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Regional sympathetic activity, severity of liver disease and hemodynamics in patients with cirrhosis

1991; Elsevier BV; Volume: 13; Issue: 2 Linguagem: Inglês

10.1016/0168-8278(91)90810-x

1600-0641

Christophe Gaudin, Alain Braillon, Jorge Luis Poo, Richard Moreau, Antoine Hadengue, Didier Lebrec,

Infrared Thermography in Medicine

One hundred and eight patients with cirrhosis (23 grade A, 46 grade B and 39 grade C, according to Pugh's classification) underwent hemodynamic studies and plasma catecholamine concentration measurements. Blood samples were withdrawn from the pulmonary artery (n = 108), the hepatic vein (n = 108), the azygos vein (n = 59), the right renal vein (n = 66), the right jugular vein (n = 34) and the femoral vein (n = 33). Plasma noradrenaline concentrations in the pulmonary artery and the hepatic vein were more elevated in grade B (607 ± 52 and 402 ± 42 pg/ml, respectively) and C patients (630 ± 59 and 475 ± 53 pg/ml, respectively) than in grade A patients (411 ± 51 and 243 ± 40 pg/ml, respectively). Plasma noradrenaline concentrations from these two vessels were negatively correlated with indocyanine green clearance. These results indicate that both overall and splanchnic sympathetic activities are dependent on altered hepatic function. Significant correlations were found between the wedged hepatic venous pressure and plasma noradrenaline concentrations from either the pulmonary artery, the hepatic vein or the azygos vein. These correlations indicate that both overall and splanchnic sympathetic activities are dependent on the degree of portal hypertension. Moreover, significant correlations were found between hepatic venous plasma noradrenaline concentrations and systemic hemodynamic values, suggesting that splanchnic sympathetic nervous activity could either play a role in the systemic hyperkinetic syndrome or be a consequence of this hyperkinetic syndrome. Net release of noradrenaline was higher in the kidneys (106 ± 20 ng/min) than in the azygos vein territory (19 ± 8 ng/min). Net splanchnic extraction of noradrenaline did not depend on the severity of liver disease. Net distributions of the central nervous system and the limbs to circulating noradrenaline were very poor. This study shows that although the splanchnic contribution to circulating noradrenaline is not predominant, due to high extraction in the liver, splanchnic sympathetic activity is highly related with both the severity of liver disease and the hemodynamic changes in cirrhosis.