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Plasma renin concentration represents an independent risk factor for mortality and is associated with liver dysfunction in patients with cirrhosis
Author(s) -
Paternostro Rafael,
Reiberger Thomas,
Mandorfer Mattias,
Schwarzer Remy,
Schwabl Philipp,
Bota Simona,
Ferlitsch Monika,
Trauner Michael,
PeckRadosavljevic Markus,
Ferlitsch Arnulf
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13439
Subject(s) - medicine , portal hypertension , gastroenterology , cirrhosis , supine position , portal venous pressure , plasma renin activity , transient elastography , liver disease , blood pressure , renin–angiotensin system , liver fibrosis
Background and Aim Plasma renin concentration (PRC) is increased in patients with cirrhosis. The aims of this study were to evaluate the relation of PRC to (i) portal hypertension, (ii) degree of liver dysfunction, and (iii) survival. Methods Plasma renin concentration (range 2.8–39.9 μU/mL) was measured after 30 min in supine position. Also, hepatic venous pressure gradient (HVPG), Child–Pugh (CPS), model for end‐stage liver disease scores and transient elastography values (TE, Fibroscan) were evaluated at this time. Mortality was recorded during follow‐up. Results One hundred fifty cirrhotic patients (age 55 ± 11 years; 73% male; CPS A 41.3%/B 41.3%/C 17.3%) were included. Mean HVPG was 16.6 ± 6.5 mmHg. Median PRC according to CPS was A 15.45 μU/mL (95%CI 1.56–261.5), B 37.3 μU/mL (95%CI 4.29–1317.65), and C 175.3 μU/mL (95%CI 5.3–5684; P < 0.001). In patients with clinical significant portal hypertension (HVPG ≥ 10 mmHg, n = 123) median PRC was 31.2 μU/mL (95%CI 2.76–1345.4), in those without was 13.7 μU/mL (95%CI 2.7–428.2; P = 0.009). Significantly higher TE values (33.2 [13–75] vs 59.65 kPa [14.5–75]; P = 0.014) were found in patients with elevated PRC. Median follow up was 711 days (95%CI 24–1152). Twenty‐two (36.1%) of the 61 patients with elevated PRC and 11 of the 89 (12.4%) with normal PRC died ( P = 0.001). Median PRC was significantly higher in patients that died (83.6 μU/mL [3.39–4451.9] vs 21.5 μU/mL [2.6–1197.9]; P = 0.001). Elevated PRC ( P = 0.005; HR 3.36; 95%CI 1.46–7.85), hepatocellular carcinoma ( P < 0.001; HR 10.68; 95%CI 3.64–31.3), CPS B ( P = 0.013; HR 3.69; 95%CI 1.31–10.4) and CPS C ( P = 0.008; HR 5.36; 95%CI 1.54–18.62) emerged as independent risk factors for mortality. Conclusions In cirrhotic patients PRC correlates with the severity of portal hypertension and liver dysfunction. Moreover, elevated PRC represents an independent risk factor for mortality.