="f0020"></elsevierMultimedia>When comparing PTX3 levels according to Child classification, it was observed that individuals in Child class C had similar levels of PTX3 to the others (3.9 vs. 3.6 ng/mL; p = 0.559). When comparing PTX3 levels in terms of the presence of complications of cirrhosis, similar levels of PTX3 were observed in subjects presenting decompensation in infection (4.5 vs. 3.5 ng/mL; p = 0.197), ascites (4.0 vs. 3.6 ng/mL; p = 0.384) and grades III or IV encephalopa-thy (4.2 vs. 3.0 ng/mL; p = 0.247).It was observed that the number of organ failures was associated with higher mean serum levels of PTX3 (<a class="elsevierStyleCrossRef" href="#f0025">Figure 4</a>) as follows: none = 3.2 ng/mL; one = 4.7 ng/mL; two or more failures = 8.0 ng/mL (p = 0.006).<elsevierMultimedia ident="f0025"></elsevierMultimedia>Survival analysis according to serum levels of PTX3Forty patients died within 90 days (30.8%). It was observed that patients who died within 90 days had higher serum levels of PTX3 on admission compared to those who survived (5.3 vs. 3.4 ng/mL; p = 0.009). <a class="elsevierStyleCrossRef" href="#f0030">Figure 5</a> shows the Kaplan-Meier curves associated with serum PTX3 levels. The probability of survival of patients with serum levels of PTX3 higher than or equal to 5.4 ng/mL was 54.0%, while those with serum levels lower than 5.4 ng/mL showed a 90-day survival rate of higher than 77.0% (p = 0.002).<elsevierMultimedia ident="f0030"></elsevierMultimedia>DiscussionThis study has identified unprecedentedly higher PTX3 levels in cirrhotic outpatients compared to healthy controls as well as higher levels in cirrhotic patients hospitalized for disease decompensation compared to cirrhotic outpatients. The higher PTX3 levels in patients with acute decompensation in comparison to cirrhotic outpatients and healthy controls is consistent with the results of studies that showed elevated PTX3 levels in diseases with an inflammatory component that affect other organs such as acute myocardial infarction,<a class="elsevierStyleCrossRef" href="#bib0085">16</a> chronic kidney disease,<a class="elsevierStyleCrossRef" href="#bib0090">17</a> acute respiratory distress syndrome (ARDS)<a class="elsevierStyleCrossRef" href="#bib0095">18</a> and severe infectious diseases affecting patients in intensive care.<a class="elsevierStyleCrossRef" href="#bib0100">19</a> Serum levels are positively correlated with disease severity.This finding is corroborated by the positive correlation between serum PTX3 levels and the scores associated with severity of liver cirrhosis (MELD, Child-Pugh and CLIF-SOFA). In patients in intensive care with systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock, there was also a positive correlation between serum PTX3 levels and the clinical severity scores APACHE II (Acute Physiology and Chronic Health Evaluation) and SAPS II (Simplified Acute Physiology Score).<a class="elsevierStyleCrossRef" href="#bib0100">19</a> PTX3 expression was evaluated serially in studies in patients with ARDS<a class="elsevierStyleCrossRef" href="#bib0095">18</a> and in patients with SIRS, sepsis, severe sepsis and septic shock.<a class="elsevierStyleCrossRef" href="#bib0100">19</a> In both studies it was observed that PTX3 was the first plasma protein to rise, with a peak at approximately 7.5 h in patients with SIRS or infections in the clinical spectrum of sepsis. Levels declined in patients with ARDS after 24 h of intu-bation.<a class="elsevierStyleCrossRef" href="#bib0095">18</a> CRP, a commonly used inflammation marker, had a later serum peak at approximately 24 h19 and remained elevated longer.<a class="elsevierStyleCrossRef" href="#bib0095">18</a> Mauri, et al. performed a preliminary retrospective study if patients with ARDS that also showed a positive correlation between PTX3 levels and the number of organ failures,<a class="elsevierStyleCrossRef" href="#bib0105">20</a> consistent with the results of this study.In this study a positive correlation was also observed between serum PTX3 levels and 90-day mortality, consistent with the results of other groups that evaluated mortality in patients with chronic kidney disease, acute myocardial infarction and ARDS. In these studies, PTX3 proved to be an important and early predictor of mortali-ty.<a class="elsevierStyleCrossRefs" href="#bib0090">17,18</a> In patients with SIRS, sepsis, severe sepsis or septic shock, both PTX3 and IL-6 showed significant positive correlations with mortality.<a class="elsevierStyleCrossRef" href="#bib0100">19</a> IL-6 was not assessed in this study. However, our group showed that IL-6 levels were positively associated with 90-day mortality (OR 1.002; 95% CI 1.000 - 1.004; p = 0.029).<a class="elsevierStyleCrossRef" href="#bib0110">21</a>Many studies have compared the efficacy of PTX3 to CRP as a predictor of severity and mortality, given the widespread use of CRP for this purpose. The results as mentioned above show positive correlation when serum levels are compared without time reference. However, no correlation was apparent when considering the time to peak of each of these markers. In liver cirrhosis, however, CRP production is affected because it is synthesized almost entirely in the liver. This may compromise its utility as an inflammation biomarker in these patients.<a class="elsevierStyleCrossRefs" href="#bib0115">22,23</a> This might explain the absence of correlation between CRP and PTX3 in this study. However, Bota, et al. have not found statistically significant differences in CRP levels between intensive care patients with or without liver cirrhosis.<a class="elsevierStyleCrossRef" href="#bib0125">24</a> Lazzarotto, et al. demonstrated that CRP levels are sensitive for diagnosis of infection and as predictors of 90-day mortality in patients with cirrhosis.<a class="elsevierStyleCrossRef" href="#bib0130">25</a> Importantly, there is, to a lesser extent, production of CRP in inflamed tis-sues.<a class="elsevierStyleCrossRefs" href="#bib0135">26,27</a> This synthesis may be responsible for incomplete suppression of CRP levels even in patients with severe hepatic impairment.There was also a positive correlation between serum levels of PTX3 and creatinine. Due to its high molecular weight (40.6 KD) and multimeric structure, PTX3 levels appear to increase as the glomerular filtration rate (GFR) decreases secondary to reduced clearance.<a class="elsevierStyleCrossRef" href="#bib0090">17</a> The same phenomenon occurs with creatinine, it is therefore used as a marker of renal function. Numerous pathological conditions that lead to reduced GFR -such as sepsis, which generates numerous shunts in circulation and redistribution of blood volume; major bleeding, by an absolute reduction in blood volume; ascites, by third space volume retention and reduction of effective circulating volume-tend to increase serum creatinine. The complications of cirrhosis involve the above hemodynamic dysfunctions. One could imagine that this would be the reason for the positive correlation between serum levels of PTX3 and creatinine. However, more hemodynamic studies are needed to confirm this hypothesis.Although recently published studies present PTX3 as a marker of severity and/or mortality, little is known about its role in vivo in humans. Garlanda, et al. demonstrated in mice deficient in PTX3 that it has many functions including regulation of innate immunity against various microorganisms, discrimination of self- from non-self molecular patterns and tissue repair.<a class="elsevierStyleCrossRef" href="#bib0140">27</a> Other studies showed that the initial function of PTX3 is protective.<a class="elsevierStyleCrossRef" href="#bib0145">28</a> It participates in the recognition of harmful stimuli, migration of neutrophils to sites of infection and promotion of phagocytosis of bacteria by neutrophils,<a class="elsevierStyleCrossRef" href="#bib0150">29</a> enhancement of nitric oxide production<a class="elsevierStyleCrossRef" href="#bib0155">30</a> and increased expression of tissue factor.<a class="elsevierStyleCrossRef" href="#bib0160">31</a> However, the prolonged persistence of stimuli can lead to overexpression of PTX3 and amplification of these inflammatory pathways,<a class="elsevierStyleCrossRef" href="#bib0145">28</a> with resulting damage to the organism. Thus far, there are no known specific antagonists to the action of PTX3. Therefore, there are no data regarding blocking of this pathway and its repercussions.Finally, the relevance of this study relies on the current difficulty in early determination of the severity of cirrhotic patients. Hemodynamic disturbances hinder the use of SIRS criteria;<a class="elsevierStyleCrossRef" href="#bib0165">32</a> because the hyperdynamic circulatory state leads to tachycardia, beta-blocker use by many of these patients reduces the heart rate and can mask SIRS, hepatic encephalopathy can lead to tachyp-nea and hypersplenism caused by congestion of the portal system can lead to reductions in the number of circulating leukocytes.<a class="elsevierStyleCrossRef" href="#bib0170">33</a> Added to these factors are the immunological changes associated with advanced liver disease, probably related to deficiencies in the complement system, which impair the elimination of op-sonized bacteria and increased bacterial translocation.<a class="elsevierStyleCrossRefs" href="#bib0175">34-36</a> This in turn predisposes patients with liver cirrhosis to infections. Furthermore, cultures of micro-organisms knowingly take at least 24 to 48 h to present results, which hampers their utility for diagnosing infectious complications. Therefore, it is important to find early markers of severity and mortality to guide appropriate treatment.ConclusionsCirculating levels of PTX3 are increased in patients with liver cirrhosis, particularly those with acute decompensation. Serum PTX3 is related to the severity of the disease, the presence of ACLF and 90-day mortality. These results are promising and indicate a potential use for PTX3 as an inflammatory and prognostic biomarker for patients with liver cirrhosis.Author ContributionsSchiavon LL designed the study. Bansho ETO and Silva TE were responsible for data collection. Morato EF, Pinheiro JT, Pereira JG, Wildner LM and Bazzo ML performed the pentraxin-3 sample processing. Schiavon LL, Narciso-Schiavon JL and Pereira JG analyzed the data and are responsible for the article as a whole. Narciso-Schia-von JL and Pereira JG wrote the paper and Dantas-Correa EB and Schiavon LL revised the manuscript.Supportive FoundationsThis study was financed by Conselho Nacional de Desenvolvimento Científico e Técnológico (CNPq).Institutional review board statementThe study was reviewed and approved by the Federal University of Santa Catarina Institutional Review Board under the number 252709.Informed Consent StatementAll study participants or their respective legal guardians provided written informed consent prior to study enrollment.Conflicts of InterestThe authors declare no conflicts of interest.Data Sharing StatementNo additional data are available." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1197558" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abs0010" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abs0015" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abs0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abs0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1116244" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "s0010" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "s0015" "titulo" => "Material and Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "s0020" "titulo" => "Sample" ] 1 => array:2 [ "identificador" => "s0025" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "s0030" "titulo" => "Statistical analysis" ] ] ] 4 => array:3 [ "identificador" => "s0035" "titulo" => "RESULTS" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "s0040" "titulo" => "Casuistry analysis" ] 1 => array:2 [ "identificador" => "s0045" "titulo" => "Comparative analysis of outpatient and hospitalized patients with liver cirrhosis" ] 2 => array:2 [ "identificador" => "s0050" "titulo" => "Correlation analysis of PTX3 with variables of interest" ] 3 => array:2 [ "identificador" => "s0055" "titulo" => "Comparative analysis of serum PTX3 levels according to complications on admission" ] 4 => array:2 [ "identificador" => "s0060" "titulo" => "Survival analysis according to serum levels of PTX3" ] ] ] 5 => array:2 [ "identificador" => "s0065" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "s0070" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "s0075" "titulo" => "Author Contributions" ] 8 => array:3 [ "identificador" => "s0080" "titulo" => "Supportive Foundations" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "s0085" "titulo" => "Institutional review board statement" ] ] ] 9 => array:2 [ "identificador" => "s0090" "titulo" => "Informed Consent Statement" ] 10 => array:2 [ "identificador" => "s0095" "titulo" => "Conflicts of Interest" ] 11 => array:2 [ "identificador" => "s0100" "titulo" => "Data Sharing Statement" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-27" "fechaAceptado" => "2017-03-20" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1116244" "palabras" => array:7 [ 0 => "Liver cirrhosis" 1 => "Inflammation" 2 => "Biomarkers" 3 => "PTX3 protein" 4 => "Prognosis" 5 => "Acute-On-Chronic Liver Failure" 6 => "Mortality" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundDespite the circulating levels of PTX3 were related to the severity of various diseases, there are no studies investigating its role in patients with liver cirrhosis. We aimed to study PTX3 levels in patients with liver cirrhosis. Material and methodsA prospective cohort study included 130 patients hospitalized for acute decompensation of liver cirrhosis, 29 stable cirrhotic outpatients and 32 healthy controls evaluated in a tertiary hospital in Southern Brasil. ResultsThe median PTX3 level was significantly higher in stable cirrhotic patients compared to controls (2.6 vs. 1.1 ng/mL; p < 0.001), hospitalized cirrhotic patients compared to controls (3.8 vs. 1.1 ng/mL; p < 0.001), and hospitalized cirrhotic patients compared to stable cirrhotic patients (3.8 vs. 2.6 ng/ mL; p = 0.001). A positive correlation was found between PTX3 and serum creatinine (r = 0.220; p = 0.012), Chronic Liver Failure -Sequential Organ Failure Assessment score (CLIF-SOFA) (r = 0.220; p = 0.010), MELD (r = 0.279; p = 0.001) and Child-Pugh score (r = 0.224; p = 0.010). Significantly higher levels of PTX3 were observed in patients on admission with ACLF (8.9 vs. 3.1 ng/mL; p < 0.001) and MELD score ≥ 20 (6.6 vs. 3.4 ng/mL; p = 0.002). Death within 90 days occurred in 30.8% of patients and was associated with higher levels of PTX3 (5.3 vs. 3.4 ng/mL; p = 0.009). The probability of Kaplan-Meier survival was 77.0% in patients with PTX-3 < 5.3 ng mL (upper tercile) and 53.5% in those with PTX3 ≥ 5.3 ng/mL (p = 0.002). ConclusionThese results indicate the potential for use of PTX3 as an inflammatory biomarker for the prognosis of patients with hepatic cirrhosis." