Regional variations in the concentrations of ketone bodies in cirrhosis and hepatic encephalopathy: a study in patients with TIPSS

Background: Little is known about the metabolism of acetoacetate and beta-hydroxybutyrate in patients with cirrhosis and encephalopathy. Aims: We investigated the fate of ketone bodies in these conditions. Materials and methods: We studied 18 cirrhotic patients with encephalopathy and 17 cirrhotics without. At the time of insertion of a transjugular intrahepatic portosystemic stent shunt (TIPSS) or at the time of portographical assessment of the shunt's patency, we collected blood from the internal jugular, the right atrium, the inferior vena cava, the hepatic, the portal, the splenic veins and the radial artery. We used nuclear magnetic resonance spectroscopy to measure the concentrations of acetoacetate and beta-hydroxybutyrate. Results: There was no difference in the total ketone body concentrations between the two groups. The mitochondrial redox potential was significantly higher in the encephalopathics (142/54 = 2.63 vs 52/83 = 0.62) (P<0.01). beta-hydroxybutyrate was significantly lower in the portal vein of encephalopathics (52 +/- 4 vs 28 +/- 3) (P<0.02) and in the splenic vein (48 +/- 6 vs 32 +/- 5) (<0.04). Acetoacetate was significantly higher in encephalopathics in the internal jugular vein (134 +/- 12 vs 92 +/- 16) (P<0.03), the right atrium (112 +/- 18 vs 68 +/- 11) (P<0.03), the hepatic vein (162 +/- 25 vs 115 +/- 19) (P<0.05), the portal vein (133 +/- 20 vs 81 +/- 14) (P<0.02) and the splenic vein (167 +/- 24 vs 122 +/- 21) (P<0.04). All measurements are expressed in mu mols/L. Conclusions: There are significant variations in the regional concentrations of the ketone bodies in encephalopathy.