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New vasoactive peptides in cirrhosis: organ extraction and relation to the vasodilatory state
Author(s) -
Kimer Nina,
Goetze Jens Peter,
Bendtsen Flemming,
Møller Søren
Publication year - 2014
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12249
Subject(s) - medicine , cirrhosis , copeptin , cardiology , circulatory system , vasodilation , natriuretic peptide , portal venous pressure , atrial natriuretic peptide , blood pressure , endocrinology , heart failure , portal hypertension , vasopressin
Background 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 (pro ANP ) in patients with cirrhosis. Materials and methods Fifty‐four cirrhotic patients and 15 controls were characterized haemodynamically during a liver vein catheterization. Copeptin, proadrenomedullin and pro ANP were measured in hepatic and renal veins and the femoral artery. Results We found no differences in concentrations of copeptin and proadrenomedullin between patients and controls. Pro ANPs were higher in cirrhotic patients, median 138 p m (25/75 percentiles 101–194) compared with controls, median 91 p m (25/75 percentiles 82–153) P = 0·02. Pro ANPs were higher in the femoral artery and renal vein, median 140 p m and 116 p m (25/75 percentiles 109–191 and 92–164, respectively), compared with controls, median 99 and 81 (25/75 percentiles 85–146 and 66–123) P = 0·02 and P = 0·007, respectively. We found no extraction of copeptin, proadrenomedullin or pro ANP over the liver. Copeptin correlated with portal pressure ( R = 0·50, P < 0·001). Proadrenomedullin correlated with portal pressure ( R = 0·48, P < 0·001) and heart rate ( R = 0·36, P < 0·01). Pro ANP correlated with cardiac output ( R = 0·46, P < 0·002) and portal pressure ( R = 0·32, P < 0·02). All propeptides correlated with C hild score ( R > 0·31, P < 0·03). Conclusions Pro‐atrial natriuretic peptide is elevated in cirrhosis. Copeptin, proadrenomedullin and pro ANP 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.