Serum bile acids in patients with hepatopulmonary syndrome

Zusammenfassung

Fragestellung Das hepatopulmonale Syndrom (HPS) ist eine Störung der arteriellen Oxygenierung, welche bei bis zu 30 % der Patienten mit Leberzirrhose auftritt und mit deutlich erhöhter Sterblichkeit einhergeht. Ikterus und cholestatische Dysfunktion sind von zentraler pathogenetischer Rolle in akuter als auch chronischer Lebererkrankung.

Ziel Deshalb war es Ziel dieser Studie den Stellenwert der Serum-Gallensäuren bei Patienten mit HPS zu untersuchen.

Methodik 74 Patienten mit Leberzirrhose wurden in diese Studie eingeschlossen. Cholestasemarker, Gesamt- als auch individuelle Gallensäuren wurden bestimmt und alle Patienten auf das Vorhandensein von HPS gescreent. 26 Patienten (35 %) erfüllten die Kriterien für HPS.

Ergebnisse Serum-Gallensäuren waren signifikant höher bei Patienten mit HPS im Vergleich zu denen ohne (mediane Gesamt-Gallensäuren 83,5 μmol/l, IQR 43,1 – 148,9 vs. 26,9 μmol/l, 11 – 75,6; p < 0,001) und korrelierten mit dem Schweregrad der Blutgasaustauschstörung anhand von PaO₂ and AaPO₂ (p < 0,01). Serum-Gesamt-Gallensäuren zeigten sich prädiktiv für das Vorhandensein von HPS - unabhängig von Alter oder Schweregrad der Lebererkrankung (OR: 1,012, 95 % CI: 1,001 – 1,023, p < 0,05).

Schlussfolgerung Serum-Gallensäuren sind mit dem Vorhandensein von HPS assoziiert und korrelieren mit dem Schweregrad der Butgasaustauschstörung. Zukünftige Studien sollten den Stellenwert der Gallensäuren bei HPS sowie den Einfluss einer direkten Regulation des Gallensäure-Metabolismus untersuchen.

Abstract

Background Hepatopulmonary syndrome (HPS) occurs in 20 – 30 % of patients with cirrhosis and is associated with increased mortality. Cholestasis and accumulation of bile acids (BAs) play a major role in chronic liver disease.

Aim We aimed to evaluate the clinical role of serum BAs in patients with HPS.

Methods Seventy-four patients with cirrhosis were included in this prospective study. Marker for cholestasis as total and individual serum BAs, bilirubin, alkaline phosphatase (AP), and gamma-glutamyl transpeptidase (GGT) were analyzed in patients screened for HPS. Criteria of HPS were fulfilled in 26 patients (35 %).

Results In contrast to AP and GGT, bilirubin and serum BAs were significantly elevated in patients with HPS (median total BAs in HPS 83.5 μmol/L, IQR 43.1 – 148.9 vs. no HPS 26.9 μmol/L, 11 – 75.6; p < 0.001). Total BAs correlated with gas exchange by means of PaO2 / AaPO2 (r: −0.28, p < 0.05; r: 0.24, p < 0.05) and portal pressure (r: 0.33, p < 0.05). BAs were associated with HPS independently severity of underlying liver disease (OR: 1.012, 95 % CI: 1.001 – 1.023, p < 0.05).

Conclusion BA retention is associated with HPS and gas exchange abnormalities. Future studies should assess whether modulation of BAs signaling may impact the course of HPS.

Schlüsselwörter

Cholestase - Gallensäuren - Hepatopulmonales Syndrom - Zirrhose

Key words

cholestasis - bile acids - hepatopulmonary syndrome - cirrhosis

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