The Effect of Oxygen Supplementation on the Arterial Ketone Body Ratio in Human Cirrhosis

Abstract

Background/Aims: Data from studies in experimental models have suggested that the impairment of mitochondrial function and altered redox state that occur in cirrhosis may be due to impaired hepatic oxygenation. Since interventions that improve oxygen delivery to hepatocytes may improve mitochondrial functions, we studied the effects of oxygen supplementation on the arterial ketone body ratio (AKBR) in normal volunteers and patients with cirrhosis. Methods: After a 2-hour fast, ketone bodies were measured in arterial blood taken from patients and controls while breathing room air and then after breathing oxygen via a face mask at 12 liters/min for 60 min. Results: The AKBR was reduced in cirrhotic patients compared with controls, 0.74 ± 0.23 and 1.51 ± 0.4, respectively (p = 0.002). Oxygen supplementation significantly improved the AKBR in cirrhotic patients, from 0.74 ± 0.23 to 1.04 ± 0.28 (p = 0.001) but did not affect the AKBR in controls. Conclusion: These findings suggest that reduced hepatocyte oxygenation contributes to impaired hepatic mitochondrial function in cirrhosis. Strategies at increasing hepatic oxygen delivery may improve hepatic mitochondrial function in patients with chronic liver disease.

Two cases of hepatopulmonary syndrome with improved liver function following long-term oxygen therapy

“…It has been reported that hepatocellular hypoxemia directly contributes to the progression of liver fi brosis, 9 and also to liver regeneration failure in cirrhotic livers. 10 Froomes et al 11 measured the arterial ketone body ratio (AKBR; acetoacetate/3-hydroxybutyrate) in patients with cirrhosis to investigate hepatic mitochondrial function. 12 Their results revealed that low AKBR levels in such patients were signifi cantly increased after they received 2 h of oxygen supplementation.…”

Regional variations in the concentrations of ketone bodies in cirrhosis and hepatic encephalopathy: a study in patients with TIPSS

“…In this study, we have for the first time looked in detail into regional variations in the concentrations of ketone bodies in cirrhosis and in patients suffering from a common complication of cirrhosis, hepatic encephalopathy. Previous studies have shown that the arterial ketone body ratios are different from controls in patients with various liver diseases (7–10). It is lower in patients with cirrhosis but it can be improved in a state of improved oxygenation.…”

“…Previous studies have described a relationship between the blood ketone body ratio (acetoacetate/β‐hydroxybutyrate) as a marker of the hepatic energy charge (5–7). As β‐hydroxybutyrate is produced from acetoacetate with the consumption of NADH, their ratio accurately reflects the ratio of free NAD to reduced NADH (6).…”

“…The NAD/NADH ratio is known as the mitochondrial redox potential. It reflects accurately the hepatic energy charge (7–10).…”

Funktionsdiagnostik vor Leberresektion - teuer und ohne klinische Relevanz?

“…jedoch kontrovers diskutiert, da ebenso Studien existieren, die keinen prognostischen Wert dieses Tests zeigen[19] und des Weiteren der Test scheinbar durch Sauerstoffgabe beeinflusst wird[13].Auch wenn verschiedene Untersucher Leberfunktionsteste in die Operationsplanung bezüglich des Ausmaßes der Operation bzw. der Operationstechnik integriert haben[49,63,64], so bleibt es jedoch unwahrscheinlich, dass ein einzelner Leberfunktionstest ausreichend ist, um Patienten mit postoperativen Leberversagen von Patienten zu unterscheiden, die eine Leberteilresektion problemlos überstehen.…”