Document Detail


Nitric-oxide-lowering effect of terlipressin in decompensated cirrhosis: comparison to the molecular adsorbent recirculating system and correlation with clinical status.
MedLine Citation:
PMID:  15618842     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Systemic vasodilatation and arterial hypotension, refractory to adrenergic vasopressors, portend a poor prognosis in patients with decompensated cirrhosis. The production of large amounts of nitric oxide, consequent to endotoxin-induced tumour necrosis factor (TNF)-alpha-mediated upregulation of inducible nitric oxide synthase (iNOS), has been suggested to be central to this phenomenon. Terlipressin has recently been shown in an animal model of cirrhosis to suppress endotoxin-induced TNF-alpha-mediated upregulation of iNOS, thereby preventing overproduction of nitric oxide and restoring normal vascular tone. We present the first evidence that this effect of terlipressin may also occur clinically, in a patient with Child-Pugh class C cirrhosis, endotoxaemia, a raised circulating TNF-alpha concentration, and marked systemic vasodilatation with refractory arterial hypotension. Beneficial effects of terlipressin on circulating nitrate and nitrite concentrations, haemodynamic status, plasma renin levels and indocyanine green clearance were comparable to those of the molecular adsorbent recirculating system (MARS). Our findings suggest that terlipressin may be the vasopressor agent of choice in patients with decompensated cirrhosis and provide a rationale for combination terlipressin and MARS therapy when the therapeutic response to either treatment alone is suboptimal.
Authors:
Jelica Kurtovic; Martin Boyle; David Bihari; Stephen M Riordan
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  16     ISSN:  0954-691X     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-12-24     Completed Date:  2005-03-17     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1335-8     Citation Subset:  IM    
Affiliation:
Gastrointestinal and Liver Unit, The Prince of Wales Hospital and University of New South Wales, Sydney, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Endotoxemia / blood,  complications,  drug therapy
Humans
Hypotension / complications,  drug therapy
Liver Cirrhosis / blood,  complications,  drug therapy*
Liver, Artificial
Lypressin / analogs & derivatives*,  therapeutic use*
Male
Nitric Oxide / blood*
Sorption Detoxification / methods*
Tumor Necrosis Factor-alpha / analysis
Vasoconstrictor Agents / therapeutic use*
Vasodilation / drug effects
Chemical
Reg. No./Substance:
0/Tumor Necrosis Factor-alpha; 0/Vasoconstrictor Agents; 10102-43-9/Nitric Oxide; 14636-12-5/terlipressin; 50-57-7/Lypressin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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