New vasoactive peptides in cirrhosis: organ extraction and relation to the vasodilatory state
Article first published online: 26 FEB 2014
© 2014 Stichting European Society for Clinical Investigation Journal Foundation
European Journal of Clinical Investigation
Volume 44, Issue 5, pages 441–452, May 2014
How to Cite
Eur J Clin Invest 2014; 44 (5): 441–452
- Issue published online: 17 APR 2014
- Article first published online: 26 FEB 2014
- Accepted manuscript online: 29 JAN 2014 11:19AM EST
- Manuscript Accepted: 25 JAN 2014
- Manuscript Received: 4 OCT 2013
- The Novo Nordisk Foundation
- Lundbeck Foundation
- portal hypertension;
- proatrial natriuretic peptide
Patients with cirrhosis have substantial circulatory imbalance between vasoconstrictive and vasodilating forces. The study of circulatory vasoactive peptides may provide important pathophysiological information. This study aimed to assess concentrations, organ extraction and relations to haemodynamic changes in the pro-peptides copeptin, proadrenomedullin and pro-atrial natriuretic peptide (proANP) in patients with cirrhosis.
Materials and methods
Fifty-four cirrhotic patients and 15 controls were characterized haemodynamically during a liver vein catheterization. Copeptin, proadrenomedullin and proANP were measured in hepatic and renal veins and the femoral artery.
We found no differences in concentrations of copeptin and proadrenomedullin between patients and controls. ProANPs were higher in cirrhotic patients, median 138 pm (25/75 percentiles 101–194) compared with controls, median 91 pm (25/75 percentiles 82–153) P = 0·02. ProANPs were higher in the femoral artery and renal vein, median 140 pm and 116 pm (25/75 percentiles 109–191 and 92–164, respectively), compared with controls, median 99 and 81 (25/75 percentiles 85–146 and 66–123) P = 0·02 and P = 0·007, respectively. We found no extraction of copeptin, proadrenomedullin or proANP over the liver. Copeptin correlated with portal pressure (R = 0·50, P < 0·001). Proadrenomedullin correlated with portal pressure (R = 0·48, P < 0·001) and heart rate (R = 0·36, P < 0·01). ProANP correlated with cardiac output (R = 0·46, P < 0·002) and portal pressure (R = 0·32, P < 0·02). All propeptides correlated with Child score (R > 0·31, P < 0·03).
Pro-atrial natriuretic peptide is elevated in cirrhosis. Copeptin, proadrenomedullin and proANP are related to portal pressure and seem associated with systemic haemodynamics. These propeptides may participate in development and perpetuation of vasodilatation and hyperdynamic circulation in cirrhosis.