Elsevier

Journal of Hepatology

Volume 13, Issue 2, September 1991, Pages 161-168
Journal of Hepatology

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

https://doi.org/10.1016/0168-8278(91)90810-XGet rights and content

Abstract

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 Blood samples were withdrawn from the pulmonary artery (n = 108), the hepatic vein (n = 108), the azygos vein (n = 59), the right renal vein (n = 66), the right jugular vein (n = 34) and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.

References (26)

  • DS Goldstein et al.

    Relationship between plasma norepinephrine and sympathetic neural activity

    Hypertension

    (1983)
  • JH Henriksen et al.

    Splanchnic and renal elimination and release of catecholamines in cirrhosis. Evidence of enhanced sympathetic nervous activity in patients with decompensated cirrhosis

    Gut

    (1984)
  • H Ring-Larsen et al.

    Sympathetic nervous activity and renal and systemic hemodynamics in cirrhosis: plasma norepinephrine concentration, hepatic extraction and renal release

    Hepatology

    (1982)
  • Cited by (0)

    View full text