The main causes of death in PA-HSOS patients were liver failure and multiple organ injury.9 Like other causes of liver failure, many inflammatory factors are found in PA-HSOS patients, such as IL-6, TNF-α, and IL-1β.5 Studies have demonstrated that liver macrophages are essential to sustain tissue homeostasis.11,12 Macrophages belonging to the innate immune system exhibit a high degree of plasticity and can adapt their phenotype in response to environmental stimuli. Here, TNF is linked to liver failure.