| Vasopressin deficiency and vasodilatory state in end-stage liver disease. | |
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MedLine Citation:
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PMID: 21126886 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Gebhard Wagener; Galina Kovalevskaya; Moury Minhaz; Fallon Mattis; Jean C Emond; Donald W Landry |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-12-03 |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: 25 ISSN: 1532-8422 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-09-13 Completed Date: 2012-03-07 Revised Date: 2012-09-25 |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 665-70 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032-3784, USA. gw72@columbia.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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UL1 RR024156/RR/NCRR NIH HHS; UL1 RR024156-04/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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11000-17-2/Vasopressins |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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