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abs0010" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abs0015" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abs0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abs0025" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 669 "Ancho" => 957 "Tamanyo" => 38406 ] ] "descripcion" => array:1 [ "en" => "Pentraxin 3 levels according to patient group." ] ] 1 => array:7 [ "identificador" => "f0015" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 675 "Ancho" => 946 "Tamanyo" => 28047 ] ] "descripcion" => array:1 [ "en" => "Pentraxin 3 levels according to the presence or absence of Acute-on-Chronic Liver Failure (ACLF)." ] ] 2 => array:7 [ "identificador" => "f0020" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 713 "Ancho" => 961 "Tamanyo" => 30805 ] ] "descripcion" => array:1 [ "en" => "Pentraxin 3 levels according to Model for End-Stage Liver Disease (MELD) score." ] ] 3 => array:7 [ "identificador" => "f0025" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 725 "Ancho" => 969 "Tamanyo" => 31856 ] ] "descripcion" => array:1 [ "en" => "Pentraxin 3 levels according to the number of organ failures." ] ] 4 => array:7 [ "identificador" => "f0030" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 846 "Ancho" => 2078 "Tamanyo" => 93206 ] ] "descripcion" => array:1 [ "en" => "Ninety days survival according to pentraxin 3 levels" ] ] 5 => array:7 [ "identificador" => "t0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "χ: Chi-square test. f: Fisher's exact test. t: Student's t test." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outpatients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Emergency \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.074 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">White skin color \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.025 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.990 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systemic arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.333 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Human immunodeficiency virus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 f \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.411 t \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.979 t \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous decompensation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.148 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Child-Pugh A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.572 f \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Child-Pugh B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.105 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Child-Pugh C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.256 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Model for End-Stage Liver Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.8 ± 2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.9 ± 6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 t \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etiology = hepatitis B virus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.450 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etiology = hepatitis C virus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.736 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etiology = alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.328 χ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2045118.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and epidemiological characteristics of the sample, according to the origin of the patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Epidemiology of Cirrhosis in the United States: A Population-based Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Scaglione S." 1 => "Kliethermes S." 2 => "Cao G." 3 => "Shoham D." 4 => "Durazo R." 5 => "Luke A." 6 => "Volk M.L." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCG.0000000000000208" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2015" "volumen" => "49" "paginaInicial" => "690" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25291348" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0015" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Yoon Y.H." 1 => "Yi H.Y." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Liver cirrhosis mortality in the United States, 1970-2003: Surveillance Report No. 75" "serieFecha" => "2006" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0020" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications requiring hospital admission and causes of in-hospital death over time in alcoholic and nonalcoholic cirrhosis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Kim H.Y." 1 => "Kim C.W." 2 => "Choi J.Y." 3 => "Lee C.D." 4 => "Lee S.H." 5 => "Kim M.Y." 6 => "Jang B.K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5009/gnl14363" "Revista" => array:6 [ "tituloSerie" => "Gut Liver" "fecha" => "2016" "volumen" => "10" "paginaInicial" => "95" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26087788" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0025" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-centre validation of the EASL-CLIF consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Silva P.E." 1 => "Fayad L." 2 => "Lazzarotto C." 3 => "Ronsoni M.F." 4 => "Bazzo M.L." 5 => "Colombo B.S." 6 => "Dantas-Correa E.B." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.12597" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2015" "volumen" => "35" "paginaInicial" => "1516" "paginaFinal" => "1523" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24840673" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0030" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pentraxin 3 (PTX3) Expression in Allergic Asthmatic Airways: Role in Airway Smooth Muscle Migration and Chemokine Production. Rojas M (Ed.)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Zhang J." 1 => "Shan L." 2 => "Koussih L." 3 => "Redhu N.S." 4 => "Halayko A.J." 5 => "Chakir J." 6 => "Gounni A.S." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0034965" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "e34965" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22529962" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0035" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long pentraxin 3 (PTX3) in the light of its structure, mechanism of action and clinical implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Cieslik P." 1 => "Hrycek A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Au-toimmunity" "fecha" => "2012" "volumen" => "45" "paginaInicial" => "119" "paginaFinal" => "128" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0040" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expression and production of the long pentraxin PTX3 in rheumatoid arthritis (RA)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Luchetti M.M." 1 => "Piccinini G." 2 => "Mantovani A." 3 => "Peri G." 4 => "Matteucci C." 5 => "Pomponio G." 6 => "Fratini M." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2249.2000.01110.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Immunol" "fecha" => "2000" "volumen" => "119" "paginaInicial" => "196" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10606983" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0045" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pentraxins, humoral innate immunity and tissue injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Manfredi A.A." 1 => "Rovere-Querini P." 2 => "Bottazzi B." 3 => "Garlanda C." 4 => "Mantovani A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.coi.2008.05.004" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Immunol" "fecha" => "2008" "volumen" => "20" "paginaInicial" => "538" "paginaFinal" => "544" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18579363" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0050" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Long Pentraxin 3 and Its Role in Autoimmunity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Ortega-Hernandez O.D." 1 => "Bassi N." 2 => "Shoenfeld Y." 3 => "Anaya J.M." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2008.03.006" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2009" "volumen" => "39" "paginaInicial" => "38" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18614204" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0055" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emerging roles of the acute phase protein pentraxin-3 during central nervous system disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Rajkovic I." 1 => "Denes A." 2 => "Allan S.M." 3 => "Pinteaux E." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jneuroim.2015.12.007" "Revista" => array:6 [ "tituloSerie" => "J Neuroimmunol" "fecha" => "2016" "volumen" => "292" "paginaInicial" => "27" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26943955" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0060" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CDC definitions for nosocomial infections, 1988" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Garner J.S." 1 => "Jarvis W.R." 2 => "Emori T.G." 3 => "Horan T.C." 4 => "Hughes J.M." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Infect Control" "fecha" => "1988" "volumen" => "16" "paginaInicial" => "128" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2841893" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0065" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review article: the modern management of hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Bajaj J.S." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2009.04211.x" "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "537" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20002027" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673617321414" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0070" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intra-hepatic portosystemic shunt" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Angermayr B." 1 => "Cejna M." 2 => "Karnel F." 3 => "Gschwantler M." 4 => "Koenig F." 5 => "Pidlich J." 6 => "Mendel H." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.52.6.879" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2003" "volumen" => "52" "paginaInicial" => "879" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12740346" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0075" "etiqueta" => "14." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A model to predict survival in patients with end-stage liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Kamath P.S." 1 => "Wiesner R.H." 2 => "Malinchoc M." 3 => "Kremers W." 4 => "Therneau T.M." 5 => "Kosberg C.L." 6 => "D’Amico G." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2001.22172" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2001" "volumen" => "33" "paginaInicial" => "464" "paginaFinal" => "470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172350" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0080" "etiqueta" => "15." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CANONIC Study Investigators of the EASL-CLIF Consortium. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Moreau R." 1 => "Jalan R." 2 => "Gines P." 3 => "Pavesi M." 4 => "Angeli P." 5 => "Cordoba J." 6 => "Durand F." