Plasma endotoxin and tumor necrosis factor-α in the hyperkinetic state of cirrhosis

• Published in: Journal of hepatology Vol. 23; no. 4; pp. 391 - 395
• Main Authors: Le Moine, Olivier, Soupison, Thierry, Sogni, Philippe, Marchant, Arnaud, Moreau, Richard, Hadengue, Antoine, Goldman, Michel, Devière, Jacques, Lebrec, Didier
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.10.1995; Elsevier
• Subjects: Biological and medical sciences; Cardiac output; Circulation; Cirrhosis; Endotoxin; Gastroenterology. Liver. Pancreas. Abdomen; Hemodynamics; Humans; Lipopolysaccharides - blood; Liver Cirrhosis - blood; Liver Cirrhosis - physiopathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Middle Aged; Other diseases. Semiology; Portal hypertension; Radioimmunoassay; Tumor Necrosis Factor-alpha - metabolism; Tumor necrosis factor-α; Cirrhosis; Cardiac output; Tumor necrosis factor-α; Endotoxin; Circulation; Portal hypertension; Human; Portal circulation disease; Liver; Cardiovascular disease; Hepatic disease; Increase; Vascular disease; Digestive diseases; Complication; Evolution; Influence; Hemodynamics; Comparative study; Tumor necrosis factor α
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/0168-8278(95)80196-0

Background/Aims: The factors which trigger the hyperdynamic circulation in cirrhosis remain poorly defined. Plasma levels of the potent vasodilators endotoxin and tumor necrosis factor-α may be elevated in patients with cirrhosis, and therefore the potential role of these substances was assessed in the hyperkinetic circulation in cirrhosis. Methods: Forty-nine patients in stable condition underwent systemic and hepatic hemodynamic measurements, and right atrial blood sampling for endotoxin and tumor necrosis factor-α assays. Patients were divided into three groups according to the severity of the disease: group 1 consisted of eight patients with normal liver or mild hepatic fibrosis, and groups 2 and 3 contained 17 and 24 patients with Child A and Child B or C cirrhosis, respectively. Results: Systemic vascular resistance decreased and cardiac index increased from group 1 to 3: 1530±196 dyn·s·cm −5 to 990±72 dyn·s·cm −5 (mea±S.E.; p<0.05) and 3.1±0.3 l·min −1·min −2 to 4.2−0.2 l·min −1·m −2, respectively. Endotoxin was not detectable in any of the groups and tumor necrosis factor-α was increased in one patient from group 1, six from group 2 and six from group 3. Mean tumor necrosis factor-α levels were not different among the groups (10±5, 18±5 and 17±7 pg/ml in groups 1, 2 and 3, respectively). Systemic vascular resistance and cardiac index were not correlated to plasma tumor necrosis factor-α levels; patients with increased levels of this cytokine did not have worse hyperdynamic circulation in any of the groups. Conclusions: These results suggest that tumor necrosis factor-α and endotoxin do not play a role in the maintenance of the hyperkinetic state of cirrhosis.