Relationship of Hemodynamic Indices and Prognosis in Patients with Liver Cirrhosis

Baik, Soon Koo; Jee, Myeong Gwan; Jeong, Phil Ho; Kim, Jae Woo; Ji, Sang Won; Kim, Hyun Soo; Lee, Dong Ki; Kwon, Sang Ok; Kim, Young Ju; Park, Joong Wha; Chang, Sei Jin

Abstract

BACKGROUND
Hyperdynamic circulation due to reduced peripheral vascular resistance and increased cardiac output, and the development of portal hypertension are the hemodynamic changes observed in patients with liver cirrhosis. Such hemodynamic abnormalities appear in patients with late stage liver cirrhosis. Therefore, hemodynamic indices, which represent hyperdynamic circulation and portal hypertension, are significant for the prognosis of patients with liver cirrhosis. The aim of this study was to determine the hemodynamic indices associated with the prognosis of patients with liver cirrhosis. METHODS: A total of 103 patients diagnosed with liver cirrhosis between December 1999 and June 2003, with a mean follow-up period of 73 weeks, ranging from 7 to 168 weeks, were recruited. Using Child-Pugh classification, the mean arterial pressure, heart rate and hepatic venous pressure gradient (HVPG) were measured. The indices of Doppler ultrasonography, including the portal and splenic venous flows, and the resistance of the hepatic, splenic, and renal arteries were also measured using the arterial pulsatility index (PI). The prognostic values of these indices were determined by their comparison with the patient survivals. RESULTS: Significant hemodynamic indices for a bad prognosis were high HVPG (> or=15 mmHg) and renal arterial PI (> or=1.14) (p< 0.05). A Child-Pugh score > or=10 was important for a poor prognosis (p< 0.05). CONCLUSION: Severe portal hypertension (HVPG> or=15 mmHg) and high renal arterial resistance (PI> or=1.14) were valuable hemodynamic indices for the prognosis of patients with liver cirrhosis. Therefore, it was concluded that the measurement of these hemodynamic indices, in addition to the Child-Pugh classification, is helpful in the prognosis of patients with liver cirrhosis.