Diagnostic Significance of Nitrates and Nitrites and L-Arginine, in Development of Hepatorenal Syndrome in Patients with End Stage Alcoholic Liver Cirrhosis

Figures & data

Figure 1. The association between NO₂ + NO₃ concentration and AST/ALT ratio in tested groups. (The relation between the tested variables was determined by linear regression analysis and goodness of fit analysis, as well as by Pearson’s correlation coefficient). NO₂ + NO₃ are expressed as μmol/L.

Figure 2. The association between NO₂ + NO₃ and CRP in tested groups. (The relation between the tested variables was determined by linear regression analysis and goodness of fit analysis, as well as by Pearson’s correlation coefficient). NO₂ + NO₃ are expressed as μmol/L and CRP as mg/L.

Figure 3. The association between NO₂ + NO₃ concentration and creatinine concentration in tested groups. (The relation between the tested variables was determined by linear regression analysis and goodness of fit analysis, as well as by Pearson’s correlation coefficient). NO₂ + NO₃ and creatinine are expressed as μmol/L.

Table 1. Basic demographic clinical and biochemical characteristics of patients and healthy examinees.

	Cirrhosis and HRS	Cirrhosis	Healthy controls
Males/females	28/0	22/0	42/0
Age (years)	55.83 ± 12.41	50.58 ± 11.08	50.76 ± 9.7
AST/ALT	2.76 ± 0.59	1.66 ± 0.40	1.05 ± 0.19
Albumin (g/L)	28.27 ± 5.59	32.57 ± 5.93	43.29 ± 5.03
Total bilirubin (μmol/L)	147.91 ± 43.21	56.77 ± 24.74	5.76 ± 2.48
Indirect bilirubin (μmol/L)	78.21 ± 13.86	30.54 ± 15.23	5.29 ± 2.15
Direct bilirubin (μmol/L)	77.31 ± 35.83	26.23 ± 17.47	0.46 ± 0.39
Urea (mmol/L)	9.29 ± 1.80	6.33 ± 2.50	4.31 ± 1.46
Creatinine (μmol/L)	160.36 ± 30.79	88.80 ± 15.80	77.09 ± 14.84
CRP (mg/L)	10.94 ± 2.81	6.90 ± 2.02	1.65 ± 1.10

Notes: * Statistically significant difference was accepted with a risk of p < 0.05. The research included two study groups: a group of patients with cirrhosis, divided based on the presence of HRS and a group of healthy examinees. The group with cirrhosis included 50 patients who had been consuming alcohol for over 10 years. General biochemical parameters were obtained from serums taken from participants using standard biochemical IFCC methods (OLYMPUS-AU680). The results obtained by the research were presented as average values with standard deviations. The significance of the differences was determined by ANOVA test. Post hoc Dunnett’s T3 analysis and Tuckey test were also performed.

Table 2. Arginine and NO₂ + NO₃ in the tested groups.

	Cirrhosis and HRS	Cirrhosis	Healthy controls
Arginine (μmol/L)	71.07 ± 12.93	86.28 ± 17.26	98.62 ± 31.68
NO2 + NO3 (μmol/L)	140.09 ± 20.34	121.68 ± 35.36	62.60 ± 16.00

Notes: * Statistically significant difference was accepted with risk of p < 0.05. NO₂ + NO₃ concentrations were determined using Navarro–Gonzalez semiautomated method, based on diazotization of sulfanilic acid l-arginine concentration wad determined by using HPLC system. The significance of the differences was determined by ANOVA test. Post hoc Dunnett’s T3 analysis and Tuckey test were also performed.

Table 3. Predictive value of analyzed markers in the development of HRS.

	B	Exp(B)	95.0% C.I. for EXP(B)		p
Albumin (g/L)	−0.22	0.81	0.71	0.92	0.00
Total proteins (g/L)	−0.07	0.93	0.87	1.00	0.06
AST/ALT	4.64	10.55	8.74	12.62	0.00
Total bilirubin (μmol/L)	0.04	1.04	1.02	1.06	0.00
CRP (mg/L)	0.40	1.49	1.21	1.83	0.00
Urea (mmol/L)	0.49	1.63	1.22	2.17	0.00
Creatinine (μmol/L)	4.87	13.1	0.00	19.00	0.00
Arginine (μmol/L)	−0.06	12.7	0.91	0.98	0.00
NO2 + NO3 (μmol/L)	0.02	45.02	1.01	1.03	0.01

Notes: The association between the monitored biochemical markers in plasma and the development of HRS in patients with alcoholic liver cirrhosis was tested using binary logistic regression analysis (Enter model).