The Erythrocyte 2,3-diphosphoglycerate Concentration and Its Related Factors in Patients with End-stage Liver Disease

Lee, Jaemin; Park, Chul Soo; Chang, Hae Wone; Kwon, Hyun Joo; Choi, Jong Ho

Abstract

BACKGROUND
It is believed that an increase in the level of erythrocyte 2,3-diphosphoglycerate is an important compensatory mechanism that allows satisfactory tissue oxygenation in hypoxic patients. This study measured the level of 2,3-diphophoglycerate and the factors affecting its concentration, as well as the position of the oxygen-hemoglobin dissociation curve in patients with end-stage liver disease.
METHODS
Fifty patients receiving liver transplantation (experimental group) and forty-five healthy donors (control group) were enrolled in this study. Arterial-mixed venous oxygen content difference, whole body oxygen delivery and consumption were measured after determining the hemodynamic parameters including cardiac output in the experimental group. The erythrocyte 2,3-diphosphoglycerate level was measured using assay procedures. The P50 value was used to determine the position of the oxygen-hemoglobin dissociation curve.
RESULTS
The 2,3-diphosphoglycerate level was higher in patients with end-stage liver disease than in the controls. A 0.3 g/L increase in the 2,3-diphosphoglycerate concentration corresponded to a P50 increase in 1.2 mmHg with a rightward displacement of the oxygen-hemoglobin dissociation curve. The 2,3-diphosphoglycerate concentration showed a significant correlation with the PaO2, Ca-vO2, P50, and blood lactate level, but not with the hemodynamic parameters such as the cardiac index, oxygen delivery index, and pH.
CONCLUSIONS
End-stage liver disease is associated with an increase in the level of the erythrocyte 2,3-diphosphoglycerate and P50. This is believed to be an important compensatory mechanism to allow better tissue oxygenation. An increase in the 2,3-diphosphoglycerate level correlates well with the oxygenation parameters, rather than with the hemodynamic parameters.