TITLE

HEPATIC INFLAMMATION IS AN IMPORTANT DETERMINANT OF PORTAL PRESSURE IN ALCOHOLIC LIVER DISEASE

AUTHOR(S)
Mookerjee, R.P.; Hodges, S.J.; Davies, N.A.; Williams, R.; Jalan, R.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA22
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: A hyperdynamic circulation and elevated portal pressure are established features of cirrhosis. Furthermore, in patients with alcoholic cirrhosis with superadded inflammation, defined on biopsy as alcoholic hepatitis (AH), an inflammatory cytokine cascade perpetuates further injury. We hypothesise that this additional hepatic inflammation in these patients is central to further deterioration in their portal haemodynamics. Methods: 10 patients with cirrhosis and superadded inflammation on biopsy, fulfilling histological criteria for AH, (5 male; age 49.5 [34-69]; discriminant function [DF] 36.8 ± 9.6) were compared with 13 patients with only alcoholic cirrhosis (12 male; age 51 [40-62]; DF 17.4 ± 5.5). Cardiovascular haemodynamics (cardiac output [CO] and systemic vascular resistance [SVR] using a Swan-Ganz catheter, and mean arterial pressure) and wedged hepatic venous pressure gradient [HVPG] were assessed in both groups using standard techniques, during routine clinical assessment, in accordance with local ethics approval. Clinical and biochemical profiles were also assessed. IL-6 and IL-8 plasma levels were assayed via commercially available ELISAs. Results: The patients fulfilling AH biopsy criteria had significantly elevated white blood cell counts (13.7±2.7 v 7.8±0.9; p < 0.05), C-reactive protein [36.0±5 v 18.9±3.8; p < 0.05) and systemic inflammatory response syndrome scores (1.4±0.3 v 0.2±0.1; p < 0.01) compared with patients with alcoholic cirrhosis alone (AC). Significant differences in haemodynamics were noted between the 2 groups, following nonparametric analysis (Mann-Whitney, *p < 0.05; **p < 0.01 ). The measured pro-inflammatory cytokines, IL-6 and IL-8, also showed substantial increases in the AH group compared to AC (p < 0.05 in each case). Conclusions: This study demonstrates a significant difference in portal and systemic haemodynamics between patients with alcoholic...
ACCESSION #
9747403

 

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