- Email: [email protected]
[218] BACTERIAL TRANSLOCATION INDUCES PROINFLAMMATORY CYTOKINES AND WORSENS SYSTEMIC HEMODYNAMICS IN CIRRHOTIC PATIENTS WITH ASCITES
POSTERS
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Results: Cases and controls were similar with respect to pretreatment with terlipressin. The HRS recurrence probability was similar between the two groups (cases: 819, 89% vs controls: 919, loo%, p=ns). No significant differences were found between cases and controls with respect to serum creatinine (1.8f0.1 vs 2.1&0.1 mgidl), blood creatinine clearance ( 2 8 f 9 vs 2 1 f 5 ml/min), urinary sodium excretion (12&2 vs 1 9 f 4 mEqid) and PRA levels (16 f 4 vs 20&2 ngimllh) after terlipressin withdrawal (p = ns). Conclusions: These results indicate that HRS recurrence in patients responders to terlipressin is not different between patients treated with midodrine and subjects who received no prophylactic treatment. These data suggest that midodrine is not effective in preventing HRS type 2 recurrence.
12171 MlDODRlNE VERSUS ALBUMIN IN THE PREVENTION OF PARACENTESIS INDUCED CIRCULATORY DYSFUNCTION IN PATIENTS WITH CIRRHOSIS AND TENSE ASCITES? A RANDOMIZED STUDY B. Appenrodt, A. Wolf, F. Gruenhage, J. Trebicka, M. Schepke, of Bonn, T. Sauerbruch, J. Heller. Depurtment of Medicine 1, Uniuer~xit?, Bonn, Germany
E-mail: [email protected]
Background and Aims: In patients with cirrhosis and tense ascites largevolume paracentesis induces arterial vasodilatation, decreases effective arterial blood volume and thus aggravates circulatory dysfunction. The use of intravenous albumin prevents this circulatory dysfunction. However, the application of albumin is costly. The alpha-adrenoceptor agonist midodrine has been shown to increase natriuresis in patients with ascites. The aim of our study was to compare midodrine with albumin in preventing circulatory dysfunction after large-volume paracentesis in patients with tense ascites. Methods: Twenty-three patients with cirrhosis and tense ascites were randomly assigned to treatment by either midodrine ( n = 1 1 ) (oral dose: 12.5 mg tid on day 0 and 1) or albumin ( n = 13) (8g per 1 of removed ascites) after large-volume paracentesis. Decrease in effective arterial blood volume was defined by increase in plasma renin concentration (day 6 by more than 50% compared to baseline). Furthermore we determined plasma aldosterone levels in all patients on day 0 and day 6. Results: In 6 patients (60%) of the midodrine-group and in only 4 patients (3 I%) of the albumin-group, there was an increase in plasma renin concentration on day 6. Plasma aldosterone concentration after paracentesis increased significantly (from 974.4+454 ngidl on day 0 vs. 1588.9+765 ngidl on day 6, p = 0.003) in the midodrine-group but not in the albumin-group (from 1470*1902 ng1dl vs. I674+2332 ng/dl, p = 0.345). One patient ofthe midodrine-group developed a hepatorenal syndrome type one. Conclusions: This randomised study suggests that the vasoconstrictor midodrine may not be as effective as intravenous albumin in preventing circulatory dysfunction following large-volume paracentesis in patients with cirrhosis and tense ascites
12181 BACTERIAL TRANSLOCATION INDUCES PROINFLAMMATORY CYTOKINES AND WORSENS SYSTEMIC HEMODYNAMICS IN CIRRHOTIC PATIENTS WITH ASCITES P. Bellot’ , J.C. Garcia-Pagan’ , R. Frances2, J.G. Abraldes’, J.M. Gonzalez-Navajas2, M. Navasa’ , M. Perez-Mateo2, J. Such’, J. Bosch’ . ‘Heputic Henzodynuniic Luhorutory, Liver Unit, IMDIM, IDlBAPS/Hospitul Clinic, Burcelonu; ’Liuer Unit, Hospitul Generul Uniuersiturio de Alicunte, Spuin E-mail: [email protected] Bacterial infections exacerbate the circulatory disturbances of cirrhosis through proinflammatory cytokine activation. Bacterial translocation (BT)
