We and others had previously shown that numerous cytokines (TNF-α, IL-6, IL-10, IL-8) are upregulated in ACLF in comparison to cirrhosis and healthy subjects, respectively.23 27 We therefore studied the effect of ACLF plasma on healthy CD14+ monocytes in vitro and indeed observed the expansion of the M-MDSC population revealing a CD16lowMERTKlow phenotype. This evidence concerns the gene TNF and Cirrhosis.