Elevated carboxy terminal cross linked telopeptide of type I collagen in alcoholic cirrhosis: relation to liver and kidney function and bone metabolism

Background-The carboxy terminal cross linked telopeptide of type I collagen (ICTP) has been put forward as a marker of bone resorption. Patients with alcoholic liver disease may have osteodystrophy. Aims-To assess circulating and regional concentrations of ICTP in relation to liver dysfunction, bone metabolism, and fibrosis. Methods-In 15 patients with alcoholic cirrhosis and 20 controls, hepatic ve nous, renal venous, and femoral arterial concentrations of ICTP, and bone m ass and metabolism were measured. Results-Circulating ICTP was higher in patients with cirrhosis than in cont rols. No overall significant hepatic disposal or production was found in th e patient or control groups but slightly increased production was found in a subset of patients with advanced disease. Significant renal extraction wa s observed in the controls, whereas only a borderline significant extractio n was observed in the patients. Measurements of bone mass and metabolism in dicated only a mild degree of osteodystrophy in the patients with cirrhosis . ICTP correlated significantly in the cirrhotic patients with hepatic and renal dysfunction and fibrosis, but not with measurements of bone mass or m etabolism. Conclusions-ICTP is highly elevated in patients with cirrhosis, with no det ectable hepatic net production or disposal. No relation between ICTP and ma rkers of bone metabolism was identified, but there was a relation to indica tors of liver dysfunction and fibrosis. As the cirrhotic patients conceivab ly only had mild osteopenia, the elevated ICTP in cirrhosis may therefore p rimarily reflect liver failure and hepatic fibrosis.