Bacterial DNA Translocation Is Associated With Systemic Circulatory Abnormalities and Intrahepatic Endothelial Dysfunction in Patients With Cirrhosis

Abstract

Presence of bacterial DNA in noninfected patients with cirrhosis and ascites is associated with a marked inflammatory response including activation of the inducible form of nitric oxide synthase and release of nitric oxide, similar to that observed in patients with sponta-neous bacterial peritonitis. Although presence of bacterial DNA is associated with an impaired prognosis, no information is available regarding its hemodynamic consequences. Systemic and hepatic hemodynamics before and after a liquid test meal were assessed in a series of 75 noninfected patients with cirrhosis (55 with ascites). Bacterial DNA was meas-ured by polymerase chain reaction. Bacterial DNA was detected only in patients with asci-tes. Clinical data and liver function were similar in ascitic patients with presence (n 5 21) or absence of bacterial DNA (n 5 34). Bacterial-DNA(1) patients had significantly lower mean arterial pressure ( P 5 0.002) and systemic vascular resistance ( P 5 0.03) than bacte-rial-DNA(2) patients. Cardiac output, cardiopulmonary pressures, hepatic venous pres-sure gradient (HVPG), and hepatic blood flow were similar in both groups. Thirty minutes after the test meal, in response to increased blood flow caused by postprandial hy-peremia, there was a significantly greater increase in HVPG and impaired hepatic vasore-laxation in bacterial-DNA(1) as compared with bacterial-DNA(2) patients, which indicates hepatic endothelial dysfunction. Indeed, the increase in HVPG after the test meal significantly correlated with serum bacterial DNA concentration. Conclusion: Pres-ence of bacterial DNA, a marker of bacterial translocation, is associated with aggravation of peripheral vasodilation and with worsening of intrahepatic endothelial dysfunction. (HEPATOLOGY 2010;52:2044-2052)