The reticuloendothelial system phagocytic activity, estimated by the plasma elimination rate constant of se"technetium-sulfur colloid, was studied in 41 decompensated cirrhotics and 10 normal subjects. The results were related to the incidence and type of bacterial infections occurring during hospitalization and follow-up, and to survival. The elimination rate constant of se"technetiumsulfur colloid was lower in cirrhotic patients (0.168 f 0.007) (x f S.E.) than in normal subjects (0.220 f 0.005) (p c 0.01). Cirrhotics were divided into two groups. Group I (16 patients) and Group I1 (25 patients) had normal or reduced elimination rate constant of se"technetium-sulfur colloid, respectively. Both groups were similar in relation to clinical and biochemical data, hepatic blood flow, and wedged hepatic venous pressure. However, the liver scan and the elimination rate constant of indocyanine green were more altered in Group 11. Patients in Group I1 developed acute bacterial infections more frequently than did patients in Group I. During hospitalization (24 2 2 days), bacteremia occurred in six patients in Group I1 and in none in Group I (p c 0.05). During follow-up (28 f 3 months), 5 patients in Group I1 and none in Group I developed bacteremia (p c 0.05). The cumulative survival rate of Group I patients was higher (p c 0.05) than that of Group I1 patients at 3 months (100 vs. 80%), 6 months (94 vs. 68%), 24 months (74 vs. 42%), and 48 months (68 vs. 34%). We suggest that decompensated cirrhotics with depressed reticuloendothelial system phagocytic activity are at great risk to acquire bacteremia, and that reticuloendothelial system phagocytic activity has prognostic value in cirrhosis.
Reticuloendothelial system (RES) phagocytic activity is impaired in most cirrhotics (1-3) mainly due to depression of the hepatic RES which is the largest fraction of the total body RES. Hepatic RES includes Kupffer cells and other sinusoidal cells. Depression of hepatic RES occurs in cirrhosis despite compensatory overactivity of other RES locations, such as spleen and bone marrow (4, 5). The most relevant function of the RES is to remove microorganisms from the blood. Therefore, the RES is an important defensive factor against infection, particularly against bacteremia (6, 7).