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Clinical significance of elevated plasma endothelin concentration in patients with cirrhosis
1Second Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
Insights
Elevated plasma endothelin levels are significantly higher in patients with cirrhosis and ascites, correlating with kidney dysfunction. This increase is linked to endotoxemia in chronic liver disease patients.
Area of Science:
- Cardiovascular Physiology
- Hepatology
- Nephrology
Background:
- Endothelin is a potent vasoconstrictor peptide.
- Chronic liver diseases can lead to significant physiological changes.
- The role of endothelin in liver disease complications requires further elucidation.
Purpose of the Study:
- To investigate the clinical significance of plasma endothelin concentrations in patients with chronic liver diseases.
- To compare endothelin levels in patients with chronic hepatitis, cirrhosis with ascites, and cirrhosis without ascites against normal controls.
- To explore the relationship between plasma endothelin levels and kidney function markers in cirrhotic patients.
Main Methods:
- Plasma endothelin concentrations were measured in patients with chronic hepatitis (n=15), cirrhosis with ascites (n=8), cirrhosis without ascites (n=12), and normal controls (n=14).
- Creatinine clearance and fractional excretion of filtered sodium were assessed in cirrhotic patients.
- Plasma endothelin levels were also compared between patients with and without endotoxemia.
Main Results:
- Plasma endothelin was significantly elevated in cirrhosis with ascites compared to controls (8.3 +/- 2.3 pg/ml vs. 3.3 +/- 1.4 pg/ml, p < 0.001).
- No significant differences were found in endothelin levels between controls and patients with chronic hepatitis or cirrhosis without ascites.
- A significant negative correlation was observed between plasma endothelin and creatinine clearance (r = -0.73, p < 0.01) in cirrhotic patients.
- Endothelin levels were markedly higher in patients with endotoxemia (10.1 +/- 2.1 pg/ml) than without (4.9 +/- 1.2 pg/ml, p < 0.001).
Conclusions:
- Elevated plasma endothelin is associated with cirrhosis, particularly when ascites is present.
- Increased endothelin levels may contribute to kidney dysfunction in cirrhosis, potentially mediated by endotoxemia.
- Endothelin warrants further investigation as a biomarker and therapeutic target in chronic liver disease complications.
Abstract:
Endothelin is a newly discovered potent vasoconstrictor peptide. To explain the clinical significance of endothelin in patients with chronic liver diseases, we measured the plasma concentration of endothelin in patients with chronic hepatitis (n = 15), cirrhosis with ascites (n = 8) and cirrhosis without ascites (n = 12), and we compared the findings with the plasma concentration of endothelin in normal controls (n = 14). The plasma endothelin concentration was significantly higher in patients with cirrhosis with ascites than in normal controls (8.3 +/- 2.3 pg/ml vs. 3.3 +/- 1.4 pg/ml, mean +/- S.D., p less than 0.001), whereas no significant difference was observed between normal controls and the other groups of patients (cirrhosis without ascites = 5.0 +/- 1.3 pg/ml; chronic hepatitis = 3.8 +/- 1.2 pg/ml). In patients with cirrhosis, the plasma endothelin concentration showed a significant negative correlation with creatinine clearance (r = -0.73, p less than 0.01), but no significant correlation was observed between plasma endothelin concentration and fractional excretion of filtered sodium. Furthermore, plasma endothelin levels were significantly higher in patients with endotoxemia than in those without (10.1 +/- 2.1 pg/ml vs. 4.9 +/- 1.2 pg/ml, p less than 0.001). From these results, elevated plasma endothelin, which has a close relation to endotoxemia, may play a contributory role in kidney dysfunction in patients with cirrhosis.