Skip to main content
SpringerLink
Log in

Endogenous endotoxemia in patients with liver cirrhosis —A quantitative analysis of endotoxin in portal and peripheral blood

  • Original Articles
  • Published:
The Japanese journal of surgery Aims and scope Submit manuscript

Abstract

In order to investigate the mechanism of endogenous endotoxemia (that is, endotoxemia observed in the absence of infection) in patients with liver cirrhosis, the concentration of endotoxin in the portal (PO-Et) and peripheral blood (PE-Et) from fifty three patients undergoing abdominal surgery was simultaneously measured by a quantitative endotoxin assay. The PE-Et of the patients with liver cirrhosis (19.8±20.2 pg/ml, n=23) was significantly elevated, when compared with that of the patients without liver cirrhosis (9.2±5.1 pg/ml, n=30), and was close to the normal range of PE-Et obtained from thirty healthy volunteers (7.2±4.1 pg/ml, n=30). The PO-Et was also higher in the patients with liver cirrhosis than in the patients without liver cirrhosis. Moreover, PO-Et was significantly higher than PE-Et in all the patients (p<0.05). The per cent difference in the endotoxin concentration between the portal and peripheral blood (percentage of ΔEt) was significantly decreased in the cirrhotic patients, especially in those with esophageal varices, which was well correlated with the phagocytic activity of the reticuloendothelial system (RES) determined by the clearance of iron colloid. The endogenous endotoxemia is thus likely to be due to the impaired clearance of endogenous endotoxin in portal blood, resulting from both the decreased phagocytic activity of RES in the liver and the coexisting porta-systemic bypass.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Caridis DT, Reinhold RB, Woodruff PWH, Fine J. Endotoxaemia in man. Lancet 1972; 1: 1381–1386.

    Article  PubMed  CAS  Google Scholar 

  2. Prytz H, Holst-Christensen J, Korner B, Liehr H. Portal venous and systemic endotoxaemia in patients without liver disease and systemic endotoxaemia in patients with cirrhosis. Scand J Gastroenterol 1976; 11: 857–863.

    PubMed  CAS  Google Scholar 

  3. Triger DR, Boyer TD, Levin J. Portal and systemic bacteraemia and endotoxaemia in liver disease. Gut 1978; 19: 935–939.

    PubMed  CAS  Google Scholar 

  4. Jacob AJ, Goldberg PK, Bloom N, Degenshein GA, Kozinn PJ. Endotoxin and bacteria in portal blood. Gastroenterology 1977; 72: 1268–1270.

    PubMed  CAS  Google Scholar 

  5. Tarao K, So K, Moroi T, Ikeuchi T, Suyama T, Endo O, Fukushima K. Detection of endotoxin in plasma and ascitic fluid of patients with cirrhosis: its clinical significance. Gastroenterology 1977; 73: 539–542.

    PubMed  CAS  Google Scholar 

  6. Liehr H, Grün M, Brunswig D, Sautter Th. Endotoxaemia in liver cirrhosis: treatment with polymyxin B (leter). Lancet 1975; 1: 810–811.

    Article  PubMed  CAS  Google Scholar 

  7. Mason JW, Colman RW. The role of Hageman factor in disseminated intravascular coagulation induced by septicemia, neoplasia or liver disease. Thromb Diath Haemorrh 1971; 26: 325–330.

    PubMed  CAS  Google Scholar 

  8. Wilkinson SP, Arroyo V, Gazzard BG. Relation of renal impairment and haemorrhagic diathesis to endotoxemia in fulminant hepatic failure. Lancet 1974; 1: 521–524.

    Article  PubMed  CAS  Google Scholar 

  9. Levin J, Poore TE, Young NS. Gram-negative sepsis: detection of endotoxemia with the limulus test. Ann Intern Med 1972; 76: 1–7.

    PubMed  CAS  Google Scholar 

  10. Greene R, Wiznitzer T, Rutenburg S. Hepatic clearance of endotoxin absorbed from the intestine. Proc Soc Exp Biol Med 1961; 108: 261–263.

    Google Scholar 

  11. Fossard DP, Kakker VV. The limulus test in experimental and clinical endotoxaemia. Brit J Surg 1974; 61: 798–804.

    PubMed  CAS  Google Scholar 

  12. Mori K, Matsumoto K, Gans H. On thein vivo clearance and detoxification of endotoxin by lung and liver. Ann Surg 1972; 177: 159–163.

    Article  Google Scholar 

  13. Mathison JC, Ulevitch RJ. The clearance, tissue distribution, and cellular localization of intravenously injected lipopolysaccharide in rabbits. J Immunol 1979; 123: 2133–2139.

