Plasma renin concentration represents an independent risk factor for mortality and is associated with liver dysfunction in patients with cirrhosis

Rafael Paternostro; Thomas Reiberger; Mattias Mandorfer; Remy Schwarzer; Philipp Schwabl; Simona Bota; Monika Ferlitsch; Michael Trauner; Markus Peck-Radosavljevic; Arnulf Ferlitsch

doi:10.1111/jgh.13439

Plasma renin concentration represents an independent risk factor for mortality and is associated with liver dysfunction in patients with cirrhosis

J Gastroenterol Hepatol. 2017 Jan;32(1):184-190. doi: 10.1111/jgh.13439.

Authors

Rafael Paternostro^{1

2}, Thomas Reiberger^{1

2}, Mattias Mandorfer^{1

2}, Remy Schwarzer^{1

2}, Philipp Schwabl^{1

2}, Simona Bota^{1

2}, Monika Ferlitsch², Michael Trauner², Markus Peck-Radosavljevic^{1

2}, Arnulf Ferlitsch^{1

2}

Affiliations

¹ Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.

PMID: 27164413
DOI: 10.1111/jgh.13439

Abstract

Background and aim: Plasma renin concentration (PRC) is increased in patients with cirrhosis. The aims of this study were to evaluate the relation of PRC to (i) portal hypertension, (ii) degree of liver dysfunction, and (iii) survival.

Methods: Plasma renin concentration (range 2.8-39.9 μU/mL) was measured after 30 min in supine position. Also, hepatic venous pressure gradient (HVPG), Child-Pugh (CPS), model for end-stage liver disease scores and transient elastography values (TE, Fibroscan) were evaluated at this time. Mortality was recorded during follow-up.

Results: One hundred fifty cirrhotic patients (age 55 ± 11 years; 73% male; CPS A 41.3%/B 41.3%/C 17.3%) were included. Mean HVPG was 16.6 ± 6.5 mmHg. Median PRC according to CPS was A 15.45 μU/mL (95%CI 1.56-261.5), B 37.3 μU/mL (95%CI 4.29-1317.65), and C 175.3 μU/mL (95%CI 5.3-5684; P < 0.001). In patients with clinical significant portal hypertension (HVPG ≥ 10 mmHg, n = 123) median PRC was 31.2 μU/mL (95%CI 2.76-1345.4), in those without was 13.7 μU/mL (95%CI 2.7-428.2; P = 0.009). Significantly higher TE values (33.2 [13-75] vs 59.65 kPa [14.5-75]; P = 0.014) were found in patients with elevated PRC. Median follow up was 711 days (95%CI 24-1152). Twenty-two (36.1%) of the 61 patients with elevated PRC and 11 of the 89 (12.4%) with normal PRC died (P = 0.001). Median PRC was significantly higher in patients that died (83.6 μU/mL [3.39-4451.9] vs 21.5 μU/mL [2.6-1197.9]; P = 0.001). Elevated PRC (P = 0.005; HR 3.36; 95%CI 1.46-7.85), hepatocellular carcinoma (P < 0.001; HR 10.68; 95%CI 3.64-31.3), CPS B (P = 0.013; HR 3.69; 95%CI 1.31-10.4) and CPS C (P = 0.008; HR 5.36; 95%CI 1.54-18.62) emerged as independent risk factors for mortality.

Conclusions: In cirrhotic patients PRC correlates with the severity of portal hypertension and liver dysfunction. Moreover, elevated PRC represents an independent risk factor for mortality.

Keywords: CSPH; ascites; cirrhosis; mortality; renin.

MeSH terms

Adult
Aged
Biomarkers / blood
Female
Follow-Up Studies
Humans
Hypertension, Portal / diagnosis*
Hypertension, Portal / mortality*
Hypertension, Portal / physiopathology
Liver / physiopathology*
Liver Cirrhosis / diagnosis*
Liver Cirrhosis / mortality*
Liver Cirrhosis / physiopathology
Liver Function Tests*
Male
Middle Aged
Renin / blood*
Risk Factors
Severity of Illness Index

Substances

Biomarkers
Renin