A recent meta-analysis documented serum IL6 may discriminant bacterial infections and predict hepatic encephalopathy in subjects with cirrhosis49,50 TNFα also elevated in decompensated cirrhosis and correlates with the severity of ACLF, although a clinical trial of anti-TNFα therapy did not show a benefit in patients with ACLF due to increased secondary infections14,51. This evidence concerns the gene IL6 and bacterial infectious disease.