Colloid Osmotic Pressure in Decompensated Cirrhosis

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Abstract
Colloid osmotic pressure in plasma (P) and ascitic fluid (A) and hydrostatic pressures in the hepatoportal system were measured simultaneously in 20 patients with decompensated cirrhosis. P was significantly decreased (mean. 21 mm Hg. versus normal, 30 mm Hg; P < 0.01), and A was significantly below that of plasma (average, 25% of P; P < 0.01). Portal pressure (transmural), determined as wedged hepatic venous minus inferior vena caval pressure (WHV - IVCP), was significantly increased (mean, 18 mm Hg, versus normal, 3 mm Hg; PA/P(r = -0.77, P < 0.001). WHV - IVCP was in most patients in the same order as and closely correlated to effective colloid osmotic pressure (P -A) (r = 0.88, P < 0.001). No relationship was found between WHV - IVCP and P. The results indicate that a fall in colloid osmotic pressure in the interstitial space and ascitic fluid is related to and most likely secondary to the elevated portal pressure in decompensated cirrhosis. Effective colloid osmotic pressure may therefore be regarded as a ‘mirror image’ of transmural portal pressure. The role of colloid osmotic pressure in the genesis and perpetuation of ascites should be reconsidered in the light of these findings.