PLASMA ADRENOMEDULLIN LEVELS IN PATIENTS WITH HEPATIC CIRRHOSIS

Objective: The role of adrenomedullin in cirrhosis is at present unkno wn. The aim of this study was to investigate plasma levels of adrenome dullin in cirrhosis. Methods: We measured plasma adrenomedullin concen trations using radioimmunoassay in 43 patients with cirrhosis (17 in C hild-Pugh's class A, 13 in Child-Pugh's class B, and 13 in Child-Pugh' s class C) and compared these values with those in 24 age-matched heal thy subjects. Renal function, plasma cyclic adenosine monophosphate (c AMP) concentration, plasma renin activity, and plasma aldosterone conc entration were measured in each patient. Results: Plasma adrenomedulli n levels were increased significantly in patients with cirrhosis compa red with healthy subjects. In addition, plasma adrenomedullin values w ere higher in patients with cirrhosis and ascites than in those withou t ascites. Moreover, plasma adrenomedullin levels increased in relatio n to the severity of cirrhosis. Significant positive correlations also were found between adrenomedullin and cAMP concentrations and plasma renin activity or plasma aldosterone concentrations. Conclusions: Plas ma adrenomedullin is increased in patients with cirrhosis compared wit h healthy subjects. The increase in plasma adrenomedullin levels is re lated at least in part to the severity of cirrhosis and may contribute to the arteriolar vasodilation in patients with cirrhosis. These effe cts are related in part to a cAMP-dependent pathway.