New vasoactive peptides in cirrhosis: organ extraction and relation to the vasodilatory state. (26th February 2014)

• Record Type: Journal Article
• Authors: Kimer, Nina; Goetze, Jens Peter; Bendtsen, Flemming; Møller, Søren
• Is Part Of: European journal of clinical investigation. Volume 44:Number 5(2014:May)
• Page Start: 441
• Page End: 452
• Publication Date: 2014-02-26
• Subjects: Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.12249
• Languages: English
• ISSNs: 0014-2972

Abstract

<abstract abstract-type="main" id="eci12249-abs-0001"> <title>Abstract</title> <sec id="eci12249-sec-0001" sec-type="section"> <title>Background</title> <p>Patients with cirrhosis have substantial circulatory imbalance between vasoconstrictive and vasodilating forces. The study of circulatory vasoactive peptides may provide important pathophysiological information. This study aimed to assess concentrations, organ extraction and relations to haemodynamic changes in the pro‐peptides copeptin, proadrenomedullin and pro‐atrial natriuretic peptide (proANP) in patients with cirrhosis.</p> </sec> <sec id="eci12249-sec-0002" sec-type="section"> <title>Materials and methods</title> <p>Fifty‐four cirrhotic patients and 15 controls were characterized haemodynamically during a liver vein catheterization. Copeptin, proadrenomedullin and proANP were measured in hepatic and renal veins and the femoral artery.</p> </sec> <sec id="eci12249-sec-0003" sec-type="section"> <title>Results</title> <p>We found no differences in concentrations of copeptin and proadrenomedullin between patients and controls. ProANPs were higher in cirrhotic patients, median 138 p<sc>m</sc> (25/75 percentiles 101–194) compared with controls, median 91 p<sc>m</sc> (25/75 percentiles 82–153) <italic>P </italic>=<italic> </italic>0·02. ProANPs were higher in the femoral artery and renal vein, median 140 p<sc>m</sc> and 116 p<sc>m</sc> (25/75 percentiles 109–191 and 92–164, respectively), compared with controls, median 99 and 81 (25/75 percentiles 85–146 and 66–123) <italic>P </italic>=<italic> </italic>0·02 and <italic>P </italic>=<italic> </italic>0·007, respectively. We found no extraction of copeptin, proadrenomedullin or proANP over the liver. Copeptin correlated with portal pressure (<italic>R</italic> = 0·50, <italic>P </italic><<italic> </italic>0·001). Proadrenomedullin correlated with portal pressure (<italic>R</italic> = 0·48, <italic>P </italic><<italic> </italic>0·001) and heart rate (<italic>R</italic> = 0·36, <italic>P </italic><<italic> </italic>0·01). ProANP correlated with cardiac output (<italic>R</italic> = 0·46, <italic>P </italic>< 0·002) and portal pressure (<italic>R</italic> = 0·32, <italic>P </italic><<italic> </italic>0·02). All propeptides correlated with Child score (<italic>R</italic> > 0·31, <italic>P </italic>< 0·03).</p> </sec> <sec id="eci12249-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Pro‐atrial natriuretic peptide is elevated in cirrhosis. Copeptin, proadrenomedullin and proANP are related to portal pressure and seem associated with systemic haemodynamics. These propeptides may participate in development and perpetuation of vasodilatation and hyperdynamic circulation in cirrhosis.</p> </sec> </abstract>