Portal and systemic bacteraemia and endotoxaemia in liver disease

Abstract

Using a percutaneous transhepatic technique, blood was obtained from the portal veins of 30 patients with various hepatic disorders and examined for the presence of bacteria and endotoxin. Simultaneous samples also were drawn from hepatic and peripheral veins. In three cases, portal vein cultures grew diphtheroids, which were of doubtful significance, while all hepatic and peripheral cultures were sterile. Endotoxin was detected in seven portal vein samples; in none of these patients were the hepatic or peripheral blood samples positive. In three cases, only peripheral blood samples were positive for endotoxin. It was concluded that portal bacteraemia occurs as infrequently in patients with liver disease as in those without. Portal endotoxaemia was detected in patients with all degrees of liver disease but, even in patients with moderately severe portal hypertension, the liver may remain an effective filter of endotoxin.