Effect of renal prostaglandins on survival in patients with liver cirrhosis.

Abstract

To assess the effect of renal prostaglandins on the prognosis of liver cirrhosis, we studied the relationship between the effect of prostaglandin synthetase inhibition by indomethacin on glomerular filtration rate (GFR) and effective renal plasma flow (RPF) and survival in 30 patients with liver cirrhosis. After indomethacin administration, GFR dropped significantly from 86 +/- 2 ml/min to 73 +/- 3 ml/min (p less than 0.01) and RPF from 421 +/- 10 to 349 +/- 14 ml/min (p less than 0.01). Survival was not correlated with baseline GFR or RPF, but was correlated with changes in both GFR and RPF after indomethacin administration (p less than 0.01). The cumulative survival rate from 1 to 7 yr was significantly higher (p less than 0.01) in patients with a decrease in GFR of less than or equal to 15% after indomethacin administration than in patients with a decrease in GFR of more than 15%. Findings for changes in RPF after indomethacin administration were similar. These results suggest that the augmentation of prostaglandin inhibition by indomethacin is associated with a poor prognosis of liver cirrhosis. It may be involved in the depletion of renal prostaglandins to maintain renal hemodynamics in patients with liver cirrhosis.