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2013.02.042" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2013" "volumen" => "144" "paginaInicial" => "1426" "paginaFinal" => "1437" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23474284" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0085" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipid Assessment Trial Italian Network (LATIN) Investigators. Prognostic significance of the long pentraxinPTX3 in acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Latini R." 1 => "Maggioni A.P." 2 => "Peri G." 3 => "Gonzini L." 4 => "Lucci D." 5 => "Mocarelli P." 6 => "Vago L." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000145167.30987.2E" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "110" "paginaInicial" => "2349" "paginaFinal" => "2354" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15477419" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0090" "etiqueta" => "17." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma pentraxin 3 in patients with chronic kidney disease: associations with renal function, protein-energy wasting, cardiovascular disease, and mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Tong M." 1 => "Carrero J.J." 2 => "Qureshi A.R." 3 => "Anderstam B." 4 => "Heimburger O." 5 => "Bárány P." 6 => "Axelsson J." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.00870207" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2007" "volumen" => "2" "paginaInicial" => "889" "paginaFinal" => "897" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17702732" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0095" "etiqueta" => "18." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pentraxin 3 in acute respiratory distress syndrome: an early marker of severity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Mauri T." 1 => "Coppadoro A." 2 => "Bellani G." 3 => "Bombino M." 4 => "Patroniti N." 5 => "Peri G." 6 => "Mantovani A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3181809aaf" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2008" "volumen" => "36" "paginaInicial" => "2302" "paginaFinal" => "2308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18596636" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0100" "etiqueta" => "19." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Circulating levels of the long pentraxin PTX3 correlate with severity of infection in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Muller B." 1 => "Peri G." 2 => "Doni A." 3 => "Torri V." 4 => "Landmann R." 5 => "Bottazzi B." 6 => "Mantovani A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2001" "volumen" => "29" "paginaInicial" => "1404" "paginaFinal" => "1407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11445697" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0105" "etiqueta" => "20." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of pentraxin 3 (PTX3) and C reactive protein as markers of inflammation in ARDS [abstract]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Mauri T." 1 => "Coppadoro A." 2 => "Bellani G." 3 => "Bombino M." 4 => "Patroniti N." 5 => "Peri G." 6 => "Mantovani A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2005" "volumen" => "31" "numero" => "S1" "paginaInicial" => "S216" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0110" "etiqueta" => "21." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Circulating interleukin 6, 10 and 17 as prognostic markers in patients with liver cirrhosis. In: The 66th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2015, 2015, San Francisco" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Fischer J." 1 => "Silva T.E." 2 => "Silva P.ES." 3 => "Colombo B.S." 4 => "Wildner L.M." 5 => "Baz-zo M.L." 6 => "Frode T.S." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Hepatology" "fecha" => "2015" "volumen" => "62" "paginaInicial" => "1220A" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0115" "etiqueta" => "22." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interleukin-6: an early marker of bacterial infection in decompensated cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Le Moine O." 1 => "Deviere J." 2 => "Devaster J.M." 3 => "Crusiaux A." 4 => "Durand F." 5 => "Bernuau J." 6 => "Goldman M." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "1994" "volumen" => "20" "paginaInicial" => "819" "paginaFinal" => "824" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7930484" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0120" "etiqueta" => "23." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Production of C-reactive protein in Escherichia coli-in-fected patients with liver dysfunction due to liver cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Park W.B." 1 => "Lee K.D." 2 => "Lee C.S." 3 => "Jang H.C." 4 => "Kim H.B." 5 => "Lee H.S." 6 => "Oh M.D." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2004.11.014" "Revista" => array:6 [ "tituloSerie" => "Diagn Microbiol Infect Dis" "fecha" => "2005" "volumen" => "51" "paginaInicial" => "227" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15808312" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0125" "etiqueta" => "24." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum levels of C reactive protein and procalcitonin in critically ill patients with cirrhosis of the liver" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Bota D.P." 1 => "Van Nuffelen M." 2 => "Zakariah A.N." 3 => "Vincent J.L." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lab.2005.08.005" "Revista" => array:6 [ "tituloSerie" => "J Lab Clin Med" "fecha" => "2005" "volumen" => "146" "paginaInicial" => "347" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16310518" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0130" "etiqueta" => "25." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute phase proteins for the diagnosis of bacterial infection and prediction of mortality in acute complications of cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Lazzarotto C." 1 => "Ronsoni M.F." 2 => "Fayad L." 3 => "Nogueira C.L." 4 => "Bazzo M.L." 5 => "Narciso-Schiavon J.L." 6 => "Schiavon L.L." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2013" "volumen" => "12" "paginaInicial" => "431" "paginaFinal" => "439" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0135" "etiqueta" => "26." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "C-reactive protein: a critical update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Pepys M.B." 1 => "Hirschfield G.M." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI18921" "Revista" => array:6 [ "tituloSerie" => "J Clin Invest" "fecha" => "2003" "volumen" => "111" "paginaInicial" => "1805" "paginaFinal" => "1812" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12813013" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0140" "etiqueta" => "27." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pentraxins at the crossroads between innate immunity, inflammation, matrix deposition, and female fertility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Garlanda C." 1 => "Bottazzi B." 2 => "Bastone A." 3 => "Mantovani A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1146/annurev.immunol.23.021704.115756" "Revista" => array:6 [ "tituloSerie" => "Annu Rev Immunol" "fecha" => "2005" "volumen" => "23" "paginaInicial" => "337" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15771574" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0145" "etiqueta" => "28." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long pentraxin 3 in pulmonary infection and acute lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "He X." 1 => "Han B." 2 => "Liu M." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol" "fecha" => "2007" "volumen" => "292" "paginaInicial" => "1039" "paginaFinal" => "1049" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0150" "etiqueta" => "29." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dual function of the long pentraxin PTX3 in resistance against pulmonary infection with Kleb-siellapneumoniaeintransgenicmice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Soares A.C." 1 => "Souza D.G." 2 => "Pinho V." 3 => "Vieira A.T." 4 => "Nicoli J.R." 5 => "Cunha F.Q." 6 => "Mantovani A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "MicrobesInfect" "fecha" => "2006" "volumen" => "8" "paginaInicial" => "1321" "paginaFinal" => "1329" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0155" "etiqueta" => "30." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TSG-14 transgenic mice have improved survival to endotoxemia and to CLP-induced sepsis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Dias A.A." 1 => "Goodman A.R." 2 => "Dos Santos J.L." 3 => "Gomes R.N." 4 => "Altmeyer A." 5 => "Bozza P.T." 6 => "Horta M.F." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Leukoc Biol" "fecha" => "2001" "volumen" => "69" "paginaInicial" => "928" "paginaFinal" => "936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11404378" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0160" "etiqueta" => "31." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The long pentraxin PTX3 up-regu-lates tissue factor in activated monocytes: Another link between inflammation and clotting activation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Napoleone E." 1 => "di Santo A." 2 => "Peri G." 3 => "Mantovani A." 4 => "de Gaetano G." 5 => "Donati M.B." 6 => "Lorenzet R." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1189/jlb.1003528" "Revista" => array:6 [ "tituloSerie" => "J Leukoc Biol" "fecha" => "2004" "volumen" => "76" "paginaInicial" => "203" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15226367" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0165" "etiqueta" => "32." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The systemic inflammatory response syndrome in cirrhot-ic patients: relationship with their in-hospital outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Cazzaniga M." 1 => "Dionigi E." 2 => "Gobbo G." 3 => "Fioretti A." 4 => "Monti V." 5 => "Salerno F." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2009.04.017" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2009" "volumen" => "51" "paginaInicial" => "475" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19560225" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0170" "etiqueta" => "33." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of bacterial infections in cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Fernandez J." 1 => "Gustot T." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0168-8278(12)60002-6" "Revista" => array:8 [ "tituloSerie" => "J Hepatol" "fecha" => "2012" "volumen" => "56" "numero" => "Suppl. 1" "paginaInicial" => "S1" "paginaFinal" => "S12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22300459" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1473309918304298" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0175" "etiqueta" => "34." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gut microflora in the pathogenesis of the complications of cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Garcia-Tsao G." 1 => "Wiest R." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bpg.2003.10.005" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Gastroenterol" "fecha" => "2004" "volumen" => "18" "paginaInicial" => "353" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15123075" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0180" "etiqueta" => "35." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patients with acute on chronic liver failure display “sepsis-like” immune paralysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Wasmuth H.E." 1 => "Kunz D." 2 => "Yagmur E." 3 => "Timmer-Stranghoner A." 4 => "Vi-dacek D." 5 => "Siewert E." 6 => "Bach J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hepatol" "fecha" => "2005" "volumen" => "42" "paginaInicial" => "195" "paginaFinal" => "201" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0185" "etiqueta" => "36." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Mookerjee R.P." 1 => "Stadlbauer V." 2 => "Lidder S." 3 => "Wright G.A." 4 => "Hodges S.J." 5 => "Davies N.A." 6 => "Jalan R." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21737" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "831" "paginaFinal" => "840" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17680644" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001600000005/v1_201905301208/S1665268119304387/v1_201905301208/en/main.assets" "Apartado" => array:4 [ "identificador" => "77721" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001600000005/v1_201905301208/S1665268119304387/v1_201905301208/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304387?idApp=UINPBA00004N"]

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Jéssica G. Pereira*, Telma Erotides Silva†, Emília T.O. Bansho*, Edelton F. Morato‡, José T. Pinheiro‡, Letícia Muraro-Wildner§, Maria Luiza Bazzo§, Esther Buzaglo Dantas-Corrêa*, Leonardo L. Schiavon*,†, Janaína L. Narciso-Schiavon

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janaina.narciso@uol.com.br

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* Núcleo de Estudos em Gastroenterologia e Hepatologia, Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil

† Postgraduate Program in Medical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina,Brazil

‡ Center for Assessment of Allergic Type Reactions to Drugs, University Hospital Polydoro Ernani de São Thiago - Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil

