title: Plasma renin concentration represents an independent risk factor for mortality and is associated with liver dysfunction in patients with cirrhosis.
abstract: OBJECTIVE
  Plasma renin concentration (PRC) is increased in patients with cirrhosis. The aims of this study were to evaluate the relation of PRC to (i) portal hypertension, (ii) degree of liver dysfunction, and (iii) survival.
  
  
  METHODS
  Plasma renin concentration (range 2.8-39.9 μU/mL) was measured after 30 min in supine position. Also, hepatic venous pressure gradient (HVPG), Child-Pugh (CPS), model for end-stage liver disease scores and transient elastography values (TE, Fibroscan) were evaluated at this time. Mortality was recorded during follow-up.
  
  
  RESULTS
  One hundred fifty cirrhotic patients (age 55 ± 11 years; 73% male; CPS A 41.3%/B 41.3%/C 17.3%) were included. Mean HVPG was 16.6 ± 6.5 mmHg. Median PRC according to CPS was A 15.45 μU/mL (95%CI 1.56-261.5), B 37.3 μU/mL (95%CI 4.29-1317.65), and C 175.3 μU/mL (95%CI 5.3-5684; P < 0.001). In patients with clinical significant portal hypertension (HVPG ≥ 10 mmHg, n = 123) median PRC was 31.2 μU/mL (95%CI 2.76-1345.4), in those without was 13.7 μU/mL (95%CI 2.7-428.2; P = 0.009). Significantly higher TE values (33.2 [13-75] vs 59.65 kPa [14.5-75]; P = 0.014) were found in patients with elevated PRC. Median follow up was 711 days (95%CI 24-1152). Twenty-two (36.1%) of the 61 patients with elevated PRC and 11 of the 89 (12.4%) with normal PRC died (P = 0.001). Median PRC was significantly higher in patients that died (83.6 μU/mL [3.39-4451.9] vs 21.5 μU/mL [2.6-1197.9]; P = 0.001). Elevated PRC (P = 0.005; HR 3.36; 95%CI 1.46-7.85), hepatocellular carcinoma (P < 0.001; HR 10.68; 95%CI 3.64-31.3), CPS B (P = 0.013; HR 3.69; 95%CI 1.31-10.4) and CPS C (P = 0.008; HR 5.36; 95%CI 1.54-18.62) emerged as independent risk factors for mortality.
  
  
  CONCLUSIONS
  In cirrhotic patients PRC correlates with the severity of portal hypertension and liver dysfunction. Moreover, elevated PRC represents an independent risk factor for mortality.
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Rafael
authors.initials: R
authors.lastname: Paternostro
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reiberger
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Mattias
authors.initials: M
authors.lastname: Mandorfer
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Remy
authors.initials: R
authors.lastname: Schwarzer
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schwabl
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Simona
authors.initials: S
authors.lastname: Bota
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Peck-Radosavljevic
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.|Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012083:Renin
keywords: CSPH; ascites; cirrhosis; mortality; renin