title: Circulating endotoxin and interleukin-6 levels are associated with Doppler-evaluated pulmonary vascular resistance in cirrhotic patients.
abstract: OBJECTIVE
  Endotoxin and interleukin-6 levels (IL-6) have been involved in the development of pulmonary hypertension (PH) in non-cirrhotic experimental models and subjects. High circulating levels of both substances have been detected in cirrhosis. The association between circulating endotoxin and IL-6 levels and echocardiographically evaluated pulmonary vascular resistance (PVR) in cirrhotic patients are investigated.
  
  
  METHODS
  Thirty-seven cirrhotic patients were studied: 25 with PVR <120 dynes s cm(-5) (group 1) and 12 with PVR >120 dynes s cm(-5) (group 2). Plasma endotoxin and serum IL-6 levels were measured. The PVR and cardiac output (CO) by Doppler ultrasound, mean arterial pressure (MAP), and systemic vascular resistance (SVR) as the ratio MAP/CO were evaluated.
  
  
  RESULTS
  Child-Pugh scores, MAP, CO, and SVR were similar in both groups. Endotoxin levels were correlated significantly with IL-6 levels (r = 0.342; P = 0.03). Endotoxin and IL-6 levels were significantly higher in group 2 compared to group 1 (2.26 [0.39-8.4] vs. 0.85 [0.37-7.6] EU/mL; P = 0.04 and 37.4 [7.85-106.5] vs. 8.36 [3.15-53.7] pg/mL; P < 0.001, respectively). The PVR was correlated significantly with endotoxin levels in group 2 (r = 0.587; P = 0.04) and with IL-6 levels in group 1 (r = 0.529; P = 0.01) and group 2 (r = 0.760; P = 0.004), respectively.
  
  
  CONCLUSIONS
  Our results suggest that endotoxin and IL-6 may contribute to cirrhosis-associated PH. In this regard, modulation of these substances could improve pulmonary pressures in cirrhotic patients.
authors.affiliation: First Division of Internal Medicine and Hepato-Gastroenterology Unit, Medical School of Ioannina, University Hospital, 45110, Ioannina, Greece. geodora@mail.gr.
authors.forename: Georgios N
authors.initials: GN
authors.lastname: Kalambokis
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Mouzaki
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Rodi
authors.affiliation: Department of Cardiology, University Hospital, Ioannina, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Pappas
authors.affiliation: Department of Cardiology, University Hospital, Ioannina, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Korantzopoulos
authors.affiliation: First Division of Internal Medicine and Hepato-Gastroenterology Unit, Medical School of Ioannina, University Hospital, 45110, Ioannina, Greece. etsianos@cc.uoi.gr.
authors.forename: Epameinondas V
authors.initials: EV
authors.lastname: Tsianos
keywords: Cirrhosis; Endotoxin; Interleukin-6; Pulmonary hypertension