Monocyte dysfunction has been defined as reduced monocyte human leukocyte antigen–DR isotype (HLA-DR) expression10 and reduced ex vivo lipopolysaccharide (LPS)-induced tumour necrosis factor alpha (TNFα) production,[11], [12], [13], [14], [15] and is associated with increased infection rates.[16], [17], [18] Several studies detail circulating monocyte dysfunction in advanced liver disease11,19 and persistently low expression of HLA-DR was associated with increased secondary infection and 28-day mortality.20 Here, TNF is linked to infection.