ArticleHepatology international2021
The differential activation of cardiovascular hormones across distinct stages of portal hypertension predicts clinical outcomes.
Article in Hepatology international, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06097715 (Clinical, Endoscopic and Radiological Assessment of Portal Hypertension in Children With Chronic Liver Diseases), which is not on this map. Cited by 17 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Clinical, Endoscopic and Radiological Assessment of Portal Hypertension in Children With Chronic Liver Diseases
Who cites it
17 citing papers in PubMed, 4 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Prognostic biomarkers for predicting decompensation in alcoholic and non-alcoholic patients with compensated cirrhosis: a systematic review and meta-analysis.Frontiers in medicine · 2025Pooled it
- Systematic review and meta-analysis of biomarkers predicting decompensation in patients with compensated cirrhosis.BMJ open gastroenterology · 2024Pooled it
- Guideline
- Circulating copeptin level and the clinical prognosis of patients with chronic liver disease.World journal of gastroenterology · 2023Pooled it
- Lower circulating angiotensinogen levels across ACLD stages are associated with hepatic dysfunction and mortality.Hepatology communications · 2026Observational
- Indocyanine Green Clearance Correlates With Biomarkers Reflecting Key Disease-Driving Mechanisms in Advanced Chronic Liver Disease and Predicts Acute-on-Chronic Liver Failure and Death.Alimentary pharmacology & therapeutics · 2026Article
- Interaction of inflammation and portal hypertension in cirrhosis progression.Nature reviews. Gastroenterology & hepatology · 2025Review
- Insulin-like growth factor-1 in cirrhosis is linked to hepatic dysfunction and fibrogenesis and predicts liver-related mortality.Alimentary pharmacology & therapeutics · 2025Article
- The Renin-Angiotensin System in Liver Disease.International journal of molecular sciences · 2024Review
- Association of Renin-Angiotensin System Inhibition With Liver-Related Events and Mortality in Compensated Cirrhosis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024Article
- Lower free triiodothyronine (fT3) levels in cirrhosis are linked to systemic inflammation, higher risk of acute-on-chronic liver failure, and mortality.JHEP reports : innovation in hepatology · 2024Article
- Markers of cardiac injury in patients with liver cirrhosis.Croatian medical journal · 2023Review
- An impaired pituitary-adrenal signalling axis in stable cirrhosis is linked to worse prognosis.JHEP reports : innovation in hepatology · 2023Article
- The systemic and hepatic alternative renin-angiotensin system is activated in liver cirrhosis, linked to endothelial dysfunction and inflammation.Scientific reports · 2023Article
- Hypoalbuminemia affects the spatio-temporal tissue distribution of ochratoxin A in liver and kidneys: consequences for organ toxicity.Archives of toxicology · 2022Article
- Application of Ultrasound Elastography in Assessing Portal Hypertension.Diagnostics (Basel, Switzerland) · 2022Review
- Cirrhosis-Associated RAS-Inflammation-Coagulation Axis Anomalies: Parallels to Severe COVID-19.Journal of personalized medicine · 2021Article
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Authors and funding
19 authors at 3 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsThe cardiovascular hormones renin/angiotensin/aldosterone (RAA), brain-type natriuretic peptide (BNP)and arginine-vasopressin (AVP) are key regulators of systemic circulatory homeostasis in portal hypertension (PH). We assessed (i) the activation of renin, BNP and AVP across distinct stages of PH and (ii) whether activation of these hormones correlates with clinical outcomes.
methodsPlasma levels of renin, proBNP and copeptin (AVP biomarker) were determined in 663 patients with advanced chronic liver disease (ACLD) undergoing hepatic venous pressure gradient (HVPG) measurement at the Vienna General Hospital between 11/2011 and 02/2019. We stratified for Child stage (A-C), HVPG (6-9 mmHg, 10-15 mmHg, ≥ 16 mmHg) and compensated vs. decompensated ACLD.
resultsWith increasing PH, hyperdynamic state was indicated by higher heart rates (6-9 mmHg: median 71.0 [IQR 18.0] bpm, 10-15 mmHg: 76.0 [19.0] bpm, ≥ 16 mmHg: 80.0 [22.0] bpm; p < 0.001), lower mean arterial pressure (6-9 mmHg: 103.0 [13.5] mmHg, 10-15 mmHg: 101.0 [19.5] mmHg, ≥ 16 mmHg: 99.0 [21.0] mmHg; p = 0.032) and lower serum sodium (6-9 mmHg: 139.0 [3.0] mmol/L, 10-15 mmHg: 138.0 [4.0] mmol/L, ≥ 16 mmHg: 138.0 [5.0] mmol/L; p < 0.001). Across HVPG strata (6-9 mmHg vs. 10-15 mmHg vs ≥ 16 mmHg), median plasma levels of renin (21.0 [50.5] vs. 25.1 [70.9] vs. 65.4 [219.6] µIU/mL; p < 0.001), proBNP (86.1 [134.0] vs. 63.6 [118.0], vs. 132.2 [208.9] pg/mL; p = 0.002) and copeptin (7.8 [7.7] vs. 5.6 [8.0] vs. 10.7 [18.6] pmol/L; p = 0.024) increased with severity of PH. Elevated renin levels independently predicted first hepatic decompensation (adjusted hazard ratio [aHR]: 1.69; 95% confidence interval [95% CI] 1.07-2.68; p = 0.025) and mortality in compensated patients (aHR: 3.15; 95% CI 1.70-5.84; p < 0.001) and the overall cohort aHR: 1.42; 95% CI 1.01-2.01; p = 0.046). Elevated copeptin levels predicted mortality in decompensated patients (aHR: 5.77; 95% CI 1.27-26.33; p = 0.024) and in the overall cohort (aHR: 3.29; 95% CI 1.36-7.95; p = 0.008). ProBNP levels did not predict clinical outcomes.
conclusionsThe cardiovascular hormones renin, proBNP and AVP are activated with progression of ACLD and PH. Renin activation is a risk factor for hepatic decompensation and mortality, especially in compensated patients. Increased plasma copeptin is a risk factor for mortality, in particular in decompensated patients.
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