The diagnostic and predictive value of ascites nitric oxide levels in patients with spontaneous bacterial peritonitis

Abstract

Nitric oxide (NO) is a messenger molecule involved in pathogen suppression. Cirrhosis is characterized by an increased risk for infections, including spontaneous bacterial peritonitis (SBP). The role of NO in the infections that develop in cirrhosis has not been clearly established. The aim of this study was to investigate the utility of measuring ascites NO in the diagnosis of SBP and/or in determining the predisposition of cirrhotic patients to develop this infection. Nitric oxide metabolites (nitrites ؉ nitrates [NOx]) were measured by chemiluminescence in 105 ascites samples obtained from 87 cirrhotic patients and in 87 simultaneously obtained serum samples. Ascites NO levels were not significantly different among ascites from patients with SBP (n ‫؍‬ 39; median, 48 mol/L), patients with sterile ascites (n ‫؍‬ 54; median, 42 mol/L), and samples obtained after patients with SBP had been treated (n ‫؍‬ 12; median, 62 mol/L). No differences in ascites NO levels were observed between culture-positive and culture-negative peritonitis. Among 50 patients with sterile ascites on initial paracentesis, 7 patients developed peritonitis during followup; no differences in baseline NO levels were observed between patients who developed peritonitis (median, 46 mol/L) and those who did not (median, 41 mol/L). Among patients with SBP, mortality was significantly higher in those with NO levels G60 mol/L. A very significant direct correlation was found between ascites and serum NO levels (r 2 ‫؍‬ .86). In conclusion, ascites NO levels in cirrhotic patients are not useful either to diagnose or to determine predisposition to SBP. Rather, ascites NO levels reflect serum levels, are higher in cirrhotic patients with more severe liver disease, and may be a useful prognostic marker. (HEPATOLOGY 1998;28:17-21.)

Effect of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterial peritonitis

“…Previous studies in patients with SBP treated with antibiotics alone have demonstrated an intense and progressive increase in the serum levels of NOx which persists for several weeks after resolution of the infection [16]. This feature was not observed neither in our study nor in a previous investigation [17].…”

Adhesion molecules as a prognostic marker of liver cirrhosis

“…Pro-inflammatory cytokines induce an endothelial activation, which can be detected by increased synthesis of nitric oxide [29] or by expression of adhesion molecules on the cellular surface [9Á/11], and they have been implicated in hemodynamic changes present in cirrhotic patients [30,31]. Ele- vated values of soluble adhesion molecules were detected in the early stages of liver dysfunction: plasma concentrations were increased in patients in Child Pugh class A, with higher values found in those in class B or C. Serum concentrations of endothelial adhesion molecules ICAM-1 and VCAM-1 were correlated with blood pressure values.…”

Bacterial translocation (BT) in cirrhosis

“…105 However, low ascites NO levels, although predictive of a poor prognosis, are unable to predict SBP in patients with cirrhosis. 106 NO also participates in maintaining gut barrier function. 107 It increases gastrointestinal mucus secretion, modulates epithelial chloride transport and associated fluid secretion, maintains blood flow, inhibits intestinal muscular motor activity, reduces mast cell reactivity and mediator release, suppresses neutrophil aggregation and sequestration, and scavenges reactive oxygen metabolites.…”