Serum and ascitic fluid nitrate levels in patients with cirrhosis

Background. Increased nitric oxide level may play a critical role in the he modynamic disturbances in patients with cirrhosis. There are few reports in vestigating the factors related to this increase and their results are cont roversial. The purpose of this study was to reveal the clinical importance of nitric oxide levels and the possible factors related to this increase in patients with cirrhosis. Methods. Serum and ascites nitrate levels were studied in 50 patients with cirrhosis and 10 control subjects. Results. All cirrhotic patients (groups 2, 3, 4, 5, 6) showed significant i ncrease in serum nitrate levels in comparison with that in control subjects (group 1) (p < 0.001). Serum nitrate levels were significantly higher (282 .4 <plus/minus> 111.3 mu mol/l; p < 0.05) in patients with spontaneous bact erial peritonitis (group 2) when compared with those in cirrhotic patients without spontaneous bacterial peritonitis (group 3) (186.4 <plus/minus> 87. 6 mu mol/l). Ascitic fluid nitrate levels were significantly higher (302.4 +/- 66 mu mol/l; p < 0.001) in patients with spontaneous bacterial peritoni tis (group 2) when compared with those in cirrhotic patients without sponta neous bacterial peritonitis (group 3) (135.4 <plus/minus> 65.8 mu mol/l). Serum nitrate levels were significantly lower in cirrhotic patients without ascites (group 5) when compared with those in cirrhotic patients with asci tes (group 3) (98.8 +/- 52.6 vs. 186.4 +/- 87.6 mu mol/l; p < 0.05). No sig nificant differences were found among patients with severe anemia (groups 4 , 6) and other cirrhotic patients (group 3) (174.5 <plus/minus> 54.5, 168.8 +/- 63.8 vs. 186.4 +/- 87.6 mu mol/l; p > 0.05). Cirrhotic patients with C hild-Pugh B and C scores showed higher serum nitrate levels (179.4 +/- 81.1 , 222.5 +/- 101.7 mu mol/l; p < 0.001) than did cirrhotic patients with Chi ld-Pugh A score (85.8 <plus/minus> 59.7 mu mol/l). Conclusion. Our findings suggest that overproduction of nitric oxide in cir rhotic patients may be related to the severity of liver damage and spontane ous bacterial peritonitis but not related to their anemia. (C) 2001 Elsevie r Science B.V. All rights reserved.