Comparison of bolus and infusion methods for estimating hepatic blood flow in patients with liver disease using indocyanine green

Clements, D.; West, R.; Elias, Elwyn

doi:10.1016/s0168-8278(87)80033-8

Cited by 22 publications

(12 citation statements)

References 7 publications

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“…The term effective hepatic blood flow comprises the combination of hepatocellular metabolic functions, the amount of intra-as well as extrahepatic shunts, and the degree of capillarization. Capillarization of the hepatic sinusoids is a key feature of cirrhosis complicating the contact between blood components and the hepatocytes, and ICG is an established test substance to assess effective hepatic blood flow (4,30,43). An increase in the ICG half-life thereby represents a decrease in ICG clearance per time, reflecting decreased effective hepatic blood flow.…”

Section: Discussionmentioning

confidence: 99%

Elevated circulating adiponectin levels in liver cirrhosis are associated with reduced liver function and altered hepatic hemodynamics

Tietge

Böker²,

Manns³

et al. 2004

American Journal of Physiology-Endocrinology and Metabolism

138

130

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. Elevated circulating adiponectin levels in liver cirrhosis are associated with reduced liver function and altered hepatic hemodynamics. Am J Physiol Endocrinol Metab 287: E82-E89, 2004. First published March 9, 2004; 10.1152/ajpendo.00494.2003Adiponectin is a novel adipocytokine negatively correlated with parameters of the metabolic syndrome, such as body mass index (BMI), body fat mass (BFM), and circulating insulin levels. Furthermore, metabolic actions directly on the liver have been described. The aim of the present study was to characterize circulating adiponectin levels, hepatic turnover, and the association of adiponectin with key parameters of hepatic as well as systemic metabolism in cirrhosis, a catabolic disease. Circulating adiponectin levels and hepatic turnover were investigated in 20 patients with advanced cirrhosis. Hepatic hemodynamics [portal pressure, liver blood flow, hepatic vascular resistance, indocyanine green (ICG) half-life], body composition, resting energy expenditure, hepatic free fatty acids (FFA) and glucose turnover, and circulating levels of hormones (catecholamines, insulin, glucagon) and proinflammatory cytokines (IL-1␤, TNF-␣, IL-6) were also assessed. Circulating adiponectin increased dependently on the clinical stage in cirrhosis compared with controls (15.2 Ϯ 1.7 vs. 8.2 Ϯ 1.1 g/ml, respectively, P Ͻ 0.01), whereas hepatic extraction decreased. Adiponectin was negatively correlated with parameters of hepatic protein synthesis (prothrombin time: r ϭ Ϫ0.62, P ϭ 0.003; albumin: r ϭ Ϫ0.72, P Ͻ 0.001) but not with transaminases or parameters of lipid metabolism. In addition, circulating adiponectin increased with portal pressure (r ϭ 0.67, P ϭ 0.003), hepatic vascular resistance (r ϭ 0.60, P ϭ 0.008), and effective hepatic blood flow (ICG half-life: r ϭ 0.69, P ϭ 0.001). Adiponectin in cirrhosis was not correlated with BMI, BFM, parameters of energy metabolism, insulin levels, hepatic FFA and glucose turnover, and circulating proinflammatory cytokines. These results demonstrate that 1) adiponectin plasma levels in cirrhosis are significantly elevated, 2) the liver is a major source of adiponectin extraction, and 3) adiponectin levels in cirrhosis do not correlate with parameters of body composition or metabolism but exclusively with reduced liver function and altered hepatic hemodynamics. hepatic turnover; hepatic venous pressure gradient; calorimetry; body composition ADIPONECTIN IS A RECENTLY DISCOVERED 244 amino acid-containing molecule that belongs to the group of adipocytokines. It has been identified by several different groups and is thus also referred to as adipocyte complement-related protein 30

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Section: Discussionmentioning

confidence: 99%

Elevated circulating adiponectin levels in liver cirrhosis are associated with reduced liver function and altered hepatic hemodynamics

