scholarly journals Plasma Cyclic Guanosine Monophosphate Is a Promising Biomarker of Clinically Significant Portal Hypertension in Patients With Liver Cirrhosis

2022 ◽  
Vol 8 ◽  
Author(s):  
Lukas Sturm ◽  
Dominik Bettinger ◽  
Lisa Roth ◽  
Katharina Zoldan ◽  
Laura Stolz ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Cyclic Guanosine Monophosphate ◽  
Guanosine Monophosphate ◽  
Healthy Controls ◽  
Screening Endoscopy ◽  
Portal Decompression ◽  
Potential Biomarker ◽  
Cirrhotic Patients ◽  
Clinically Significant

Introduction: Despite intensive research, reliable blood-derived parameters to detect clinically significant portal hypertension (CSPH) in patients with cirrhosis are lacking. As altered homeostasis of cyclic guanosine monophosphate (cGMP), the central mediator of vasodilatation, is an essential factor in the pathogenesis of portal hypertension, the aim of our study was to evaluate plasma cGMP as potential biomarker of cirrhotic portal hypertension.Methods: Plasma cGMP was analyzed in cirrhotic patients with CSPH (ascites, n = 39; esophageal varices, n = 31), cirrhotic patients without CSPH (n = 21), patients with chronic liver disease without cirrhosis (n = 11) and healthy controls (n = 8). cGMP was evaluated as predictor of CSPH using logistic regression models. Further, the effect of transjugular intrahepatic portosystemic shunt (TIPS) placement on plasma cGMP was investigated in a subgroup of cirrhotic patients (n = 13).Results: Plasma cGMP was significantly elevated in cirrhotic patients with CSPH compared to cirrhotic patients without CSPH [78.1 (67.6–89.2) pmol/ml vs. 39.1 (35.0–45.3) pmol/l, p < 0.001]. Of note, this effect was consistent in the subgroup of patients with esophageal varices detected at screening endoscopy who had no prior manifestations of portal hypertension (p < 0.001). Cirrhotic patients without CSPH displayed no significant elevation of plasma cGMP compared to patients without cirrhosis (p = 0.347) and healthy controls (p = 0.200). Regression analyses confirmed that cGMP was an independent predictor of CSPH (OR 1.042, 95% CI 1.008–1.078, p = 0.016). Interestingly, portal decompression by TIPS implantation did not lead to normalization of plasma cGMP levels (p = 0.101).Conclusions: Plasma cGMP is a promising biomarker of CSPH in patients with cirrhosis, especially with respect to screening for esophageal varices. The lacking normalization of plasma cGMP after portal decompression suggests that elevated plasma cGMP in cirrhotic portal hypertension is mainly a correlate of systemic and splanchnic vasodilatation, as these alterations have been shown to persist after TIPS implantation.

scholarly journals “SPLEEN STIFFNESS MEASUREMENT IN LIVER CIRRHOSIS PATIENTS FOR NONINVASIVE ASSESSMENT OF ESOPHAGEAL VARICES USING FIBROSCAN”

2020 ◽  
pp. 1-2
Author(s):  
Revathy Marimuthu Shanmugam ◽  
Vinay C ◽  
Sathya Gopalasamy ◽  
Chitra Shanmugam
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Esophageal Varix ◽  
Esophageal Varices ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Surrogate Marker ◽  
Stiffness Measurement ◽  
Spleen Stiffness ◽  
Cirrhotic Patients