    PubMed  CAS  Google Scholar 

  14. Yamaguchi Y, Yamaguchi K, Babb JL, Gans H.In vivo quantitation of the rat liver’s ability to eliminate endotoxin from portal vein blood. J Reticuloendothel Soc 1982; 32: 409–422.

    PubMed  CAS  Google Scholar 

  15. Caruana JA, Camaro DS, Schneeberger GJ, Nolan JP. The clearance capacity of the canine liver for a portal vein endotoxin infusion. J Surg Res 1984; 37: 197–201.

    Article  PubMed  CAS  Google Scholar 

  16. Bang FB. A bacterial disease of Limulus polyphemus. Bull Johns Hopkins Hosp 1956; 98: 325–351.

    PubMed  CAS  Google Scholar 

  17. Levin J, Bang FB. The role of endotoxin in the extracellular coagulation of Limulus blood. Bull Johns Hopkins Hosp 1964; 115: 265–274.

    PubMed  CAS  Google Scholar 

  18. Iwanaga S, Morita T, Harada T, Nakamura S, Niwa M, Takada K, Kimura T, Sakakibara S. Chromogenic substrate for horseshoe crab clotting enzyme. Its application for the assay of bacterial endotoxins. Haemostasis 1978; 7: 183–188.

    PubMed  CAS  Google Scholar 

  19. Obayashi T. Addition of perchloric acid to blood samples for colorimetric limulus test using chromogenic substrate: Comparison with conventional procedures and clinical applications. J Lab Clin Med 1984; 104: 321–330.

    PubMed  CAS  Google Scholar 

  20. Harris RI, Stone P, Evans GR, Stuart J. Endotoxaemia as a cause of fever in immunosuppressed patients. J Clin Pathol 1984; 37: 467–470.

    PubMed  CAS  Google Scholar 

  21. Tachiyama G, Sakon M, Kambayashi J, Ohshiro T, Mori T. Chromogenic assay of endotoxin in platelet poor or rich plasma. Thrombos Res 1986; 37: 309–317.

    Article  Google Scholar 

  22. Sakon M, Tachiyama G, Kambayashi J, Ohshiro T, Mori T. Studies on blood sample preparation for clinical endotoxin assay. Thrombos Res 1986; 43: 361–365.

    Article  CAS  Google Scholar 

  23. Child CG. The liver and portal hypertension. In: Saunders WB ed. MPCS. Philadelphia. 1964; 50.

    Google Scholar 

  24. Paumgartner G, Probst R, Kraines R, Leevy CM. Kinetics of indocyanine green removal from the blood. Ann NY Acad Sci 1970; 170: 134–147.

    CAS  Google Scholar 

  25. Kuratsune H, Koda T, Kurahori T. The relationship between endotoxin and the phagocytic activity of the reticuloendothelial system. Hepato-gastroenterol 1982; 30: 79–82.

    Google Scholar 

  26. Danielle PRD, Adriaan B, Dick LK Clearance capacity of rat liver Kupffer, endothelial, and parenchymal cells. Gastroenterology 1981; 81: 1036–1044.

    Google Scholar 

  27. Freudenberg N, Freudenberg MA, Bandara K, Galanos C. Distribution and localization of endotoxin in the reticuloendothelial system (RES) and in the main vessels of the rat during shock. Path Res Pract 1985; 179: 517–527.

    PubMed  CAS  Google Scholar 

  28. Nolan JP, Ali MV. Effect of cholestyramine on endotoxin toxicity and absorption. Am J Dig Dis 1972; 17: 161–166.

    Article  PubMed  CAS  Google Scholar 

  29. Ravin HA, Rowley D, Jenkins C. On the absorption of bacterial endotoxin from the gastro-intestinal tract of the normal and shocked animal. Exp Med 1960; 112: 783–792.

    Article  CAS  Google Scholar 

  30. Ohnishi K, Chin N, Sugita S, Saito M, Tanaka H, Terabayashi H, Saito M, Iida S, Nomura F, Okuda K. Quantitative aspects of portal-systemic and arteriovenous shunts within the liver in cirrhosis. Gastroenterology 1987; 93: 129–134.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Second Department of Surgery, Osaka University Medical School, 1-1-50 Fukushima, 553, Osaka, Japan

    Goro Tachiyama, Masato Sakon, Junichi Kambayashi MD, Shöhei Iijima, Toshimasa Tsujinaka & Takesada Mori

Authors
  1. Goro Tachiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masato Sakon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junichi Kambayashi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shöhei Iijima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshimasa Tsujinaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takesada Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tachiyama, G., Sakon, M., Kambayashi, J. et al. Endogenous endotoxemia in patients with liver cirrhosis —A quantitative analysis of endotoxin in portal and peripheral blood. The Japanese Journal of Surgery 18, 403–408 (1988). https://doi.org/10.1007/BF02471464

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02471464

Key Words

Search

Navigation