Tietge

Böker²,

Manns³

et al. 2004

American Journal of Physiology-Endocrinology and Metabolism

138

130

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“…Grainger et al claimed that ''This analysis enabled the hepatic extraction ratio (ER ss ) of dye to be determined solely from the plasma disappearance curve''. Unfortunately, their claim is not supported either by their own experimental data or by the results of subsequent experimental studies (Clements et al 1987;Burns et al 1990).…”

Section: Introductionmentioning

confidence: 93%

“…The mean value of the ratio, ER ss, single bolus /ER ss, direct measurement , is 0.87, which corresponds to a mean value of g = 0.13. Clements et al (1987) and Burns et al (1990) compared values of ER ss determined by continuous infusion with values determined by injection of a single bolus, and concluded that the single-bolus method is definitely not applicable to subjects with cirrhotic livers. As shown in Table 1, extraction ratios determined by the single-bolus method were several times larger than ratios determined by continuous infusion, and hepatic flow rates were correspondingly smaller.…”

Section: Transient Concentration Of Icg In Hepatic Venous Blood Follomentioning

confidence: 99%

Identifying a long standing error in single-bolus determination of the hepatic extraction ratio for indocyanine green

Wissler

2010

Eur J Appl Physiol

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For approximately 50 years, hepatic clearance of indocyanine green (ICG) has been used to assess liver function. Steady-state infusion of ICG with simultaneous measurement of arterial and hepatic venous ICG concentrations provides unambiguous measures of the extraction ratio for ICG and the hepatic blood flow rate, but also requires cannulation of a hepatic vein. Transient clearance following injection of a single bolus of ICG, which typically involves only measurement of arterial ICG concentration, is a more commonly used procedure. Since drawing blood from a hepatic vein is often impossible, and, in any event can be difficult, there has been considerable interest in the claim by Grainger et al. (Clin Sci 64:207-212, 1983) that a single-bolus, two-compartment model "enabled the hepatic extraction ratio (ER(ss)) of dye to be determined solely from the plasma disappearance curve". The principal purpose of this paper is to show that the claim by Grainger et al. is not valid because it ignores the fact that a finite fraction of ICG entering the liver passes directly into hepatic veins without being sequestered in the liver. A valid relationship between ER(ss) and parameters determined from single-bolus clearance data is derived in this paper. For individuals with normally functioning livers, the single-bolus method of Grainger et al. yields an extraction ratio approximately 20% too large, but in cirrhotic patients with extensive intrahepatic shunting, the extraction ratio evaluated using the single-bolus method of Grainger et al. may be too large by a factor of two.

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“…After achieving steady-state conditions, HBF was calculated as HBFϭI ICG /(ICG a -ICG hv )/(1-hct), with I ICG representing the individual ICG-infusion rate (mg/min), ICG a representing the arterial ICG concentration (mg/L), ICG hv representing the hepatic venous ICG concentration (mg/L), and hct representing the hemat- ocrit. If the arteriohepatic venous ICG concentration difference was less than 0.1 mg/L, no HBF calculation was performed (19).…”

Section: Assessment Of Splanchnic Hemodynamicsmentioning

confidence: 99%

Altered alanine plasma levels despite normalized hepatic alanine extraction in the long-term course after liver transplantation

et al. 2003

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Comparison of bolus and infusion methods for estimating hepatic blood flow in patients with liver disease using indocyanine green

Cited by 22 publications

References 7 publications

Elevated circulating adiponectin levels in liver cirrhosis are associated with reduced liver function and altered hepatic hemodynamics

Elevated circulating adiponectin levels in liver cirrhosis are associated with reduced liver function and altered hepatic hemodynamics

Identifying a long standing error in single-bolus determination of the hepatic extraction ratio for indocyanine green

Altered alanine plasma levels despite normalized hepatic alanine extraction in the long-term course after liver transplantation

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