The association between clinical symptoms, laboratory findings and serum endothelin 1 concentrations, in cirrhotic patients with and without hepatopulmonary syndrome.
OBJECTIVE
This study evaluated the association between serum endothelin- 1 level and symptoms, clinical examination, laboratory and cardio-respiratory parameters, in patients with cirrhosis compared to controls.


BACKGROUND
Cirrhosis is associated with significant portal, pulmonary and systemic vascular abnormities. Recent studies have suggested that endothelin -1 may have a significant role in the regulation of vascular tone.


METHODS
In this case - control study, subjects that had been evaluated and diagnosed with biopsy-proven cirrhosis and age-matched controls with no evidence of cardio-vascular or liver disease were recruited. Review of medical records, routine laboratory investigations and cardio-respiratory investigations including echocardiography to look for evidence of hepato-pulmonary syndrome were performed.


RESULTS
50 patients were subjects were recruited. The most common aetiology of the cirrhosis was chronic hepatitis B viral infection. 7/50 cases had evidence of the hepatopulmonary syndrome. Among the patients with evidence of the hepatopulmonary syndrome, dyspnoea (100%) and cyanosis (90%) were the most common of the symptoms and signs recorded. Pao2 and arterial - alveolar oxygen gradients were the most sensitive tests in the diagnosis of hepatopulmonary syndrome. Orthodoxy specificity was 100%. The median concentration of serum endothelin-1 in cases with hepatopulmonary syndrome was 1.06+/- 0.015 pg/ml (range 0.92 - 1.21), in cases of sub-clinical hepatopulmonary syndrome, 2.49+/- 0.08 (4.05- 0.93) in patients with cirrhosis but no evidence of hepatopulmonary syndrome criteria 0.85+/-0.74(1.06-0.64) in controls.


CONCLUSIONS
There was a significant difference in serum endothelin- 1 levels between patients with cirrhosis and controls, but not between patients with cirrhosis complicated by hepatopulmonary syndrome and controls.
Liver and gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Manouchehr
M
Khoshbaten
Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mohammad
M
Rostami Nejad
Pulmonary Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Khalil
K
Ansarin
Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Reza
R
Fatemi
Department of Gastroenterology, Alexandra Hospital, Redditch, UK.
David Al
DA
Dulaimi
Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Faramarz
F
Derakhshan
Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nagmeh
N
Jafarinia
Department of Gastroenterology, Alexandra Hospital, Redditch, UK.
Sophie
S
Barford
Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mohammad Reza
MR
Zali
Endothelin −1; Gastrointestinal symptom; Hepatopulmonary syndrome