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Vasodilatory State of Decompensated Cirrhosis: Relation to Hepatic Dysfunction, Ascites, and Vasoactive Substances
Author(s) -
Friedman Howard S.,
Cirillo Nicholas,
Schiano Frank,
Nathan Paul,
Khan Sultan,
Rosero Hugo,
Vaseghi Mehdi,
Sacchi Terrence,
Vasavada Balendu,
Bjornson Loring
Publication year - 1995
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/j.1530-0277.1995.tb01479.x
Subject(s) - vasoactive , ascites , vasodilation , cirrhosis , hepatic dysfunction , medicine , cardiology
The objective of this study was to determine the relations between the hallmark circulatory finding of decompensated cirrhosis, a reduced systemic vascular resistance (SVR), and the indices of hepatic decompensation, the accumulation of ascites, and the concentrations of various vasoactive substances. At a university‐affiliated teaching hospital, eighteen hospitalized patients with cirrhosis and 18 age‐ and sex‐matched healthy subjects were used. This was a case‐control study. Measurements included cardiac dimensions and indices derived from echocardiograms and Doppler studies, abdominal ultrasound estimates of ascites, indices of hepatic function, and various serum (S) and urinary (U) substances. Results showed that cirrhotics had increased left atrial and left ventricular dimensions, left ventricular mass, heart rate, cardiac output (CO), transvalvular velocities, and a decreased SVR. SVR was related to hepatic dysfunction, as reflected by an abnormal prothrombin time ratio ( r = ‐0.64, p = 0.006), and also related to overall severity of liver disease as estimated by the Child‐Pugh score ( r = ‐0.53, p = 0.044). Although cirrhotics with ascites generally had a reduced SVR, estimates of ascites were directly related to SVR (r = 0.57, p = 0.03) and inversely related to CO ( r = ‐0.53, p = 0.04). Concentrations of S and U digoxin‐like immunoreactive substance (DLIS) were also increased, but the concentrations of S glucagon and estradiol were not elevated. The accumulations of S and U DLIS, S glucagon, and S estradiol were all related to hepatic dysfunction. S estradiol was also related to SVR ( r = ‐0.55, p = 0.04), but this was only evident with S estradiol expressed as a logarithm and did not emerge as significant on a multivariate analysis. The reduced SVR observed in decompensated cirrhosis is related to various indices of hepatic dysfunction. Certain substances that accumulate in cirrhosis (such as DLIS, glucagon, and estradiol) do not explain the vasodilatation observed. Although ascites in decompensated cirrhosis generally signifies a vasodilated state, a reduced SVR may be found even before ascites is clinically evident, and tense ascites may actually obscure this finding.