Effect of oral propranolol on circulating catecholamines in cirrhosis: relationship to severity of liver disease and splanchnic haemodynamics

Abstract

Patients with cirrhosis, especially those with decompensated disease have enhanced sympathetic nervous activity. We have investigated the effect of a single oral dose of 80 mg propranolol on circulating catecholamines and related the effect to splanchnic and systemic haemodynamics in 22 patients with cirrhosis. Plasma noradrenaline (NA) was significantly above normal average (NA: 0.52 vs. 0.23 ng/ml, p < 0.01) and increased with the severity of the liver disease ( p < 0.01). NA was negatively correlated with liver function as estimated by ICG clearance ( r = −0.74, p < 0.01). Azygos blood flow was increased (0.75 l/min) and positively related to plasma NA ( r = 0.57, p = 0.05, n = 12). After propranolol intake, plasma NA increased from 0.52 to 0.59 ng/ml ( p < 0.01). This response was found in all Child-Turcotte classes (A: 0.37 to 0.43; B: 0.49 to 0.56; C: 0.78 to 0.88 ng/ml), and in patients with as well as without ascites. Plasma adrenaline increased in the same way ( p < 0.01). Hepatic blood flow (from 1.10 to 0.93 l/min, p < 0.01) and azygos blood flow (from 0.75 to 0.55 l/min, n = 9, p < 0.05) decreased significantly after oral propranolol. A borderline significant correlation was observed between the decrease in azygos blood flow and the increase in NA ( r = 0.64, p = 0.06). Our results suggest that besides a relationship to liver function and severity of disease, sympathetic nervous activity, as reflected by circulating NA, will further enhance during β-adrenergic blockade, probably by a compensatory mechanism. Catecholamines and their response to propranolol may have a substantial influence on splanchnic and collateral haemodynamics.