The porphyrin metabolism in liver cirrhosis

Aim. To comparatively study porphyrin metabolic disturbances in liver cirrhosis (LC) of varying etiology and to estimate the diagnostic and prognostic value of the detected disorders. Subjects and methods. Seventy-one patients were examined; among them 34, 15, and 22 patients were diagnosed as having alcoholic, viral, and alcoholic-and-viral LC, respectively. Its predictors and porphyrin fractions were determined in their urine and feces. Results. Porphyrin metabolic disturbances were recorded in 62 (87.3%) patients and found in the majority of patients with viral (86.7%), alcoholic (94.1%), and mixed (77.3%) LC. The detected abnormalities corresponded to 4 variants of porphyrin dysmetabolism: elevation of porphyrin predictors, biochemical syndromes of symptomatic elevation of fecal porphyrins, secondary coproporphyrinuria, and latent chronic hepatic porphyria (LCHP). Some patients were found to have comorbidities, suggesting the stepwise development of porphyrin dysmetabolism. The disturbances were identified in patients with LC irrespective of the Child-Pugh class. The prognostically less favorable biochemical syndrome LCHP was recorded only in the presence of progressive hepatocellular failure in Child's class C decompensated LC. This trend should be considered to be prognostically unfavorable, preceding or occurring in the presence of decompensated LC that is more often a cause of death in this contingent of patients. Conclusion. Porphyrin metabolism should be regarded as a highly sensitive indicator. The differential assessment of the porphyrin excretory profile may be referred to as additional diagnostic and prognostic criteria indicating the Child-Pugh class.