§ Clinical Analysis Laboratory, University Hospital Polydoro Ernani de São Thiago - Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Introduction</span><p id="p0010" class="elsevierStylePara elsevierViewall">Liver cirrhosis is the most advanced stage of chronic liver disease&#46; It is characterized histologically by the presence of regenerative nodules&#46; Its prevalence is estimated at 0&#46;27&#37; in the United States&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> and it is associated with multiple etiologies&#44; most commonly ethanol consumption&#44; chronic viral hepatitis B and C and diabetes mellitus&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">1&#44;2</span></a> In-hospital mortality for disease decompensation is 9&#46;1&#37; in South Korea<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a> and is 25&#46;0&#37; after 30 days of admission in Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">4</span></a> Identifying patients with worse prognosis would facilitate early management of potentially severe cases&#46; Several prognostic markers have been studied to identify mortality associated with decompensated cirrhosis&#44; including the Model for End-Stage Liver Disease &#40;MELD&#41; score and its derivatives&#44; Acute-on-Chronic Liver Failure &#40;ACLF&#41; score&#44; Interleukins 2&#44; 6 and 8 &#40;IL-2&#44; IL-6 and IL-8&#44; respectively&#41;&#44; C-reactive protein &#40;CRP&#41; and even total leukocyte count&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Pentraxins are proteins formed by 5 monomers that form a ring in radial symmetry&#46; They are a class of pattern recognition receptors&#46; Among pentraxins&#44; the main ones are pentraxin-3&#44; CRP and serum amyloid P component&#46; PTX3 is a long-chain pentraxin considered an acute phase marker produced mainly by endothelial and vascular smooth muscle cells at the site of inflammation&#46; It is also produced by macrophages&#44; fibroblasts&#44; neutrophils&#44; epithelial cells&#44; dendritic cells and other cell types both near and far from the inflammation site&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">5&#44;6</span></a> Pentraxin production is influenced by certain inflammatory stimuli such as interleukin 1 beta &#40;IL-1&#946;&#41; and tumor necrosis factor alfa &#40;TNF-&#945;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a> It differs considerably from CRP in terms of expression patterns by affected organs&#46; In particular&#44; this is a short pentraxin mainly produced in the liver in response to IL-6&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">8</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">PTX3 has been recognized as an independent marker of inflammation associated with various disorders<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8&#44;9</span></a> such as atherosclerosis&#44; cancer&#44; respiratory diseases and central nervous system diseases in which increased levels are related to the risk of the disease or its progression&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a> However&#44; according to our knowledge there are no studies that analyze its role in liver cirrhosis&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">The aim of this study is to describe PTX3 levels in ambulatory patients and hospitalized patients with liver cirrhosis and their association with disease prognosis&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Material and Methods</span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Sample</span><p id="p0030" class="elsevierStylePara elsevierViewall">This is a prospective cohort study with consecutive inclusion of patients with liver cirrhosis treated at the hepa-tology ambulatory department and admitted to the emergency service of a tertiary hospital in southern Brazil between January 2011 and January 2014 because of disease decompensation&#46; Patients were excluded from the study because of insufficient clinical and laboratory data in the medical records&#44; hepatocellular carcinoma that did not meet Milan criteria and refusal to participate in the study&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">During routine outpatient or emergency admission&#44; subjects were asked to participate and sign the free and informed consent form&#46; A family member or guardian would authorize data collection if the patient had encepha-lopathy grades III or IV&#46; Clinical and laboratory variables were collected from interviews and from the medical records&#46; The following clinical variables were studied&#58; age&#44; sex&#44; skin color&#44; etiology of cirrhosis and presence of ascites&#46; Laboratory variables collected on admission included serum creatinine&#44; MELD&#44; Child-Pugh and Chronic Liver Failure - Sequential Organ Failure Assessment &#40;CLIF-SOFA&#41; scores&#44; total leukocyte count&#44; serum sodium&#44; platelet count&#44; international normalized ratio &#40;INR&#41;&#44; albumin&#44; CRP and total bilirubin&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">The diagnosis of cirrhosis was established either histo-logically when liver biopsy was available or by a combination of clinical&#44; imaging and laboratory data in patients with evidence of portal hypertension&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">PTX3 assays were performed by Enzyme-Linked Im-munosorbent Assay with serum samples collected on admission or at an outpatient visit and stored in a freezer at -80 &#176;C &#40;ELISA&#59; R&#38;D Systems - Minneapolis&#44; MN&#41;&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Methods</span><p id="p0050" class="elsevierStylePara elsevierViewall">Patients were followed during hospitalization and 90-day mortality was assessed by telephone in case of discharge&#46; The 90-day mortality rates did not include patients who underwent liver transplantation &#40;because they were excluded from the study&#41;&#46;</p><p id="p0055" class="elsevierStylePara elsevierViewall">Individuals with suspected bacterial infection at admission underwent clinical examination to confirm the diagnosis and establish the primary source of infection&#46; The diagnosis of infection was performed according to the criteria of the Center for Disease Control&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">11</span></a> Diagnostic paracentesis was performed for all patients with ascites present at admission&#46; Hepatic encephalopathy was graded according to the criteria of West-Haven&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">12</span></a> If present&#44; the precipitating factor was investigated and lactulose was administered with dose adjustment as needed&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">The severity of liver disease was estimated by Child-Pugh<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">13</span></a> and MELD scores<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">14</span></a> calculated based on laboratory tests performed on admission&#46; ACLF and CLIF-SOFA were defined as proposed by the European Association for the Study of the Liver-Chronic Liver Failure &#40;EASL-CLIF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">15</span></a></p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Statistical analysis</span><p id="p0065" class="elsevierStylePara elsevierViewall">Numerical variables with normal distribution were expressed as the mean and standard deviation &#40;SD&#41; and were compared using Student&#39;s t test&#46; Numerical variables with non-normal distribution were expressed as medians and compared using the Mann-Whitney test&#46; The normality of variable distribution was determined by the Kolmorogov-Smirnov test&#46; Qualitative variables were represented by frequency &#40;&#37;&#41; and chi-square test or Fisher&#39;s exact test were used when needed for analysis&#46; Bivariate analyses were performed to compare cirrhotic individuals from outpatient visits with hospitalized patients&#46; Bivariate analysis was performed to compare the mean levels of PTX3 in terms of the presence of cirrhosis complications at time of admission&#46; Spearman correlation analysis was performed to compare the values of serum PTX3 to the laboratory variables and prognostic markers MELD&#44; Child-Pugh and CLIF-SOFA&#46; A cutoff point for the PTX3 was determined by Receiver Operating Characteristic &#40;ROC&#41; curve&#46; Survival probability was calculated using Kaplan-Meier method and differences in survival between groups were compared using the log-rank test&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">All tests were performed using the Statistical Package for the Social Sciences&#44; version 22&#46;0 &#40;IBM SPSS statistics&#44; Chicago&#44; Illinois&#44; USA&#41;&#46; P values lower than 0&#46;05 were considered statistically significant&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall">The study protocol was in accordance with the ethical principles of the Declaration of Helsinki and was approved by the local research ethics committee under the number 252709&#46;</p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">RESULTS</span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Casuistry analysis</span><p id="p0080" class="elsevierStylePara elsevierViewall">Between January 2011 and January 2014&#44; studied patients included 32 healthy controls&#44; 29 subjects with liver cirrhosis treated at the hepatology ambulatory department and 130 cirrhotic patients admitted to the hospital for disease decompensation&#46; <a class="elsevierStyleCrossRef" href="#t0010">Table 1</a> shows the demographic and epi-demiological characteristics of patients included in the study&#46; The mean age of the controls was 41&#46;8 &#177; 15&#46;4 years and 78&#46;0&#37; were male&#46; Individuals with cirrhosis had a mean age of 54&#46;1 &#177; 11&#46;7 years&#44; 73&#46;8&#37; were male&#44; 35&#46;6&#37; were Child-Pugh class C and the mean MELD score was 15&#46;0 &#177; 6&#46;2&#46; Only seven patients underwent needle biopsy of the liver to diagnose cirrhosis&#46; The etiology of cirrhosis was related to alcohol in 35&#46;0&#37;&#44; alcohol and hepatitis C virus &#40;HCV&#41; in 22&#46;5&#37; and HCV only in 16&#46;9&#37;&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Comparative analysis of outpatient and hospitalized patients with liver cirrhosis</span><p id="p0085" class="elsevierStylePara elsevierViewall">Outpatients and hospitalized patients with liver cirrhosis had similar clinical characteristics except for skin color&#44; in which there was a higher proportion of individuals with white skin color among outpatients &#40;50&#46;0&#37; <span class="elsevierStyleItalic">vs&#46;</span> 71&#46;3&#37;&#59; p &#61; 0&#46;025&#41;&#46; These characteristics are shown in <a class="elsevierStyleCrossRef" href="#t0010">table 1</a>&#46; When comparing PTX3 levels between groups&#44; it was observed that the cirrhotic outpatients had higher means compared to healthy controls &#40;2&#46;6 <span class="elsevierStyleItalic">vs&#46;</span> 1&#46;1 ng&#47;mL&#59; p &#60; 0&#46;001&#41;&#46; Hospitalized cirrhotic patients had higher means compared both to healthy controls &#40;3&#46;8 <span class="elsevierStyleItalic">vs&#46;</span> 1&#46;1 ng&#47;mL&#59; p &#60; 0&#46;001&#41; and to cirrhotic outpatients &#40;3&#46;8 <span class="elsevierStyleItalic">vs&#46;</span> 2&#46;6 ng&#47;mL&#59; p &#60; 0&#46;001&#41; as can be seen in <a class="elsevierStyleCrossRef" href="#f0010">figure 1</a>&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Correlation analysis of PTX3 with variables of interest</span><p id="p0090" class="elsevierStylePara elsevierViewall">There was a positive correlation between serum levels of PTX3 and creatinine &#40;r &#61; 0&#46;220&#59; p &#61; 0&#46;012&#41;&#44; MELD &#40;r &#61; 0&#46;279&#59; p &#61; 0&#46;001&#41;&#44; Child-Pugh score &#40;r &#61; 0&#46;224&#59; p &#61; 0&#46;010&#41; and CLIF-SOFA score &#40;r &#61; 0&#46;225&#59; p &#61; 0&#46;010&#41;&#46; There was no correlation between PTX3 levels and total leukocyte count&#44; serum sodium&#44; platelet count&#44; INR&#44; albumin&#44; CRP and total bilirubin&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Comparative analysis of serum PTX3 levels according to complications on admission</span><p id="p0095" class="elsevierStylePara elsevierViewall">When comparing PTX3 levels in terms of the presence or absence of ACLF &#40;<a class="elsevierStyleCrossRef" href="#f0015">Figure 2</a>&#41;&#44; it was observed that patients with ACLF showed higher PTX3 medians than those without ACLF &#40;8&#46;0 <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;1 ng&#47;mL&#59; p &#60; 0&#46;001&#41;&#46; When comparing PTX3 levels according to MELD score &#40;<a class="elsevierStyleCrossRef" href="#f0020">Figure 3</a>&#41;&#44; it was observed that patients with MELD higher than 20 had higher median PTX3 levels compared to others &#40;6&#46;7 <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;4 ng&#47;mL&#59; p &#61; 0&#46;002&#41;&#46;</p><elsevierMultimedia ident="f0015"></elsevierMultimedia><elsevierMultimedia ident="f0020"></elsevierMultimedia><p id="p0100" class="elsevierStylePara elsevierViewall">When comparing PTX3 levels according to Child classification&#44; it was observed that individuals in Child class C had similar levels of PTX3 to the others &#40;3&#46;9 <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;6 ng&#47;mL&#59; p &#61; 0&#46;559&#41;&#46; When comparing PTX3 levels in terms of