Z Gastroenterol 2011; 49 - P5_08
DOI: 10.1055/s-0030-1269714

Different cell death mechanisms are triggered by acute or chronic right heart failure-induced liver failure

K Herzer 1, G Kneiseler 1, F Post 2, M Schlattjan 1, T Neumann 3, G Gerken 1, A Canbay 1
  • 1Klinik für Gastroenterologie und Hepatologie, Uniklinikum Essen, Essen
  • 2Universitätsmedizin der Johannes Gutenberg-Universität, II. Medizinische Klinik und Poliklinik, Mainz
  • 3Klinik für Kardiologie, Universitätsklinikum Essen, Essen

Background and Aims: Heart failure is a major issue in cardiologic patients and surgical interventions which can lead to liver failure (LF). The prognosis of LF due to right heart failure (RHF) depends on various factors like age of the patient, comorbidities, BMI and amount of cell death within the liver. However, course of liver failure and prognosis are hard to predict. The cytokeratin-18 (CK18) epitopes M65 and M30 are reported to distinguish between overall (necrotic) and apoptotic cell death, respectively. We investigated whether these cell death markers predict outcome of patients with RHF-induced LF and which cell death mechanism is predominant in each group. Methods: In a prospective study, 18 patients with LF on acute right heart failure (ARHF) and 23 patients with chronic right heart failure (CRHF) were included. Demographic and clinical parameters of the patients were collected and CK18/M65 and M30 ELISA was performed. M65 and M30 levels were correlated with outcome of liver failure, patient age and cause of liver failure. Results: Serum M65, representing overall cell death, in patients with ARHF-induced LF was significantly higher than in CRHF (19976.44±3364.63U/ml vs. 1283.29±138.43U/ml, p<0.0001). Absolute M30 (as marker of apoptosis) was also higher in patients with liver affection caused by ARHF as opposed to CRHF (3956.32±1147.97U/ml vs. 642.25±41.82U/ml, p=0.009). In contrast the M30/M65 ratio was significantly higher in CRHF than in ARHF patients (0.54±0.04 vs. 0.22±0.04, p<0.0001), indicating a greater contribution of apoptotic cell death in CRHF. Conclusions: The ratio of CK18 M30/M65 is a potential marker to discriminate between ARHF- induced and CRHF-induced liver failure and could probably be employed to predict outcome in patients with ARHF-induced LF.