The presence of occult sepsis could have been a confounding factor in those studies as it can lead to increased neutrophil expression of CD66b and CD16 through emergency granulopoiesis, thereby leading to a higher number of phenotypically normal neutrophils.15 Ours is the only study to exclude infection at baseline, thereby isolating the neutrophil dysfunction of ACLF from sepsis. This evidence concerns the gene CEACAM8 and infection.