the presence of complications of cirrhosis&#44; similar levels of PTX3 were observed in subjects presenting decompensation in infection &#40;4&#46;5 <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;5 ng&#47;mL&#59; p &#61; 0&#46;197&#41;&#44; ascites &#40;4&#46;0 <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;6 ng&#47;mL&#59; p &#61; 0&#46;384&#41; and grades III or IV encephalopa-thy &#40;4&#46;2 <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;0 ng&#47;mL&#59; p &#61; 0&#46;247&#41;&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">It was observed that the number of organ failures was associated with higher mean serum levels of PTX3 &#40;<a class="elsevierStyleCrossRef" href="#f0025">Figure 4</a>&#41; as follows&#58; none &#61; 3&#46;2 ng&#47;mL&#59; one &#61; 4&#46;7 ng&#47;mL&#59; two or more failures &#61; 8&#46;0 ng&#47;mL &#40;p &#61; 0&#46;006&#41;&#46;</p><elsevierMultimedia ident="f0025"></elsevierMultimedia></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Survival analysis according to serum levels of PTX3</span><p id="p0110" class="elsevierStylePara elsevierViewall">Forty patients died within 90 days &#40;30&#46;8&#37;&#41;&#46; It was observed that patients who died within 90 days had higher serum levels of PTX3 on admission compared to those who survived &#40;5&#46;3 <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;4 ng&#47;mL&#59; p &#61; 0&#46;009&#41;&#46; <a class="elsevierStyleCrossRef" href="#f0030">Figure 5</a> shows the Kaplan-Meier curves associated with serum PTX3 levels&#46; The probability of survival of patients with serum levels of PTX3 higher than or equal to 5&#46;4 ng&#47;mL was 54&#46;0&#37;&#44; while those with serum levels lower than 5&#46;4 ng&#47;mL showed a 90-day survival rate of higher than 77&#46;0&#37; &#40;p &#61; 0&#46;002&#41;&#46;</p><elsevierMultimedia ident="f0030"></elsevierMultimedia></span></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Discussion</span><p id="p0115" class="elsevierStylePara elsevierViewall">This study has identified unprecedentedly higher PTX3 levels in cirrhotic outpatients compared to healthy controls as well as higher levels in cirrhotic patients hospitalized for disease decompensation compared to cirrhotic outpatients&#46; The higher PTX3 levels in patients with acute decompensation in comparison to cirrhotic outpatients and healthy controls is consistent with the results of studies that showed elevated PTX3 levels in diseases with an inflammatory component that affect other organs such as acute myocardial infarction&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">16</span></a> chronic kidney disease&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">17</span></a> acute respiratory distress syndrome &#40;ARDS&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">18</span></a> and severe infectious diseases affecting patients in intensive care&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">19</span></a> Serum levels are positively correlated with disease severity&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">This finding is corroborated by the positive correlation between serum PTX3 levels and the scores associated with severity of liver cirrhosis &#40;MELD&#44; Child-Pugh and CLIF-SOFA&#41;&#46; In patients in intensive care with systemic inflammatory response syndrome &#40;SIRS&#41;&#44; sepsis&#44; severe sepsis and septic shock&#44; there was also a positive correlation between serum PTX3 levels and the clinical severity scores APACHE II &#40;Acute Physiology and Chronic Health Evaluation&#41; and SAPS II &#40;Simplified Acute Physiology Score&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">19</span></a> PTX3 expression was evaluated serially in studies in patients with ARDS<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">18</span></a> and in patients with SIRS&#44; sepsis&#44; severe sepsis and septic shock&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">19</span></a> In both studies it was observed that PTX3 was the first plasma protein to rise&#44; with a peak at approximately 7&#46;5 h in patients with SIRS or infections in the clinical spectrum of sepsis&#46; Levels declined in patients with ARDS after 24 h of intu-bation&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">18</span></a> CRP&#44; a commonly used inflammation marker&#44; had a later serum peak at approximately 24 h19 and remained elevated longer&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">18</span></a> Mauri&#44; et al&#46; performed a preliminary retrospective study if patients with ARDS that also showed a positive correlation between PTX3 levels and the number of organ failures&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">20</span></a> consistent with the results of this study&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">In this study a positive correlation was also observed between serum PTX3 levels and 90-day mortality&#44; consistent with the results of other groups that evaluated mortality in patients with chronic kidney disease&#44; acute myocardial infarction and ARDS&#46; In these studies&#44; PTX3 proved to be an important and early predictor of mortali-ty&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">17&#44;18</span></a> In patients with SIRS&#44; sepsis&#44; severe sepsis or septic shock&#44; both PTX3 and IL-6 showed significant positive correlations with mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">19</span></a> IL-6 was not assessed in this study&#46; However&#44; our group showed that IL-6 levels were positively associated with 90-day mortality &#40;OR 1&#46;002&#59; 95&#37; CI 1&#46;000 - 1&#46;004&#59; p &#61; 0&#46;029&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a></p><p id="p0130" class="elsevierStylePara elsevierViewall">Many studies have compared the efficacy of PTX3 to CRP as a predictor of severity and mortality&#44; given the widespread use of CRP for this purpose&#46; The results as mentioned above show positive correlation when serum levels are compared without time reference&#46; However&#44; no correlation was apparent when considering the time to peak of each of these markers&#46; In liver cirrhosis&#44; however&#44; CRP production is affected because it is synthesized almost entirely in the liver&#46; This may compromise its utility as an inflammation biomarker in these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">22&#44;23</span></a> This might explain the absence of correlation between CRP and PTX3 in this study&#46; However&#44; Bota&#44; <span class="elsevierStyleItalic">et al</span>&#46; have not found statistically significant differences in CRP levels between intensive care patients with or without liver cirrhosis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a> Lazzarotto&#44; et al&#46; demonstrated that CRP levels are sensitive for diagnosis of infection and as predictors of 90-day mortality in patients with cirrhosis&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">25</span></a> Importantly&#44; there is&#44; to a lesser extent&#44; production of CRP in inflamed tis-sues&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">26&#44;27</span></a> This synthesis may be responsible for incomplete suppression of CRP levels even in patients with severe hepatic impairment&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">There was also a positive correlation between serum levels of PTX3 and creatinine&#46; Due to its high molecular weight &#40;40&#46;6 KD&#41; and multimeric structure&#44; PTX3 levels appear to increase as the glomerular filtration rate &#40;GFR&#41; decreases secondary to reduced clearance&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">17</span></a> The same phenomenon occurs with creatinine&#44; it is therefore used as a marker of renal function&#46; Numerous pathological conditions that lead to reduced GFR -such as sepsis&#44; which generates numerous shunts in circulation and redistribution of blood volume&#59; major bleeding&#44; by an absolute reduction in blood volume&#59; ascites&#44; by third space volume retention and reduction of effective circulating volume-tend to increase serum creatinine&#46; The complications of cirrhosis involve the above hemodynamic dysfunctions&#46; One could imagine that this would be the reason for the positive correlation between serum levels of PTX3 and creatinine&#46; However&#44; more hemodynamic studies are needed to confirm this hypothesis&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">Although recently published studies present PTX3 as a marker of severity and&#47;or mortality&#44; little is known about its role <span class="elsevierStyleItalic">in vivo</span> in humans&#46; Garlanda&#44; et al&#46; demonstrated in mice deficient in PTX3 that it has many functions including regulation of innate immunity against various microorganisms&#44; discrimination of self- from non-self molecular patterns and tissue repair&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">27</span></a> Other studies showed that the initial function of PTX3 is protective&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">28</span></a> It participates in the recognition of harmful stimuli&#44; migration of neutrophils to sites of infection and promotion of phagocytosis of bacteria by neutrophils&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">29</span></a> enhancement of nitric oxide production<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">30</span></a> and increased expression of tissue factor&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">31</span></a> However&#44; the prolonged persistence of stimuli can lead to overexpression of PTX3 and amplification of these inflammatory pathways&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">28</span></a> with resulting damage to the organism&#46; Thus far&#44; there are no known specific antagonists to the action of PTX3&#46; Therefore&#44; there are no data regarding blocking of this pathway and its repercussions&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">Finally&#44; the relevance of this study relies on the current difficulty in early determination of the severity of cirrhotic patients&#46; Hemodynamic disturbances hinder the use of SIRS criteria&#59;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">32</span></a> because the hyperdynamic circulatory state leads to tachycardia&#44; beta-blocker use by many of these patients reduces the heart rate and can mask SIRS&#44; hepatic encephalopathy can lead to tachyp-nea and hypersplenism caused by congestion of the portal system can lead to reductions in the number of circulating leukocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">33</span></a> Added to these factors are the immunological changes associated with advanced liver disease&#44; probably related to deficiencies in the complement system&#44; which impair the elimination of op-sonized bacteria and increased bacterial translocation&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">34-36</span></a> This in turn predisposes patients with liver cirrhosis to infections&#46; Furthermore&#44; cultures of micro-organisms knowingly take at least 24 to 48 h to present results&#44; which hampers their utility for diagnosing infectious complications&#46; Therefore&#44; it is important to find early markers of severity and mortality to guide appropriate treatment&#46;</p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Conclusions</span><p id="p0150" class="elsevierStylePara elsevierViewall">Circulating levels of PTX3 are increased in patients with liver cirrhosis&#44; particularly those with acute decompensation&#46; Serum PTX3 is related to the severity of the disease&#44; the presence of ACLF and 90-day mortality&#46; These results are promising and indicate a potential use for PTX3 as an inflammatory and prognostic biomarker for patients with liver cirrhosis&#46;</p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0105">Author Contributions</span><p id="p0155" class="elsevierStylePara elsevierViewall">Schiavon LL designed the study&#46; Bansho ETO and Silva TE were responsible for data collection&#46; Morato EF&#44; Pinheiro JT&#44; Pereira JG&#44; Wildner LM and Bazzo ML performed the pentraxin-3 sample processing&#46; Schiavon LL&#44; Narciso-Schiavon JL and Pereira JG analyzed the data and are responsible for the article as a whole&#46; Narciso-Schia-von JL and Pereira JG wrote the paper and Dantas-Correa EB and Schiavon LL revised the manuscript&#46;</p></span><span id="s0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0110">Supportive Foundations</span><p id="p0160" class="elsevierStylePara elsevierViewall">This study was financed by Conselho Nacional de Desenvolvimento Cient&#237;fico e T&#233;cnol&#243;gico &#40;CNPq&#41;&#46;</p><span id="s0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0115">Institutional review board statement</span><p id="p0165" class="elsevierStylePara elsevierViewall">The study was reviewed and approved by the Federal University of Santa Catarina Institutional Review Board under the number 252709&#46;</p></span></span><span id="s0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0120">Informed Consent Statement</span><p id="p0170" class="elsevierStylePara elsevierViewall">All study participants or their respective legal guardians provided written informed consent prior to study enrollment&#46;</p></span><span id="s0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0125">Conflicts of Interest</span><p id="p0175" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span><span id="s0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0130">Data Sharing Statement</span><p id="p0180" class="elsevierStylePara elsevierViewall">No additional data are available&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        0 => array:3 [