BACKGROUND: Many noninvasive surrogate marker for Portal hypertension or for the presence or grade of esophageal varices were studied..Splenomegaly along with splenic congestion secondary to splenic hyperdynamic circulation is seen secondary to Portal hypertension in cirrhotic patients that can be quantified by elastography. AIM:The aim of this study was to investigate whether spleen stiffness, assessed by TE, useful tool for grading chronic liver diseases and to compare its performance in predicting the presence and size of esophageal varices in liver cirrhosis patients. METHODOLOGY:86 patients with cirrhosis and 80 controls underwent transient elastography of liver and spleen for the assessment of liver stiffness (LSM) and spleen stiffness (SSM) . Upper GI endoscopy done in all Cirrhotic patients. RESULTS: Spleen stiffness showed higher values in liver cirrhosis patients as compared with controls: 58.2 kpa vs14.8 kpa (P < 0.0001) and also found to be significantly higher in cirrhotic patients compared with varices and those without varices (69.01 vs 42.05 kpa, P < 0.0001). Liver stiffness was also found to be higher in cirrhotic patients with varices when compared to patients without varices (38.5vs 21.2 kpa). Using both liver and spleen stiffness measurement we can predicted the presence of esophageal varices correctly. CONCLUSION: Spleen stiffness can be assessed using transient elastography, higher value correlated well with liver cirrhosis and presence of esophageal varices although it couldn’t correlate with grade of Esophageal Varix. Combined assessment of spleen and liver stiffness had better prediction of presence of Esophageal Varix.

scholarly journals Divergences in Macrophage Activation Markers Soluble CD163 and Mannose Receptor in Patients With Non-cirrhotic and Cirrhotic Portal Hypertension

2021 ◽  
Vol 12 ◽  
Author(s):  
Nikolaj Worm Ørntoft ◽  
Michel Blé ◽  
Anna Baiges ◽  
Jose Ferrusquia ◽  
Virginia Hernández-Gea ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Macrophage Activation ◽  
Mannose Receptor ◽  
Idiopathic Portal Hypertension ◽  
Healthy Controls ◽  
Activation Markers ◽  
Vein Thrombosis ◽  
Soluble Cd163 ◽  
Cirrhotic Patients

IntroductionMacrophages are involved in development and progression of chronic liver disease and portal hypertension. The macrophage activation markers soluble (s)CD163 and soluble mannose receptor (sMR), are associated with portal hypertension in patient with liver cirrhosis but never investigated in patients with non-cirrhotic portal hypertension. We hypothesized higher levels in cirrhotic patients with portal hypertension than patients with non-cirrhotic portal hypertension. We investigated sCD163 and sMR levels in patients with portal hypertension due to idiopathic portal hypertension (IPH) and portal vein thrombosis (PVT) in patients with and without cirrhosis.MethodsWe studied plasma sCD163 and sMR levels in patients with IPH (n = 26), non-cirrhotic PVT (n = 20), patients with cirrhosis without PVT (n = 31) and with PVT (n = 17), and healthy controls (n = 15).ResultsMedian sCD163 concentration was 1.51 (95% CI: 1.24–1.83) mg/L in healthy controls, 1.96 (95% CI: 1.49–2.56) in patients with non-cirrhotic PVT and 2.16 (95% CI: 1.75–2.66) in patients with IPH. There was no difference between non-cirrhotic PVT patients and healthy controls, whereas IPH patients had significantly higher levels than controls (P &lt; 0.05). The median sCD163 was significantly higher in the cirrhotic groups compared to the other groups, with a median sCD163 of 6.31 (95% CI: 5.16–7.73) in cirrhotics without PVT and 5.19 (95% CI: 4.18–6.46) with PVT (P &lt; 0.01, all). Similar differences were observed for sMR.ConclusionSoluble CD163 and sMR levels are elevated in patients with IPH and patients with cirrhosis, but normal in patients with non-cirrhotic PVT. This suggests that hepatic macrophage activation is more driven by the underlying liver disease with cirrhosis than portal hypertension.

scholarly journals Rapid Development of Bleeding Esophageal Varices after Placement of Continuous Flow Left Ventricular Assist Device

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Kaushal Majmudar ◽  
Michael Northcutt ◽  
Robert Gordon ◽  
Claus J. Fimmel
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Continuous Flow ◽  
Rapid Development ◽  
Fatal Outcome ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Compensated Cirrhosis ◽  
Bleeding Esophageal Varices ◽  
Cirrhotic Patients