from intestinal lumen plays a prominent role in the development of bacterial infections in cirrhotic patients, although most episodes of BT do not result in overt infections. DNA fragments from bacterial origin (BactDNA) is considered a marker of BT, and may by itself promotes a proinflammatory response. Aims: Evaluate the presence of BT (assessed by detecting BactDNA in plasma), the inflammatory response and the hepatic and systemic hemodynamics in patients with cirrhosis. Methods: 59 cirrhotic patients (40 with ascites) with negative blood culture and no clinical evidence of infections were included in the study and had measurements of plasma BactDNA (assessed by broadrange PCR and sequencing analysis of the prokaryote I6sRNA gen), nitrites + nitrates (NO,), tumor necrosis factor (TNFa), lipopolysaccharide binding protein (LBP), blood cultures and hemodynamics (cardiac output, cardiopulmonary and hepatic venous pressure). Results: BactDNA was detected in 15 patients ( I 1 from Gram-negative microorganisms and 4 from Gram-positives). BactDNA was only detected in patients with ascites. There were no significant differences between the 15 ascitic patients with BactDNA and the 25 without BactDNA in age, gender and ethiology of cirrhosis. Liver function was slightly better in patients without BactDNA (MELD= 14.5f3.8 vs. 17+3.8 in patients with BactDNA, p = 0.072). LBP and TNFa were significantly higher in patients with BactDNA than in those without (LBP =92f27 vs. 57f26pgimL, p=O.O07; TN Fa= 4 1 5 f 1 1 6 vs. 173&70pgimL, p=O.O01). NO, levels were also higher in the bactDNA group (NO, = 36.8+1 I .3 vs. 29.4f 12.7 pg1mL; p = 0.07). Patients with BactDNA showed lower median arterial pressure (MAP) and systemic vascular resistance (SVR) than those without (MAP=74&9 vs. 8 6 f l l mmHg, p=0.007; SVR= 1241f442 vs. 1537f410dynsegm2cm-5, p=0.04). Cardiac output, heart rate, cardiopulmonar pressures and hepatic venous pressure gradient were similar in both groups. Results were similar in patients with BactDNA from Gram(+) or Gram(-) microorganisms. Conclusions: These results supports the hypothesis that the passage of enteric bacterial products to systemic circulation contributes to proinflamatory cytolcine activation and to worsening of peripheral vasodilatation in patients with cirrhosis and ascites.
12191 NATURAL HISTORY OF SPONTANEOUS BACTERIAL PERITONITIS: A LONGITUDINAL STUDY IN 263 CIRRHOTIC PATIENTS AFTER THE FIRST ASCITES DECOMPENSATION N. Canete’, E. Erice2, A. Bargallo’, 1. Cirera’, H. Masnou’, M. Mique12, S . Coll’, M.D. Gimenez’, J.A. Galeras’, R.M. Morillas2, R. Planas2, R. Sola’ . ‘Liuer Section, Digextiue Seruice, Hospitul Del Mur; Burcelonu; ’Liuer Section, Digextiue Seruice, Hospitul Germuns Trius I Pujol,
Badalona, Spain E-mail: [email protected] Spontaneous bacterial peritonitis (SBP) is a well-known complication of cirrhotic ascites. However, the information about longitudinal studies assessing the probability of SBP development in cirrhotic patients after the first ascites decompensation is scarce. Aims: Longitudinal study aimed to evaluate the probability of SBP development after the first ascites decompensation in cirrhotic patients, as well as to assess its characteristics, outcome and prognosis. Methods: A total of 263 consecutive cirrhotic patients (HCV related in 127 cases and alcoholic in 136 cases), with a mean age of 6 I .2+ I I .4 years, were followed for a mean of 41 f 3 months after their first ascites decompensation. Results: Fifty-eight patients (22%) developed 78 SBP episodes, with an actuarial probability of SBP development of 8% and 23% after I and 3 years of follow-up, respectively. The only independent predictor of SBP development was an ascitic fluid protein concentration below 10 g/L. SBP was community-acquired in 55 cases (70.5%), and the ascitic-fluid culture
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Results: Cases and controls were similar with respect to pretreatment with terlipressin. The HRS recurrence probability was similar between the two groups (cases: 819, 89% vs controls: 919, loo%, p=ns). No significant differences were found between cases and controls with respect to serum creatinine (1.8f0.1 vs 2.1&0.1 mgidl), blood creatinine clearance ( 2 8 f 9 vs 2 1 f 5 ml/min), urinary sodium excretion (12&2 vs 1 9 f 4 mEqid) and PRA levels (16 f 4 vs 20&2 ngimllh) after terlipressin withdrawal (p = ns). Conclusions: These results indicate that HRS recurrence in patients responders to terlipressin is not different between patients treated with midodrine and subjects who received no prophylactic treatment. These data suggest that midodrine is not effective in preventing HRS type 2 recurrence.