          "identificador" => "xres1197558"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abs0010"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abs0015"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abs0020"
              "titulo" => "Results"
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            3 => array:2 [
              "identificador" => "abs0025"
              "titulo" => "Conclusion"
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        1 => array:2 [
          "identificador" => "xpalclavsec1116244"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "s0010"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "s0015"
          "titulo" => "Material and Methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "s0020"
              "titulo" => "Sample"
            ]
            1 => array:2 [
              "identificador" => "s0025"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "s0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "s0035"
          "titulo" => "RESULTS"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "s0040"
              "titulo" => "Casuistry analysis"
            ]
            1 => array:2 [
              "identificador" => "s0045"
              "titulo" => "Comparative analysis of outpatient and hospitalized patients with liver cirrhosis"
            ]
            2 => array:2 [
              "identificador" => "s0050"
              "titulo" => "Correlation analysis of PTX3 with variables of interest"
            ]
            3 => array:2 [
              "identificador" => "s0055"
              "titulo" => "Comparative analysis of serum PTX3 levels according to complications on admission"
            ]
            4 => array:2 [
              "identificador" => "s0060"
              "titulo" => "Survival analysis according to serum levels of PTX3"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "s0065"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "s0070"
          "titulo" => "Conclusions"
        ]
        7 => array:2 [
          "identificador" => "s0075"
          "titulo" => "Author Contributions"
        ]
        8 => array:3 [
          "identificador" => "s0080"
          "titulo" => "Supportive Foundations"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "s0085"
              "titulo" => "Institutional review board statement"
            ]
          ]
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        9 => array:2 [
          "identificador" => "s0090"
          "titulo" => "Informed Consent Statement"
        ]
        10 => array:2 [
          "identificador" => "s0095"
          "titulo" => "Conflicts of Interest"
        ]
        11 => array:2 [
          "identificador" => "s0100"
          "titulo" => "Data Sharing Statement"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-10-27"
    "fechaAceptado" => "2017-03-20"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1116244"
          "palabras" => array:7 [
            0 => "Liver cirrhosis"
            1 => "Inflammation"
            2 => "Biomarkers"
            3 => "PTX3 protein"
            4 => "Prognosis"
            5 => "Acute-On-Chronic Liver Failure"
            6 => "Mortality"
          ]
        ]
      ]
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015"><span class="elsevierStyleBold">Background</span></span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Despite the circulating levels of PTX3 were related to the severity of various diseases&#44; there are no studies investigating its role in patients with liver cirrhosis&#46; We aimed to study PTX3 levels in patients with liver cirrhosis&#46;</p></span> <span id="abs0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020"><span class="elsevierStyleBold">Material and methods</span></span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort study included 130 patients hospitalized for acute decompensation of liver cirrhosis&#44; 29 stable cirrhotic outpatients and 32 healthy controls evaluated in a tertiary hospital in Southern Brasil&#46;</p></span> <span id="abs0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025"><span class="elsevierStyleBold">Results</span></span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">The median PTX3 level was significantly higher in stable cirrhotic patients compared to controls &#40;2&#46;6 <span class="elsevierStyleItalic">vs</span>&#46; 1&#46;1 ng&#47;mL&#59; p &#60; 0&#46;001&#41;&#44; hospitalized cirrhotic patients compared to controls &#40;3&#46;8 <span class="elsevierStyleItalic">vs</span>&#46; 1&#46;1 ng&#47;mL&#59; p &#60; 0&#46;001&#41;&#44; and hospitalized cirrhotic patients compared to stable cirrhotic patients &#40;3&#46;8 <span class="elsevierStyleItalic">vs</span>&#46; 2&#46;6 ng&#47; mL&#59; p &#61; 0&#46;001&#41;&#46; A positive correlation was found between PTX3 and serum creatinine &#40;r &#61; 0&#46;220&#59; p &#61; 0&#46;012&#41;&#44; Chronic Liver Failure -Sequential Organ Failure Assessment score &#40;CLIF-SOFA&#41; &#40;r &#61; 0&#46;220&#59; p &#61; 0&#46;010&#41;&#44; MELD &#40;r &#61; 0&#46;279&#59; p &#61; 0&#46;001&#41; and Child-Pugh score &#40;r &#61; 0&#46;224&#59; p &#61; 0&#46;010&#41;&#46; Significantly higher levels of PTX3 were observed in patients on admission with ACLF &#40;8&#46;9 <span class="elsevierStyleItalic">vs</span>&#46; 3&#46;1 ng&#47;mL&#59; p &#60; 0&#46;001&#41; and MELD score &#8805; 20 &#40;6&#46;6 <span class="elsevierStyleItalic">vs</span>&#46; 3&#46;4 ng&#47;mL&#59; p &#61; 0&#46;002&#41;&#46; Death within 90 days occurred in 30&#46;8&#37; of patients and was associated with higher levels of PTX3 &#40;5&#46;3 <span class="elsevierStyleItalic">vs</span>&#46; 3&#46;4 ng&#47;mL&#59; p &#61; 0&#46;009&#41;&#46; The probability of Kaplan-Meier survival was 77&#46;0&#37; in patients with PTX-3 &#60; 5&#46;3 ng mL &#40;upper tercile&#41; and 53&#46;5&#37; in those with PTX3 &#8805; 5&#46;3 ng&#47;mL &#40;p &#61; 0&#46;002&#41;&#46;</p></span> <span id="abs0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030"><span class="elsevierStyleBold">Conclusion</span></span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">These results indicate the potential for use of PTX3 as an inflammatory biomarker for the prognosis of patients with hepatic cirrhosis&#46;</p></span>"
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            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abs0020"
            "titulo" => "Results"
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Pentraxin 3 levels according to patient group&#46;</p>"
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          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Pentraxin 3 levels according to the presence or absence of Acute-on-Chronic Liver Failure &#40;ACLF&#41;&#46;</p>"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 713
            "Ancho" => 961
            "Tamanyo" => 30805
          ]
        ]
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          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Pentraxin 3 levels according to Model for End-Stage Liver Disease &#40;MELD&#41; score&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "f0025"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 725
            "Ancho" => 969
            "Tamanyo" => 31856
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Pentraxin 3 levels according to the number of organ failures&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "f0030"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 846
            "Ancho" => 2078
            "Tamanyo" => 93206
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        "descripcion" => array:1 [
          "en" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Ninety days survival according to pentraxin 3 levels</p>"
        ]
      ]
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">&#967;&#58; Chi-square test&#46; f&#58; Fisher&#39;s exact test&#46; t&#58; Student&#39;s t test&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outpatients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;074 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">White skin color&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;025 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;990 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;333 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Human immunodeficiency virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000 <span class="elsevierStyleItalic">f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous alcoholism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;411 <span class="elsevierStyleItalic">t</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Current alcoholism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;979 <span class="elsevierStyleItalic">t</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous decompensation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;148 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Child-Pugh A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;572 <span class="elsevierStyleItalic">f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Child-Pugh B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;105 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Child-Pugh C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;256 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Model for End-Stage Liver Disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;8 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9 &#177; 6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001 <span class="elsevierStyleItalic">t</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etiology &#61; hepatitis B virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;450 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etiology &#61; hepatitis C virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;736 <span class="elsevierStyleItalic">&#967;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etiology &#61; alcoholism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Epidemiology of Cirrhosis in the United States&#58; A Population-based Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Scaglione S&#46;"
                            1 => "Kliethermes S&#46;"
                            2 => "Cao G&#46;"
                            3 => "Shoham D&#46;"
                            4 => "Durazo R&#46;"
                            5 => "Luke A&#46;"
                            6 => "Volk M&#46;L&#46;"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/MCG.0000000000000208"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "2015"
                        "volumen" => "49"
                        "paginaInicial" => "690"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25291348"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Yoon Y&#46;H&#46;"
                            1 => "Yi H&#46;Y&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Liver cirrhosis mortality in the United States&#44; 1970-2003&#58; Surveillance Report No&#46; 75"
                        "serieFecha" => "2006"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications requiring hospital admission and causes of in-hospital death over time in alcoholic and nonalcoholic cirrhosis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Kim H&#46;Y&#46;"
                            1 => "Kim C&#46;W&#46;"
                            2 => "Choi J&#46;Y&#46;"
                            3 => "Lee C&#46;D&#46;"
                            4 => "Lee S&#46;H&#46;"
                            5 => "Kim M&#46;Y&#46;"
                            6 => "Jang B&#46;K&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5009/gnl14363"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut Liver"
                        "fecha" => "2016"
                        "volumen" => "10"
                        "paginaInicial" => "95"
                        "paginaFinal" => "100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26087788"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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            3 => array:3 [
              "identificador" => "bib0025"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Single-centre validation of the EASL-CLIF consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Silva P&#46;E&#46;"
                            1 => "Fayad L&#46;"
                            2 => "Lazzarotto C&#46;"
                            3 => "Ronsoni M&#46;F&#46;"
                            4 => "Bazzo M&#46;L&#46;"
                            5 => "Colombo B&#46;S&#46;"
                            6 => "Dantas-Correa E&#46;B&#46;"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/liv.12597"
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                        "tituloSerie" => "Liver Int"
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                        "volumen" => "35"
                        "paginaInicial" => "1516"
