LONG-LASTING NO OVERPRODUCTION IN CIRRHOTIC-PATIENTS WITH SPONTANEOUSBACTERIAL PERITONITIS

Nitric oxide production was studied in cirrhotic patients with spontan eous bacterial peritonitis (SEP) or with other infections, We followed up on the time course of serum nitrate levels in 51 hospitalized pati ents aged between 34 and 81 years, Four groups were defined: patients with SEP (group 1, n = 14), patients with bacteremia (group 2, n = 11) , patients with urinary tract infection (group 3, n = 11) and patients in a stable clinical condition (group 4, n = 20), The four groups did not differ in terms of Pugh score (11 +/- 1, 10 +/- 1, 11 +/- 1, 10 /- 1, respectively), Serum nitrate levels averaged 31 +/- 2 mu mol/L i n group 4 (84 samples), On the day results of cytobacteriological exam ination were positive, mean serum nitrate levels were 75 +/- 17, 63 +/ - 9, and 36 +/- 9 mu mol/L, respectively, in groups 1 (17 cases), 2 (1 1 cases), and 3 (11 cases) (P < .001), The maximum nitrate Values reco rded during follow-up were higher in groups 1 (149 +/- 15 mu mol/L) an d 2 (112 +/- 11 mu mol/L) than in group 3 (66 +/- 7 mu mol/L; P < .001 and < .01, respectively), These maximum values were recorded in all g roups approximately 2 weeks after the infection was diagnosed, The mea n duration of NO overproduction, as defined by nitrate level (3)90 mu mol/L, was 15 +/- 3 days in group 1 and 5 +/- 1 day in group 2, When t he nitrate concentration was studied in serum and ascitic fluid sample d on the same day, it was found robe higher in ascitic fluid than in s erum in eight cases of SEP in the period preceding the peak serum nitr ate concentration (100 +/- 17 vs, 63 +/- 14 mu mol/L; P < .001), Our d ata indicate that SEP in cirrhotic patients led to a long-lasting incr eased local production of NO, This overproduction may contribute to ma intaining splanchnic vasodilation and thus worsen the hyperkinetic sta te in these patients.