Plasma erythropoietin level in patients with cirrhosis and its relationship to the severity of cirrhosis and renal function.
OBJECTIVE
The level of plasma erythropoietin (EPO) in patients with cirrhosis is controversial. It is known that overproduction of nitric oxide (NO) plays, in part, a role for the development of peripheral arterial vasodilatation in cirrhosis with portal hypertension. It has also been hypothesized that a possible interaction is noted between endogenous EPO and NO production. The current study was undertaken to evaluate the relationship between plasma EPO levels and the severity of liver disease, hemodynamic values, renal functions, and plasma nitrate/nitrite levels in patients with cirrhosis.


METHODS
The authors measured the biochemistry, plasma EPO and nitrate/nitrite levels in 67 patients with cirrhosis (Child-Pugh class A in 23 and Child-Pugh class B and C in 44) and compared their values with those in 34 healthy subjects. Systemic and splanchnic hemodynamic measurements and effective renal plasma flow were obtained from cirrhotic patients.


RESULTS
Plasma EPO and nitrate/nitrite levels were significantly increased in patients with cirrhosis compared with healthy subjects. Additionally, plasma EPO values were higher in cirrhotic patients with ascites or with anemia than in those without ascites or without anemia, respectively. Plasma EPO levels were positively correlated to the hepatic venous pressure gradient (HVPG) and Child-Pugh score, negatively correlated to the renal and hepatic blood flows, but were not correlated to nitrate/nitrite level and systemic vascular resistance in cirrhotic patients. Multiple regression analysis showed that HVPG and renal plasma flow were independent predictors for the elevated EPO level in cirrhotic patients.


CONCLUSIONS
Plasma EPO levels were increased in patients with cirrhosis compared with those in healthy subjects. The increase in plasma EPO levels is related to the degree of portal hypertension, the severity of cirrhosis and the renal plasma flow. In contrast, the EPO levels had no correlation to the nitrate/nitrite levels and systemic vascular resistance in patients with cirrhosis.
Yang
Ying-Ying
YY
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, and Institute of Traditional Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Lin
Han-Chieh
HC
Lee
Wui-Chiang
WC
Huang
Yi-Tsau
YT
Hou
Ming-Chih
MC
Lee
Fa-Yauh
FY
Chang
Full-Young
FY
Lee
Shou-Dong
SD
D000740:Anemia / Q000150:complications; D001201:Ascites / Q000209:etiology; D001794:Blood Pressure; D002302:Cardiac Output; D004921:Erythropoietin / Q000097:blood*; D006503:Hepatic Veins; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D007668:Kidney / Q000503:physiopathology*; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D009566:Nitrates / Q000097:blood; D009569:Nitric Oxide / Q000097:blood; D009573:Nitrites / Q000097:blood; D017597:Renal Blood Flow, Effective; D014655:Vascular Resistance; D014690:Venous Pressure
D009566:Nitrates; D009573:Nitrites; D004921:Erythropoietin; D009569:Nitric Oxide