                        "paginaFinal" => "1523"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24840673"
                            "web" => "Medline"
                          ]
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            4 => array:3 [
              "identificador" => "bib0030"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pentraxin 3 &#40;PTX3&#41; Expression in Allergic Asthmatic Airways&#58; Role in Airway Smooth Muscle Migration and Chemokine Production&#46; Rojas M &#40;Ed&#46;&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
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                            1 => "Shan L&#46;"
                            2 => "Koussih L&#46;"
                            3 => "Redhu N&#46;S&#46;"
                            4 => "Halayko A&#46;J&#46;"
                            5 => "Chakir J&#46;"
                            6 => "Gounni A&#46;S&#46;"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0034965"
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                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "e34965"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22529962"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0035"
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                0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                            1 => "Hrycek A&#46;"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Au-toimmunity"
                        "fecha" => "2012"
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                        "paginaInicial" => "119"
                        "paginaFinal" => "128"
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            6 => array:3 [
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                          "etal" => true
                          "autores" => array:7 [
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                            1 => "Piccinini G&#46;"
                            2 => "Mantovani A&#46;"
                            3 => "Peri G&#46;"
                            4 => "Matteucci C&#46;"
                            5 => "Pomponio G&#46;"
                            6 => "Fratini M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2249.2000.01110.x"
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                        "tituloSerie" => "Clin Exp Immunol"
                        "fecha" => "2000"
                        "volumen" => "119"
                        "paginaInicial" => "196"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10606983"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0045"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pentraxins&#44; humoral innate immunity and tissue injury"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Manfredi A&#46;A&#46;"
                            1 => "Rovere-Querini P&#46;"
                            2 => "Bottazzi B&#46;"
                            3 => "Garlanda C&#46;"
                            4 => "Mantovani A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.coi.2008.05.004"
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                        "tituloSerie" => "Curr Opin Immunol"
                        "fecha" => "2008"
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                        "paginaInicial" => "538"
                        "paginaFinal" => "544"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18579363"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0050"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The Long Pentraxin 3 and Its Role in Autoimmunity"
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                          "autores" => array:4 [
                            0 => "Ortega-Hernandez O&#46;D&#46;"
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                            2 => "Shoenfeld Y&#46;"
                            3 => "Anaya J&#46;M&#46;"
                          ]
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2008.03.006"
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                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2009"
                        "volumen" => "39"
                        "paginaInicial" => "38"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18614204"
                            "web" => "Medline"
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              "identificador" => "bib0055"
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                    0 => array:2 [
                      "titulo" => "Emerging roles of the acute phase protein pentraxin-3 during central nervous system disorders"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "Rajkovic I&#46;"
                            1 => "Denes A&#46;"
                            2 => "Allan S&#46;M&#46;"
                            3 => "Pinteaux E&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jneuroim.2015.12.007"
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                        "tituloSerie" => "J Neuroimmunol"
                        "fecha" => "2016"
                        "volumen" => "292"
                        "paginaInicial" => "27"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26943955"
                            "web" => "Medline"
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                      "titulo" => "CDC definitions for nosocomial infections&#44; 1988"
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                          "autores" => array:5 [
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                            1 => "Jarvis W&#46;R&#46;"
                            2 => "Emori T&#46;G&#46;"
                            3 => "Horan T&#46;C&#46;"
                            4 => "Hughes J&#46;M&#46;"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Infect Control"
                        "fecha" => "1988"
                        "volumen" => "16"
                        "paginaInicial" => "128"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2841893"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Review article&#58; the modern management of hepatic encephalopathy"
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                    0 => array:2 [
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                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2010"
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                        "paginaInicial" => "537"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20002027"
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                          "issn" => "01406736"
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              "identificador" => "bib0070"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intra-hepatic portosystemic shunt"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
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                            2 => "Karnel F&#46;"
                            3 => "Gschwantler M&#46;"
                            4 => "Koenig F&#46;"
                            5 => "Pidlich J&#46;"
                            6 => "Mendel H&#46;"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1136/gut.52.6.879"
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                        "tituloSerie" => "Gut"
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                        "volumen" => "52"
                        "paginaInicial" => "879"
                        "paginaFinal" => "885"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12740346"
                            "web" => "Medline"
                          ]
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              ]
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            13 => array:3 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A model to predict survival in patients with end-stage liver disease"
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                          "autores" => array:7 [
                            0 => "Kamath P&#46;S&#46;"
                            1 => "Wiesner R&#46;H&#46;"
                            2 => "Malinchoc M&#46;"
                            3 => "Kremers W&#46;"
                            4 => "Therneau T&#46;M&#46;"
                            5 => "Kosberg C&#46;L&#46;"
                            6 => "D&#8217;Amico G&#46;"
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                      ]
                    ]
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                        "paginaInicial" => "464"
                        "paginaFinal" => "470"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172350"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                        0 => array:2 [
                          "etal" => true
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                            2 => "Gines P&#46;"
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                            4 => "Angeli P&#46;"
                            5 => "Cordoba J&#46;"
                            6 => "Durand F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
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                        "paginaFinal" => "1437"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23474284"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0085"
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                0 => array:2 [
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                    0 => array:2 [
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                          "etal" => true
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                            1 => "Maggioni A&#46;P&#46;"
                            2 => "Peri G&#46;"
                            3 => "Gonzini L&#46;"
                            4 => "Lucci D&#46;"
                            5 => "Mocarelli P&#46;"
                            6 => "Vago L&#46;"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000145167.30987.2E"
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                        "paginaInicial" => "2349"
                        "paginaFinal" => "2354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15477419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0090"
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              "referencia" => array:1 [
                0 => array:2 [
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                      "titulo" => "Plasma pentraxin 3 in patients with chronic kidney disease&#58; associations with renal function&#44; protein-energy wasting&#44; cardiovascular disease&#44; and mortality"
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                        0 => array:2 [
                          "etal" => true
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                            1 => "Carrero J&#46;J&#46;"
                            2 => "Qureshi A&#46;R&#46;"
                            3 => "Anderstam B&#46;"
                            4 => "Heimburger O&#46;"
                            5 => "B&#225;r&#225;ny P&#46;"
                            6 => "Axelsson J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.2215/CJN.00870207"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2007"
                        "volumen" => "2"
                        "paginaInicial" => "889"
                        "paginaFinal" => "897"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17702732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0095"
              "etiqueta" => "18&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pentraxin 3 in acute respiratory distress syndrome&#58; an early marker of severity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Mauri T&#46;"
                            1 => "Coppadoro A&#46;"
                            2 => "Bellani G&#46;"
                            3 => "Bombino M&#46;"
                            4 => "Patroniti N&#46;"
                            5 => "Peri G&#46;"
                            6 => "Mantovani A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3181809aaf"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "36"
                        "paginaInicial" => "2302"
                        "paginaFinal" => "2308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18596636"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Circulating levels of the long pentraxin PTX3 correlate with severity of infection in critically ill patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Muller B&#46;"
                            1 => "Peri G&#46;"
                            2 => "Doni A&#46;"
                            3 => "Torri V&#46;"
                            4 => "Landmann R&#46;"
                            5 => "Bottazzi B&#46;"
                            6 => "Mantovani A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "paginaInicial" => "1404"
                        "paginaFinal" => "1407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11445697"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of pentraxin 3 &#40;PTX3&#41; and C reactive protein as markers of inflammation in ARDS &#91;abstract&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Mauri T&#46;"
