The differential activation of cardiovascular hormones across distinct stages of portal hypertension predicts clinical outcomes

作者：Lukas Hartl, Mathias Jachs, Christopher Desbalmes, Dunja Schaufler, Benedikt Simbrunner, Rafael Paternostro, Philipp Schwabl, David Bauer, Georg Semmler, Bernhard Scheiner, Theresa Bucsics, Ernst Eigenbauer, Rodrig Marculescu, Thomas Szekeres, Markus Peck‐Radosavljevic, Stefan Kastl, Michael Trauner, Mattias Mandorfer, Thomas Reiberger · 发表于：Hepatology International · 年份：2021 · DOI：10.1007/s12072-021-10203-9 · 被引用次数：24 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Pulmonary Hypertension Research and Treatments

BACKGROUND AND AIMS: The cardiovascular hormones renin/angiotensin/aldosterone (RAA), brain-type natriuretic peptide (BNP)and arginine-vasopressin (AVP) are key regulators of systemic circulatory homeostasis in portal hypertension (PH). We assessed (i) the activation of renin, BNP and AVP across distinct stages of PH and (ii) whether activation of these hormones correlates with clinical outcomes. METHODS: Plasma levels of renin, proBNP and copeptin (AVP biomarker) were determined in 663 patients with advanced chronic liver disease (ACLD) undergoing hepatic venous pressure gradient (HVPG) measurement at the Vienna General Hospital between 11/2011 and 02/2019. We stratified for Child stage (A-C), HVPG (6-9 mmHg, 10-15 mmHg, ≥ 16 mmHg) and compensated vs. decompensated ACLD. RESULTS: With increasing PH, hyperdynamic state was indicated by higher heart rates (6-9 mmHg: median 71.0 [IQR 18.0] bpm, 10-15 mmHg: 76.0 [19.0] bpm, ≥ 16 mmHg: 80.0 [22.0] bpm; p < 0.001), lower mean arterial pressure (6-9 mmHg: 103.0 [13.5] mmHg, 10-15 mmHg: 101.0 [19.5] mmHg, ≥ 16 mmHg: 99.0 [21.0] mmHg; p = 0.032) and lower serum sodium (6-9 mmHg: 139.0 [3.0] mmol/L, 10-15 mmHg: 138.0 [4.0] mmol/L, ≥ 16 mmHg: 138.0 [5.0] mmol/L; p < 0.001). Across HVPG strata (6-9 mmHg vs. 10-15 mmHg vs ≥ 16 mmHg), median plasma levels of renin (21.0 [50.5] vs. 25.1 [70.9] vs. 65.4 [219.6] µIU/mL; p < 0.001), proBNP (86.1 [134.0] vs. 63.6 [118.0], vs. 132.2 [208.9] pg/mL; p = 0.002) and copeptin (7.8 [7.7] vs. 5.6 [8.0...