12171 MlDODRlNE VERSUS ALBUMIN IN THE PREVENTION OF PARACENTESIS INDUCED CIRCULATORY DYSFUNCTION IN PATIENTS WITH CIRRHOSIS AND TENSE ASCITES? A RANDOMIZED STUDY B. Appenrodt, A. Wolf, F. Gruenhage, J. Trebicka, M. Schepke, of Bonn, T. Sauerbruch, J. Heller. Depurtment of Medicine 1, Uniuer~xit?, Bonn, Germany
E-mail: [email protected]
Background and Aims: In patients with cirrhosis and tense ascites largevolume paracentesis induces arterial vasodilatation, decreases effective arterial blood volume and thus aggravates circulatory dysfunction. The use of intravenous albumin prevents this circulatory dysfunction. However, the application of albumin is costly. The alpha-adrenoceptor agonist midodrine has been shown to increase natriuresis in patients with ascites. The aim of our study was to compare midodrine with albumin in preventing circulatory dysfunction after large-volume paracentesis in patients with tense ascites. Methods: Twenty-three patients with cirrhosis and tense ascites were randomly assigned to treatment by either midodrine ( n = 1 1 ) (oral dose: 12.5 mg tid on day 0 and 1) or albumin ( n = 13) (8g per 1 of removed ascites) after large-volume paracentesis. Decrease in effective arterial blood volume was defined by increase in plasma renin concentration (day 6 by more than 50% compared to baseline). Furthermore we determined plasma aldosterone levels in all patients on day 0 and day 6. Results: In 6 patients (60%) of the midodrine-group and in only 4 patients (3 I%) of the albumin-group, there was an increase in plasma renin concentration on day 6. Plasma aldosterone concentration after paracentesis increased significantly (from 974.4+454 ngidl on day 0 vs. 1588.9+765 ngidl on day 6, p = 0.003) in the midodrine-group but not in the albumin-group (from 1470*1902 ng1dl vs. I674+2332 ng/dl, p = 0.345). One patient ofthe midodrine-group developed a hepatorenal syndrome type one. Conclusions: This randomised study suggests that the vasoconstrictor midodrine may not be as effective as intravenous albumin in preventing circulatory dysfunction following large-volume paracentesis in patients with cirrhosis and tense ascites
12181 BACTERIAL TRANSLOCATION INDUCES PROINFLAMMATORY CYTOKINES AND WORSENS SYSTEMIC HEMODYNAMICS IN CIRRHOTIC PATIENTS WITH ASCITES P. Bellot’ , J.C. Garcia-Pagan’ , R. Frances2, J.G. Abraldes’, J.M. Gonzalez-Navajas2, M. Navasa’ , M. Perez-Mateo2, J. Such’, J. Bosch’ . ‘Heputic Henzodynuniic Luhorutory, Liver Unit, IMDIM, IDlBAPS/Hospitul Clinic, Burcelonu; ’Liuer Unit, Hospitul Generul Uniuersiturio de Alicunte, Spuin E-mail: [email protected] Bacterial infections exacerbate the circulatory disturbances of cirrhosis through proinflammatory cytokine activation. Bacterial translocation (BT)
from intestinal lumen plays a prominent role in the development of bacterial infections in cirrhotic patients, although most episodes of BT do not result in overt infections. DNA fragments from bacterial origin (BactDNA) is considered a marker of BT, and may by itself promotes a proinflammatory response. Aims: Evaluate the presence of BT (assessed by detecting BactDNA in plasma), the inflammatory response and the hepatic and systemic hemodynamics in patients with cirrhosis. Methods: 59 cirrhotic patients (40 with ascites) with negative blood