Lipoprotein alterations in liver cirrhosis: a possible contribution to changes in plasma oncotic pressure and viscosity

Plasma viscosity changes in patients with liver cirrhosis

OBJECTIVES

Plasma viscosity (PV) is a major determinant of capillary blood flow through the microcirculation, which, if impaired, can result in potentially important clinical sequelae. The objectives of this study were to investigate the alterations of PV values in different stages of cirrhosis, and to determine if any change in PV correlates with Child score or Model for End-Stage Liver Disease (MELD) score or has any prognostic significance.

METHOD

The study included 92 patients with cirrhosis and 28 healthy volunteers. Upper endoscopic and ultrasonographic examinations of the patients were obtained. Serum biochemistry fibrinogen, complete blood count, C-reactive protein (CRP), and lipid profile were performed. PV was determined using a rotational viscosimeter.

RESULTS

PV decreased with the progression in Child scores (Child A: 1.46 +/- 0.20 mPa-s, Child B: 1.33 +/- 0.21 mPa-s, Child C: 1.12 +/- 0.15 mPa-s), (P < 0.001). A similar change was detected between the MELD score and PV (P < 0.001). There was a positive correlation between the total protein, albumin and plasma viscosity in the control group, but a similar relationship was not found in cirrhotic patients. History of hepatic encephalopathy (30 of 92 patients) was independently associated with decreased PV (P = 0.003).

CONCLUSION

We observed that increasing Child and MELD scores were significantly associated with lower PV levels irrespective of biochemical and hematologic values. These observations support the concept that hemorheologic changes in cirrhotic patients might be either the cause or the result of a pathophysiological process, and it may not be easy to distinguish between these two possibilities.

Expression of apolipoprotein AI mRNA in peripheral white blood cells of patients with alcoholic liver disease

Because (i) changes in plasma and liver mRNA of apolipoprotein (apo) AI have been observed in patients with alcoholic liver disease, (ii) apo AI mRNA can be induced in non-hepatic tissues, and (iii) apolipoproteins expression is influenced by plasma colloid osmotic pressure (P(CO)) and viscosity (eta), we analyzed the Apo AI mRNA expression in the peripheral white blood cells (PWBC), P(CO), and eta in control volunteers (C), patients with liver cirrhosis (LC), and cirrhotic patients with superimposed alcoholic hepatitis (LC+AH). We found that apo AI mRNA is expressed in the PWBC in 20% of C and it is induced 1.5 fold in 66.6% of LC and 1.95 fold in 85% of LC+AH. A significant decrease of P(CO) in LC and LC + AH (14.8 +/- 2.4 and 16.2 +/- 2.4 mm Hg, respectively) compared to C (27.9 +/- 2 mm Hg) was observed. By contrast, eta was mildly increased from 1.7389 +/- 0.07 in C to 1.8022 +/- 0.154 in LC and 1.9030 +/- 0.177 in LC+AH. No significant correlation was found between P(CO) and eta with apo AI mRNA but with lipid profile. In conclusion, apo AI mRNA expression in PWBC is associated to liver disease severity and could be an indirect indicator of alcoholic liver damage.

Plasma phospholipid fatty acid pattern in severe liver disease

BACKGROUND/AIMS

In acute liver failure the liver has to regenerate, which may increase the consumption of essential fatty acids. Nutritional support consists mainly of infusion of glucose. It is therefore possible that essential fatty acid deficiency may develop in such patients.

METHODS

Plasma phospholipid composition was studied in healthy controls (n=11), in patients with acute liver failure, (n=10), in patients with stable cirrhosis (n=7), and in patients with acute on chronic liver disease with hepatic encephalopathy (n=6). The influence of 2 days of fat-free diet followed by infusion of glucose was studied in five healthy controls.

RESULTS

The ratio between the sums of nonessential/ essential fatty acids, (n-7+n-9)/(n-3+n-6), was higher in patients with acute liver failure (0.73+/-0.17) compared to healthy controls (0.35+/-0.06, p<0.001). The ratio was also higher in patients with acute on chronic liver disease (1.11+/-0.39) compared to patients with cirrhosis (0.61+/-0.18, p<0.01). These differences were mainly due to low levels of linoleic acid and high levels of oleic acid in the patients with acute liver failure and acute on chronic liver disease. Two days of fat-free diet followed by infusion of glucose did not change this ratio (0.40+/-0.04 vs. 0.47+/-0.05, NS) in healthy controls. The essential fatty acid deficiency indicator eicosatrienoic acid was detectable in 2 out of 11 controls, in 5/10 with acute liver failure, in 7/7 with cirrhosis, and in 6/7 with acute on chronic liver disease.

CONCLUSION

Acute severe deterioration of liver function was associated with changes in the fatty acid composition of plasma phospholipids suggestive of essential fatty acid deficiency.

The organ extraction and splanchnic haemodynamic effects of octreotide in cirrhotic patients

BACKGROUND

Intravenous octreotide is an established treatment of oesophageal variceal haemorrhage in the cirrhotic patient.

AIM

To examine the organ extraction and splanchnic haemodynamic effects of octreotide in cirrhotic patients with portal hypertension.

METHODS

Thirteen patients with cirrhosis had hepatic venous catheterization performed. Hepatic venous pressure gradient (HVPG), indocyanine green (ICG) clearance and hepatic blood flow (HBF) were determined in the basal state and during 60 min of octreotide infusion by bolus injection (0.75 microg/kg) followed by continuous infusion of 0.75 microg/kg x h. Blood samples were simultaneously drawn from the femoral artery and the hepatic and renal veins.

RESULTS

The extraction fraction of octreotide in the liver was 0.05 (-0.01 - 0.14) (median (interquartile range)) and in the kidneys 0.16 (-0.06 - 0.35). The extraction fraction ratio (E(liver)/E(kidney)) was 0.69 (-0.20 - 1.06). Hepatic clearance was 47 mL/min (3-88) (n = 11). No correlations were found between liver biochemistry or galactose elimination capacity (GEC; a metabolic measure of liver function) and renal extraction fraction or liver clearance. Octreotide had no effect on HVPG or wedged hepatic venous pressure although free hepatic venous pressure increased during octreotide infusion: 6 mmHg (5-9) vs. 7 mmHg (6-10) (P = 0.02). No effect on HBF was observed while ICG clearance decreased significantly.

CONCLUSIONS

Octreotide is extracted in cirrhotic patients by both the liver and the kidney, the latter being the most important organ of elimination. Octreotide decreases liver metabolic activity determined by the ICG clearance technique, but no significant effects of octreotide on HVPG or HBF could be demonstrated.

Evaluation of a homogeneous assay for high-density lipoprotein cholesterol: limitations in patients with cardiovascular, renal, and hepatic disorders

We evaluated the performance of a homogeneous assay for the automated measurement of high-density lipoprotein cholesterol (HDL-C) and compared it with a conventional precipitation technique in the following groups of people: control subjects (group A), clinically-healthy elderly (group B), myocardial infarction patients (group C), nephrotic syndrome patients (group D), and liver cirrhosis patients (group E). The performance of the technique was acceptable with respect to precision, accuracy, linearity, and detection limit. Triglycerides up to 40 mmol/L and bilirubin up to 150 μmol/L did not cause interferences. Hemoglobin decreased HDL-C measurements. Samples were stable at −20 °C for up to four months. Bland–Altman plots showed a good agreement between both techniques in the control group but with a progressive divergence in the patient groups B to E. Results indicate limitations of the technique in certain clinical conditions and, coincidentally, the need for reliable calibration materials.