                            1 => "Coppadoro A&#46;"
                            2 => "Bellani G&#46;"
                            3 => "Bombino M&#46;"
                            4 => "Patroniti N&#46;"
                            5 => "Peri G&#46;"
                            6 => "Mantovani A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "numero" => "S1"
                        "paginaInicial" => "S216"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Circulating interleukin 6&#44; 10 and 17 as prognostic markers in patients with liver cirrhosis&#46; In&#58; The 66th Annual Meeting of the American Association for the Study of Liver Diseases&#58; The Liver Meeting 2015&#44; 2015&#44; San Francisco"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Fischer J&#46;"
                            1 => "Silva T&#46;E&#46;"
                            2 => "Silva P&#46;ES&#46;"
                            3 => "Colombo B&#46;S&#46;"
                            4 => "Wildner L&#46;M&#46;"
                            5 => "Baz-zo M&#46;L&#46;"
                            6 => "Frode T&#46;S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2015"
                        "volumen" => "62"
                        "paginaInicial" => "1220A"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interleukin-6&#58; an early marker of bacterial infection in decompensated cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Le Moine O&#46;"
                            1 => "Deviere J&#46;"
                            2 => "Devaster J&#46;M&#46;"
                            3 => "Crusiaux A&#46;"
                            4 => "Durand F&#46;"
                            5 => "Bernuau J&#46;"
                            6 => "Goldman M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "1994"
                        "volumen" => "20"
                        "paginaInicial" => "819"
                        "paginaFinal" => "824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7930484"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Production of C-reactive protein in Escherichia coli-in-fected patients with liver dysfunction due to liver cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Park W&#46;B&#46;"
                            1 => "Lee K&#46;D&#46;"
                            2 => "Lee C&#46;S&#46;"
                            3 => "Jang H&#46;C&#46;"
                            4 => "Kim H&#46;B&#46;"
                            5 => "Lee H&#46;S&#46;"
                            6 => "Oh M&#46;D&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diagmicrobio.2004.11.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Microbiol Infect Dis"
                        "fecha" => "2005"
                        "volumen" => "51"
                        "paginaInicial" => "227"
                        "paginaFinal" => "230"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15808312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum levels of C reactive protein and procalcitonin in critically ill patients with cirrhosis of the liver"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Bota D&#46;P&#46;"
                            1 => "Van Nuffelen M&#46;"
                            2 => "Zakariah A&#46;N&#46;"
                            3 => "Vincent J&#46;L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.lab.2005.08.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Lab Clin Med"
                        "fecha" => "2005"
                        "volumen" => "146"
                        "paginaInicial" => "347"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16310518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute phase proteins for the diagnosis of bacterial infection and prediction of mortality in acute complications of cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Lazzarotto C&#46;"
                            1 => "Ronsoni M&#46;F&#46;"
                            2 => "Fayad L&#46;"
                            3 => "Nogueira C&#46;L&#46;"
                            4 => "Bazzo M&#46;L&#46;"
                            5 => "Narciso-Schiavon J&#46;L&#46;"
                            6 => "Schiavon L&#46;L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Hepatol"
                        "fecha" => "2013"
                        "volumen" => "12"
                        "paginaInicial" => "431"
                        "paginaFinal" => "439"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "C-reactive protein&#58; a critical update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Pepys M&#46;B&#46;"
                            1 => "Hirschfield G&#46;M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1172/JCI18921"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Invest"
                        "fecha" => "2003"
                        "volumen" => "111"
                        "paginaInicial" => "1805"
                        "paginaFinal" => "1812"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12813013"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pentraxins at the crossroads between innate immunity&#44; inflammation&#44; matrix deposition&#44; and female fertility"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Garlanda C&#46;"
                            1 => "Bottazzi B&#46;"
                            2 => "Bastone A&#46;"
                            3 => "Mantovani A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1146/annurev.immunol.23.021704.115756"
                      "Revista" => array:6 [
                        "tituloSerie" => "Annu Rev Immunol"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "337"
                        "paginaFinal" => "366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15771574"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long pentraxin 3 in pulmonary infection and acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "He X&#46;"
                            1 => "Han B&#46;"
                            2 => "Liu M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol"
                        "fecha" => "2007"
                        "volumen" => "292"
                        "paginaInicial" => "1039"
                        "paginaFinal" => "1049"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dual function of the long pentraxin PTX3 in resistance against pulmonary infection with Kleb-siellapneumoniaeintransgenicmice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Soares A&#46;C&#46;"
                            1 => "Souza D&#46;G&#46;"
                            2 => "Pinho V&#46;"
                            3 => "Vieira A&#46;T&#46;"
                            4 => "Nicoli J&#46;R&#46;"
                            5 => "Cunha F&#46;Q&#46;"
                            6 => "Mantovani A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "MicrobesInfect"
                        "fecha" => "2006"
                        "volumen" => "8"
                        "paginaInicial" => "1321"
                        "paginaFinal" => "1329"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "TSG-14 transgenic mice have improved survival to endotoxemia and to CLP-induced sepsis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Dias A&#46;A&#46;"
                            1 => "Goodman A&#46;R&#46;"
                            2 => "Dos Santos J&#46;L&#46;"
                            3 => "Gomes R&#46;N&#46;"
                            4 => "Altmeyer A&#46;"
                            5 => "Bozza P&#46;T&#46;"
                            6 => "Horta M&#46;F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Leukoc Biol"
                        "fecha" => "2001"
                        "volumen" => "69"
                        "paginaInicial" => "928"
                        "paginaFinal" => "936"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11404378"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The long pentraxin PTX3 up-regu-lates tissue factor in activated monocytes&#58; Another link between inflammation and clotting activation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Napoleone E&#46;"
                            1 => "di Santo A&#46;"
                            2 => "Peri G&#46;"
                            3 => "Mantovani A&#46;"
                            4 => "de Gaetano G&#46;"
                            5 => "Donati M&#46;B&#46;"
                            6 => "Lorenzet R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1189/jlb.1003528"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Leukoc Biol"
                        "fecha" => "2004"
                        "volumen" => "76"
                        "paginaInicial" => "203"
                        "paginaFinal" => "209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15226367"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The systemic inflammatory response syndrome in cirrhot-ic patients&#58; relationship with their in-hospital outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Cazzaniga M&#46;"
                            1 => "Dionigi E&#46;"
                            2 => "Gobbo G&#46;"
                            3 => "Fioretti A&#46;"
                            4 => "Monti V&#46;"
                            5 => "Salerno F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2009.04.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2009"
                        "volumen" => "51"
                        "paginaInicial" => "475"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19560225"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of bacterial infections in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Fernandez J&#46;"
                            1 => "Gustot T&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0168-8278(12)60002-6"
                      "Revista" => array:8 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2012"
                        "volumen" => "56"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22300459"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1473309918304298"
                          "estado" => "S300"
                          "issn" => "14733099"
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                    ]
                  ]
                ]
              ]
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            33 => array:3 [
              "identificador" => "bib0175"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gut microflora in the pathogenesis of the complications of cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Garcia-Tsao G&#46;"
                            1 => "Wiest R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bpg.2003.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Gastroenterol"
                        "fecha" => "2004"
                        "volumen" => "18"
                        "paginaInicial" => "353"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15123075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patients with acute on chronic liver failure display &#8220;sepsis-like&#8221; immune paralysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Wasmuth H&#46;E&#46;"
                            1 => "Kunz D&#46;"
                            2 => "Yagmur E&#46;"
                            3 => "Timmer-Stranghoner A&#46;"
                            4 => "Vi-dacek D&#46;"
                            5 => "Siewert E&#46;"
                            6 => "Bach J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2005"
                        "volumen" => "42"
                        "paginaInicial" => "195"
                        "paginaFinal" => "201"
                      ]
                    ]
                  ]
                ]
              ]
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Article information

ISSN: 16652681
Original language: English

DOI:10.5604/01.3001.0010.2789

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	1	6
2024 October	22	8	30
2024 September	31	9	40
2024 August	39	7	46
2024 July	31	7	38
2024 June	22	8	30
2024 May	20	10	30
2024 April	38	6	44
2024 March	30	4	34
2024 February	23	4	27
2024 January	13	3	16
2023 December	4	4	8
2023 November	13	4	17
2023 October	22	7	29
2023 September	10	3	13
2023 August	24	3	27
2023 July	20	6	26
2023 June	19	2	21
2023 May	48	0	48
2023 April	55	2	57
2023 March	36	4	40
2023 February	25	0	25
2023 January	18	6	24
2022 December	38	7	45
2022 November	28	8	36
2022 October	63	10	73
2022 September	35	7	42
2022 August	38	13	51
2022 July	35	6	41
2022 June	29	11	40
2022 May	56	10	66
2022 April	72	12	84
2022 March	124	12	136
2022 February	126	7	133
2022 January	106	18	124
2021 December	112	14	126
2021 November	77	9	86
2021 October	59	12	71
2021 September	31	12	43
2021 August	59	6	65
2021 July	38	12	50
2021 June	25	5	30
2021 May	27	15	42
2021 April	89	27	116
2021 March	79	28	107
2021 February	44	8	52
2021 January	30	10	40
2020 December	30	8	38
2020 November	53	17	70
2020 October	31	5	36
2020 September	32	9	41
2020 August	21	7	28
2020 July	32	11	43
2020 June	25	6	31
2020 May	23	9	32
2020 April	22	2	24
2020 March	31	6	37
2020 February	21	5	26
2020 January	19	7	26
2019 December	23	5	28
2019 November	12	6	18
2019 October	17	7	24
2019 September	8	6	14
2019 August	1	3	4
2019 July	3	7	10
2019 June	9	9	18
2019 May	2	5	7

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