culture and no clinical evidence of infections were included in the study and had measurements of plasma BactDNA (assessed by broadrange PCR and sequencing analysis of the prokaryote I6sRNA gen), nitrites + nitrates (NO,), tumor necrosis factor (TNFa), lipopolysaccharide binding protein (LBP), blood cultures and hemodynamics (cardiac output, cardiopulmonary and hepatic venous pressure). Results: BactDNA was detected in 15 patients ( I 1 from Gram-negative microorganisms and 4 from Gram-positives). BactDNA was only detected in patients with ascites. There were no significant differences between the 15 ascitic patients with BactDNA and the 25 without BactDNA in age, gender and ethiology of cirrhosis. Liver function was slightly better in patients without BactDNA (MELD= 14.5f3.8 vs. 17+3.8 in patients with BactDNA, p = 0.072). LBP and TNFa were significantly higher in patients with BactDNA than in those without (LBP =92f27 vs. 57f26pgimL, p=O.O07; TN Fa= 4 1 5 f 1 1 6 vs. 173&70pgimL, p=O.O01). NO, levels were also higher in the bactDNA group (NO, = 36.8+1 I .3 vs. 29.4f 12.7 pg1mL; p = 0.07). Patients with BactDNA showed lower median arterial pressure (MAP) and systemic vascular resistance (SVR) than those without (MAP=74&9 vs. 8 6 f l l mmHg, p=0.007; SVR= 1241f442 vs. 1537f410dynsegm2cm-5, p=0.04). Cardiac output, heart rate, cardiopulmonar pressures and hepatic venous pressure gradient were similar in both groups. Results were similar in patients with BactDNA from Gram(+) or Gram(-) microorganisms. Conclusions: These results supports the hypothesis that the passage of enteric bacterial products to systemic circulation contributes to proinflamatory cytolcine activation and to worsening of peripheral vasodilatation in patients with cirrhosis and ascites.
12191 NATURAL HISTORY OF SPONTANEOUS BACTERIAL PERITONITIS: A LONGITUDINAL STUDY IN 263 CIRRHOTIC PATIENTS AFTER THE FIRST ASCITES DECOMPENSATION N. Canete’, E. Erice2, A. Bargallo’, 1. Cirera’, H. Masnou’, M. Mique12, S . Coll’, M.D. Gimenez’, J.A. Galeras’, R.M. Morillas2, R. Planas2, R. Sola’ . ‘Liuer Section, Digextiue Seruice, Hospitul Del Mur; Burcelonu; ’Liuer Section, Digextiue Seruice, Hospitul Germuns Trius I Pujol,
Badalona, Spain E-mail: [email protected] Spontaneous bacterial peritonitis (SBP) is a well-known complication of cirrhotic ascites. However, the information about longitudinal studies assessing the probability of SBP development in cirrhotic patients after the first ascites decompensation is scarce. Aims: Longitudinal study aimed to evaluate the probability of SBP development after the first ascites decompensation in cirrhotic patients, as well as to assess its characteristics, outcome and prognosis. Methods: A total of 263 consecutive cirrhotic patients (HCV related in 127 cases and alcoholic in 136 cases), with a mean age of 6 I .2+ I I .4 years, were followed for a mean of 41 f 3 months after their first ascites decompensation. Results: Fifty-eight patients (22%) developed 78 SBP episodes, with an actuarial probability of SBP development of 8% and 23% after I and 3 years of follow-up, respectively. The only independent predictor of SBP development was an ascitic fluid protein concentration below 10 g/L. SBP was community-acquired in 55 cases (70.5%), and the ascitic-fluid culture