Systemic hemodynamic response to terlipressin predicts development of hepatorenal syndrome and survival in advanced cirrhosis

Autor: Georgios N. Kalambokis, Ilias Tsiakas, Maria Christaki, Christina Koustousi, Leonidas Christou, Gerasimos Baltayiannis, Dimitrios K. Christodoulou
Rok vydání: 2018
Předmět:
Liver Cirrhosis
Male
Time Factors
Cirrhosis
Lypressin
Plasma renin activity
Gastroenterology
Liver disease
0302 clinical medicine
Hepatorenal syndrome
Risk Factors
Ascites
Vasoconstrictor Agents
Cardiac Output
Middle Aged
medicine.anatomical_structure
Area Under Curve
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
medicine.symptom
medicine.drug
medicine.medical_specialty
Hepatorenal Syndrome
03 medical and health sciences
Predictive Value of Tests
Internal medicine
medicine
Humans
Arterial Pressure
Aged
Proportional Hazards Models
Retrospective Studies
Hepatology
business.industry
Proportional hazards model
Hemodynamics
Reproducibility of Results
medicine.disease
Logistic Models
ROC Curve
Multivariate Analysis
Linear Models
Vascular resistance
Vascular Resistance
business
Terlipressin
Zdroj: European Journal of Gastroenterology & Hepatology. 30:659-667
ISSN: 0954-691X
DOI: 10.1097/meg.0000000000001088
Popis: Background The aim of this study was to predict the occurrence of hepatorenal syndrome (HRS) and death in patients with advanced cirrhosis and ascites. Patients and methods We retrospectively evaluated 2-year data of 78 patients with cirrhosis and ascites (Child-Pugh B/C: 45/43). The mean arterial pressure (MAP) and cardiac output (CO) were measured in all patients just before administration of 2 mg of terlipressin and 30 min later. Systemic vascular resistance (SVR) was calculated as MAP/CO. ΔMAP, and ΔCO, and ΔSVR were defined as the percentage change of MAP, CO, and SVR, respectively, after terlipressin injection. Plasma renin activity (PRA) and plasma aldosterone were evaluated at baseline. Two multivariate models were used: one excluding (model 1) and one including (model 2) the Model of End-stage Liver Disease score. Results Higher ΔSVR, Model of End-stage Liver Disease score, and PRA were related independently to the severity of cirrhosis. Independent predictors of HRS at 12 and 24 months were ΔSVR (models 1/2: P=0.008/0.01 and 0.01/0.02, respectively), ΔCO (models 1/2: P=0.01/0.03 and 0.03/0.04, respectively), and PRA (models 1/2: P=0.04 and model 1: P=0.04, respectively). ΔSVR at 12 and 24 months (models 1/2: P=0.005/0.01 and 0.01/0.03, respectively) and ΔCO at 24 months (models 1/2: P=0.02/0.01, respectively) were related independently to survival. Patient groups with significantly higher probability of HRS and mortality were identified by certain cutoffs of ΔSVR (20.6 and 22.8%, respectively) and ΔCO (-10.6 and -11.8%, respectively). ΔSVR and ΔCO independently predicted survival in patients with the most advanced cirrhosis and infection-related survival. Conclusion An increase in SVR by at least 20% and a decrease in CO at least 10% in response to terlipressin could predict HRS and mortality in patients with advanced cirrhosis.
Databáze: OpenAIRE
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