Blood cyclic guanosine monophosphate levels as potential marker of portal hypertension in patients with liver cirrhosis

Question Despite intensive research reliable blood-derived parameters to detect portal hypertension in patients with liver cirrhosis are lacking. As dysregulation of the nitric oxide - cyclic guanosine monophosphate (NO – cGMP) pathway is considered a major factor in the pathogenesis of portal hypertension, the aim of our study was to investigate blood cGMP levels in different stages of chronic liver disease and to evaluate cGMP as potential biomarker of portal hypertension.

Methods cGMP levels were analyzed in blood of patients with liver cirrhosis and clinically significant portal hypertension (n = 32), patients with liver cirrhosis without clinically significant portal hypertension (n = 21), patients with chronic liver disease without cirrhosis (n = 11) and healthy controls (n = 8). cGMP levels were evaluated as biomarker of portal hypertension by ROC-analyses in comparison to the Lok-index as established score to predict portal hypertension.

Results Blood cGMP was significantly elevated in liver cirrhosis patients who had clinically significant portal hypertension compared to liver cirrhosis patients without portal hypertension (90.1 ±46.8 pmol/ml vs. 50.1 ±46.4 pmol/l, p  <  0.001). In contrast, there was no significant difference in blood cGMP between patients with liver cirrhosis without portal hypertension and patients without liver cirrhosis/fibrosis (p = 0.347). ROC-analyses revealed a high diagnostic value of blood cGMP for the prediction of portal hypertension (AUC 0.925 [0.827-0.999]) that was superior to the Lok-index (0.737 [0.568-0.907]).

Conclusions Blood cGMP may be a valuable biomarker of cirrhotic portal hypertension in clinical practice that invites further investigation.

Publication History

Article published online:
04 January 2021