Nitric oxide in ascitic fluid is an independent predictor of the development of renal impairment in patients with cirrhosis and spontaneous bacterial peritonitis.
OBJECTIVE
Cirrhotic patients with spontaneous bacterial peritonitis show a marked activation of the cytokine cascade, and cytokines induce the synthesis of nitric oxide in vitro. Our aim was to assess whether patients with ascitic fluid infection show increased levels of nitric oxide, and whether this is related to the development of renal impairment.


METHODS
Retrospective analysis of prospectively collected specimens from 168 patients with cirrhosis and presence of sterile or infected ascitic fluid. Routine biochemical data together with nitric oxide metabolites, tumour necrosis factor and interleukin-6 were measured. Univariate and multivariate analyses were performed to identify factors related to the development of renal impairment.


RESULTS
Patients with infected ascites showed increased serum and ascitic-fluid levels of nitric oxide metabolites and cytokines compared with patients with sterile ascites. A significant direct correlation was observed between serum and ascitic fluid nitric oxide metabolite levels. Multivariate analysis identified ascitic-fluid nitric oxide metabolites as an independent predictor of renal impairment.


CONCLUSIONS
The increased serum and ascitic fluid nitric oxide found in patients with infected ascites might induce a deterioration of the increased peripheral vasodilation found in this setting, leading to the development of renal impairment in a series of patients with spontaneous bacterial peritonitis.
Such
José
J
Liver Unit and Department of Immunology, Hospital General Universitario, Alicante, Spain. such_jos@gva.es
Hillebrand
Donald J
DJ
Guarner
Carlos
C
Berk
Lee
L
Zapater
Pedro
P
Westengard
Jim
J
Peralta
Carmen
C
Soriano
Germán
G
Pappas
James
J
Francés
Rubén
R
Muñoz
Carlos
C
Runyon
Bruce A
BA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001202:Ascitic Fluid / Q000737:chemistry*; D001424:Bacterial Infections / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis; D007668:Kidney / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis*; D010538:Peritonitis / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide