Gut Liver.  2018 Sep;12(5):555-561. 10.5009/gnl17342.

Measuring Intrahepatic Vascular Changes Using Contrast-Enhanced Ultrasonography to Predict the Prognosis of Alcoholic Hepatitis Combined with Cirrhosis: A Prospective Pilot Study

• Park MS
• Hong S
• Lim YL
• Kang SH
• Baik SK
• Kim MY

• KMID: 2424084
• DOI: http://doi.org/10.5009/gnl17342

Abstract

BACKGROUND/AIMS
Acute hepatic dysfunction combined with alcoholic hepatitis (AH) in alcoholic cirrhosis is related to hepatic hypo-perfusion secondary to intrahepatic necroinflammation, neoangiogenesis, and shunt. The hepatic vein arrival time (HVAT) assessed by microbubble contrast-enhanced ultrasonography (CEUS) is closely correlated with the severity of intrahepatic changes. We investigated the usefulness of HVAT to predict short-term mortality of AH in cirrhosis.
METHODS
Thirty-nine patients with alcoholic cirrhosis (27 males) and AH were prospectively enrolled. HVAT study was performed within 3 days after admission using ultrasonic contrast (SonoVue®). The primary outcome was 12-week mortality.
RESULTS
Twelve-week mortality developed in nine patients. HVAT was significantly different between the mortality and survival groups (9.3±2.0 seconds vs 12.6±3.5 seconds, p=0.002). The odds ratio of a shortened HVAT for 12-week mortality was 1.481 (95% confidence interval, 1.050-2.090; p=0.025). The area under the receiver operating characteristic curve of HVAT for 12-week mortality was 0.787 (p=0.010). The combination of MDF and HVAT ≥11.0 seconds resulted in an 87.5% survival rate even if the MDF score ≥32; however, HVAT < 11.0 seconds was related with mortality despite a MDF score < 32.
CONCLUSIONS
HVAT using microbubble CEUS could be a useful additional index to predict short-term mortality in patients with AH and cirrhosis.

Keyword

Hepatitis, alcoholic; Liver cirrhosis, alcoholic; Hepatic veins; Ultrasonography, contrast-enhanced

MeSH Terms

Alcoholics*
Fibrosis*
Hepatic Veins
Hepatitis, Alcoholic*
Humans
Liver Cirrhosis, Alcoholic
Microbubbles
Mortality
Odds Ratio
Pilot Projects*
Prognosis*
Prospective Studies*
ROC Curve
Survival Rate
Ultrasonics
Ultrasonography*