Maintained cerebral and skeletal muscle oxygenation during maximal exercise in patients with liver cirrhosis

Background/Aims In cirrhotic patients, insufficient redistribution of blood from splanchnic organs to the central circulation could limit blood supply to skeletal muscles and the brain during exercise. Methods Eight cirrhotic patients performed incremental cycling to exhaustion (74 (49–123) W; median with range). Results Heart rate increased from 68 (62–88) beats/min at rest to 142 (116–163) beats/min, cardiac output from 5.1 (3.3–7.2) to 12.9 (8.5–15.9) l/min, and mean arterial pressure from 89 (75–104) to 115 (92–129) mmHg (P<0.05), while the indocyanine green elimination determined hepatosplanchnic blood flow declined from 0.97 (0.55–1.46) to 0.62 (0.36–1.06) l/min (P<0.05). As assessed by near-infrared spectrophotometry, cerebral oxygenation (NIRS) was 61% (48–85%) and increased to 72% (57–86%) during exercise (P<0.05). The NIRS determined oxygenation of the vastus lateralis muscle also increased: the concentrations of oxygenated haemoglobin by 5.9 (0.57–9.47) μmol/l, deoxygenated haemoglobin by 7.2 (1.8–12.0) μmol/l, and thus total haemoglobin by 12.1 (3.6–21.5) μmol/l (P<0.05). Conclusions In patients with cirrhosis, exercise reduces hepatosplanchnic blood flow, while O2 supply to muscle and brain appears to increase indicating that blood redistribution from splanchnic organs does not limit blood flow to working muscles and the brain.