Document Detail


Vasopressin deficiency and vasodilatory state in end-stage liver disease.
MedLine Citation:
PMID:  21126886     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Relative vasopressin deficiency, a contributor to vasodilatory septic shock, also may be a cause of the vasodilatory state in liver disease. This study assessed endogenous vasopressin levels in patients with liver disease and their hemodynamic response to exogenous vasopressin.
DESIGN: A prospective, observational study.
SETTING: A single-center, tertiary hospital.
PARTICIPANTS: Human subjects undergoing liver transplantation or major surgery.
INTERVENTIONS: Vasopressin levels were measured in 28 patients with liver disease undergoing liver transplantation and 7 control patients with normal liver function. Additionally, intravenous vasopressin was administered to 20 liver transplant recipients, and the hemodynamic response was observed.
MEASUREMENTS AND MAIN RESULTS: Patients with liver disease had significantly lower baseline vasopressin levels than controls (19.3 ± 27.1 pg/mL v 50.9 ± 36.7 pg/mL, p = 0.015). Patients with low vasopressin levels (≤20 pg/mL) were more likely to have lower baseline mean blood pressure (≤80 mmHg) than patients with high vasopressin levels (11/16 v 0/4, p = 0.013). Systemic vascular resistance increased by 33% 3 minutes after intravenous vasopressin. Thirteen of 16 patients with low vasopressin levels compared with 1 of 4 patients with high vasopressin levels responded to exogenous vasopressin, with an increase of mean blood pressure by more than 20% (p = 0.028).
CONCLUSIONS: Patients with liver disease have lower vasopressin levels than controls and respond with a brisk vasoconstrictor response to exogenous vasopressin. Therefore, relative endogenous vasopressin deficiency may contribute to vasodilatory shock in liver disease similar to what has been observed in septic shock.
Authors:
Gebhard Wagener; Galina Kovalevskaya; Moury Minhaz; Fallon Mattis; Jean C Emond; Donald W Landry
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-12-03
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  25     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-09-13     Completed Date:  2012-03-07     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  665-70     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032-3784, USA. gw72@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
End Stage Liver Disease / blood,  physiopathology*
Female
Humans
Liver Transplantation
Male
Middle Aged
Prospective Studies
Shock, Septic / blood
Vascular Resistance
Vasodilation*
Vasopressins / blood,  deficiency*,  physiology
Grant Support
ID/Acronym/Agency:
UL1 RR024156/RR/NCRR NIH HHS; UL1 RR024156-04/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
11000-17-2/Vasopressins
Comments/Corrections

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


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