Capillary microvascular function in patients with liver cirrhosis: a nailfold video-capillaroscopy study

Liver cirrhosis is characterized by major circulatory dysregulation, related to an imbalance between several vasoactive agents. Although alterations in intrahepatic and systemic vasculature have been rather well described, the peripheral microcirculation and endothelial function are less well studied. Our aim was to evaluate peripheral microcirculatory function in patients with cirrhosis via nailfold video-capillaroscopy.

We enrolled 60 patients with cirrhosis and 20 controls. All participants underwent nailfold video-capillaroscopy. Capillary density was measured at rest (baseline), after 4-min arterial occlusion (post-occlusive reactive hyperemia) and after 2-min venous congestion.

Cirrhotic patients presented lower capillary density than controls at baseline (35.8±3.6 vs. 38±1.1 capillaries/mm², P=0.01), during post-occlusive reactive hyperemia (40.0±4.4 vs. 45.3±1.5 capillaries/mm², P<0.001), and after venous congestion (43.3±4.2 vs. 47.2±1.5 capillaries/mm², P<0.001). Capillary density decreased significantly with deterioration of Child-Pugh class at baseline (Child-Pugh A: 38.0±3.9 vs. Child-Pugh B: 35.6±2.7 vs. Child-Pugh C: 33.9±3.2 capillaries/mm², P<0.001), during post-occlusive reactive hyperemia (43.5±3.4 vs. 39.8±3.0 vs. 36.8±3.9 capillaries/mm², respectively, P<0.001), and after venous congestion (46.7±3.1 vs. 43.0±2.7 vs. 40.1±3.8 capillaries/mm², respectively, P<0.001).

Capillary density in all phases was significantly lower in cirrhotic patients compared to controls. Moreover, a lower capillary density was associated with deteriorating Child-Pugh stages, suggesting that increasing severity of cirrhosis is associated with more impaired peripheral microcirculatory function.