Relationship between endotoxaemia and protein concentration of ascites in cirrhotic patients

Abstract

Endotoxemia was investigated by the Limulus assay in 42 cirrhotic patients with ascites and in 33 without ascites. The incidence of endotoxemia in the former group (59.5%) was significantly (P < 0.05) higher than in the latter (36.4%). Correlation between endotoxemia and specific gravity and concentrations of total protein, albumin, and globulin in ascitic fluid was studied in the group with ascites. The specific gravity of ascites in 25 patients with endotoxemia was significantly greater than that in 17 patients with endotoxemia (P < 0.01). The concentration of total protein in patients with endotoxemia (13.95 ± 7.18 g/l, mean ± SD) was nearly twice as high (P < 0.01) as in patients without endotoxemia (7.49 ± 3.60 g/l). The protein content of those who showed reactions greater or equal to 2(+) in the Limulus assay (16.78 ± 7.14 g/l) was significantly (P < 0.05) higher than in those with 1(+) reaction (11.26 ± 6.33 g/l). Moreover, the concentration of albumin in patients with endotoxemia (7.68 ± 4.60 g/l) was more than twice that of the patients without endotoxemia (3.39 ± 1.58 g/l, P < 0.01). On the other hand, globulin concentration in patients with endotoxemia was 1.6 times that of patients without endotoxemia (P < 0.01). Similar differences were noted between endotoxemic and non-endotoxemic patients in the ascites-to-serum ratio in protein, albumin, and globulin. These results suggest that in liver cirrhosis endotoxemia may cause an increase in protein concentrations in ascitic fluid, and that it may be a precipitating factor in the formation of ascites.