We describe a patient with compensated cirrhosis and portal hypertension who underwent continuous flow LVAD implantation. Shortly after LVAD implantation, the patient developed new onset bleeding esophageal varices and ultimately had a fatal outcome. Our experience suggests that even well-compensated cirrhotic patients with significant portal hypertension are at risk of variceal bleeding after LVAD placement.

scholarly journals A study on non endoscopic predictors of esophageal varices and portal hypertension in chronic liver disease

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 228-234
Author(s):  
Karthick M ◽  
Prabakaran P T ◽  
Rajendran K ◽  
Gowrishankar A ◽  
Halleys Kumar E ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Chronic Liver ◽  
First Episode ◽  
Oesophageal Varices ◽  
Screening Endoscopy

Portal hypertension is associated with liver cirrhosis and esophageal varices is a common complication. Cirrhotic liver increases resistance to the passage of blood and thereby increased splanchnic blood flow secondary to vasodilation. Prevalence of portal hypertension varies from 50-60% in patients with liver cirrhosis. The first episode of variceal bleeding causes mortality, which ranges from 40-70%. All cirrhotic patients should be screened for the oesophageal varices according to  Baveno III consensus conference on portal hypertension and recommendation for endoscopy is at 2-3 years intervals in patients without varices and at 1-2 years interval in patients with small varices in order to evaluate the development or variceal progression. But this is questionable as endoscopy is an invasive procedure and also cost-effective. Only 9-36% of patients with cirrhosis were found to have varices on screening endoscopy. Non-invasive assessment of variceal bleeding with good predictivity includes biochemical, clinical and ultrasonographic parameters. Thus unnecessary intervention is avoided and at the same time, the patients at risk of bleeding are also not missed. This study emphasizes the need for an annual ultrasonogram examination as a part of a surveillance program for screening of oesophageal varices in patients of chronic liver disease.

scholarly journals Hyaluronic Acid, Spleen Size and Prothrombin Time Predict the Existence of High-Risk Esophageal Varices in Non-Viral Cirrhosis in Real Life

2020 ◽  
Vol 17 (1) ◽  
pp. 7-19
Author(s):  
Silvia Sovaila ◽  
Adrian Purcarea ◽  
Jean Pierre Fauchart ◽  
Dan Gheonea ◽  
Tudorel Ciurea
Keyword(s):  
Platelet Count ◽  
Hyaluronic Acid ◽  
Portal Hypertension ◽  
High Risk ◽  
Prothrombin Time ◽  
Esophageal Varices ◽  
Liver Stiffness ◽  
Real Life ◽  
Spleen Size ◽  
Cirrhotic Patients

AbstractBackground and aims. Biomarkers are a simple and inexpensive way to replace the invasive diagnostic test(1,2). Portal hypertension screening recommendations in cirrhotic patients propose two such biomarkers: the platelet count and liver elastography. This recommendation derives from studies on viral cirrhosis(3). Viral cirrhosis is biologically and histologically different from steatosis related cirrhosis and traditional biomarkers used for high-risk varices screening might not be of use in this category. We aimed to evaluate their utility compared to other biomarkers for the prediction of high-risk varices of non-viral etiology in cirrhotic patients.Methods. Our current study is a monocentric, real-life, cross-sectional analysis of non-viral cirrhosis patients.Results. 50 patients with suspected cirrhosis, who underwent upper gastrointestinal endoscopy, were included prospectively for over 8 months and 41 were analyzed. The etiology was steatohepatitis (alcohol and non-alcohol related steatohepatitis). Hyaluronic acid (AUC 0.866, r =0.600), prothrombin time (AUC 0.708, r =0.445) and spleen size (AUC 0.763, r =0.337) significantly correlated with high-risk esophageal varices. In the meantime, liver stiffness was difficult to obtain and only correlated modestly with high-risk esophageal varices and platelet count was a poor predictor of high-risk esophageal varices in this mainly steatosis related cohort of cirrhotic patients.Conclusion. We proposed hyaluronic acid, spleen size and prothrombin time as alternatives biomarkers for portal hypertension in steatohepatitis patients. Their potency should be further proven in larger studies.

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