Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender

Abstract

.-The size of the central and arterial blood volume (CBV) is essential in the understanding of fluid retention in cirrhosis. Previously, it has been reported decreased, normal, or increased, but no reports have analyzed CBV with respect to gender and lean body mass. The aim of the present study was by means of an optimized technique to reassess it in a large group of patients with cirrhosis compared with healthy controls and matched controls in relationship to their body dimensions and gender. Eighty-three patients with cirrhosis (male/female, 60:23), 67 patients without liver disease (male/ female, 22:45), and 14 young healthy controls (male/female, 6:8) underwent a hemodynamic investigation with determination of cardiac output, central circulation time, and CBV determined according to kinetic principles. Related to gender, CBV was lower in male cirrhotics (1.48 Ϯ 0.30 liter) than in matched and young controls (1.68 Ϯ 0.33 and 1.72 Ϯ 0.33 liter, respectively; P Ͻ 0.05-0.01). No significant differences in CBV were seen between female cirrhotics and controls. Absolute and adjusted CBVs were lower in the females than in men with cirrhosis (P Ͻ 0.001), and men with cirrhosis had lower absolute and body weight-adjusted CBVs than matched controls (P Ͻ 0.01). Normalized values of CBV (%total blood volume) were significantly lower in patients with cirrhosis (25 Ϯ 4%) than in matched controls (31 Ϯ 7%) and young controls (28 Ϯ 4%; P Ͻ 0.02). CBV correlated significantly with anthropometrics, including lean body mass (r ϭ 0.68-0.82; P Ͻ 0.0001). In conclusion, the CBV of patients with cirrhosis was lower than that of controls when adjusted for body dimensions and gender. There are significant gender differences, and signs of underfilling are more pronounced in male than in female patients. The results emphasize the importance of adjustments of blood volumes for anthropometrics and gender. central circulation time; hyperdynamic circulation; lean body mass; peripheral vasodilatation; portal hypertension; systemic vascular resistance IN PATIENTS WITH CIRRHOSIS, peripheral and splanchnic arterial vasodilatation leads to a hyperdynamic circulation with increased cardiac output (CO) and heart rate and an abnormal distribution of the blood volume (4, 19). The total blood and plasma volumes are increased and abnormally distributed with an increase in the noncentral or peripheral blood volume (2,12,21,23,30). The size of the central and arterial blood volume (CBV), which represents the effective blood volume where baro-and volume receptors are located, has been the subject of debate (7,23,31). According to the peripheral arterial vasodilatation theory, central hypovolemia leads to a baroreceptor-induced activation of fluid-retaining mechanisms and the development of ascites (4, 26). The alternative overflow theory holds that central and peripheral hypervolemia leads to spill-over of fluid into the peritoneal cavity and thereby the formation of ascites (15). When kinetic principles were applied, earlier results from our laboratory...

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

“…Vasodilatation appears in the splanchnic area while vasoconstriction is present in the kidneys. These conditions are responsible for the decreased effective central blood volume [9,12]. High concentration of vasodilators and reduced sensitivity to vasoconstrictors play an important role in the genesis of vasodilatation in patients with cirrhosis known to be caused by various substances.…”

Hypertension and liver disease

“…Patients with cirrhosis have increased blood and plasma volumes [8,10]. The distribution of the blood to the different vascular beds is abnormal as it relates to the severity of disease [38-40,41•].…”

“…The distribution of the blood to the different vascular beds is abnormal as it relates to the severity of disease [38-40,41•]. Moreover, dynamic, as well as static, techniques have revealed that the central (thoracic) blood volume is most often decreased, whereas the non-central (especially splanchnic) blood volume is increased in patients with cirrhosis [10,38]. The effective arterial blood volume is decreased, and the abnormal volume distribution contributes to the systemic circulatory derangement [41•].…”

Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

“…He et al [29] had already reported similar results, but the difference was not statistically significant. We hypothesize that there may be some differences as to etiopathogenesis, disease severity and gender distribution among the cirrhotic patients in previous studies [5,30,31] . The patients enrolled in our study (women/men: 9/30) had a cirrhosis mostly MTT in a control subject (A) was higher than in a cirrhotic patient (B).…”