Relationship between intra-abdominal pressure and indocyanine green plasma disappearance rate: hepatic perfusion may be impaired in critically ill patients with intra-abdominal hypertension (original) (raw)
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Journal of Clinical and Experimental Hepatology, 2018
Background: Liver failure (LF) is a serious complication of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). This could be influenced by the hemodynamic and functional status of the underlying cirrhotic liver. We evaluated baseline hepatic venous pressure gradient (HVPG) and indocyanine green (ICG) clearance as predictive factors for the development of LF in patients with liver cirrhosis undergoing TACE for HCC. Methods: Forty-two patients with cirrhosis and HCC, referred for TACE, were clinically evaluated including the assessment of Child Turcotte Pugh score (CTP), Model for End-Stage Liver Disease (MELD), HVPG measurement, and ICG retention test. Predictors of development of hepatic failure after TACE were determined. Results: In our study population, the mean age of the patients was 58 years, with mean CTP of 6.60 ± 1.149 and mean MELD score of 9.57 ± 2.923. The mean HVPG and ICG retention at 15 min was 13.57 ± 4.64 mmHg and 21.571 ± 12.434, respectively. Post-TACE Liver Failure (PTLF within 1 month after TACE) developed in 23.80% patients, whereas 76.19% patients did not have PTLF. The statistically significant preprocedure variables that might predict hepatic failure after TACE using univariate analysis were found to be high CTP, MELD score, ICG retention, HVPG, serum bilirubin, serum creatinine, alfa-fetoprotein levels, large tumor size, and low baseline serum albumin. On multivariate analysis, ICG was an independent factor predictive of hepatic failure after TACE. Conclusion: Pretreatment evaluation of routine liver function is of fundamental importance before TACE. Baseline ICG retention test (ICG-R15) is a marker indicating the state of liver function in patients undergoing TACE and is an independent predictor for PTLF. Our study concludes that with a cutoff of 25, ICG-R15 has 92.9% accuracy, 90% sensitivity, and 87.5% specificity to predict hepatic failure after TACE.
Transplantation Proceedings, 2006
Intra-abdominal hypertension (IAH) can affect liver hemodynamics but it is not known if has a significant clinical impact on liver function. The aim of this study was to investigate the relationship between IAH and liver function. A prospective study was performed in 110 adult intensive care unit (ICU) patients. Intra-abdominal pressure (IAP) was measured on admission and every other day, and liver sequential organ failure assessment (SOFA) score was collected whenever IAP was measured. IAH was defined by a IAP Ն 10 mm Hg, and liver dysfunction was defined by a hepatic SOFA score Ն 2. An overall IAH incidence of 56.3% was found (n ϭ 62). Thirty-three patients presented a liver SOFA score Ն 2, with an overall incidence of 30%. Liver SOFA score of the group of patients with abdominal hypertension was higher than in group of patients without abdominal hypertension. (0.8 Ϯ 1.05 vs 0.4 Ϯ 0.7; P Ͻ .05), but IAH and liver dysfunction were not significantly associated ( 2 ϭ 2.03; P ϭ .15). When the whole sample was divided according to the worst IAP score (IAP Ͻ 10, IAP between 10 and 15, and IAP Ͼ 15), the corresponding liver dysfunction scores in the three groups were 0.35 Ϯ 0.6, 0.74 Ϯ 1, and 1.2 Ϯ 1.3, respectively (P ϭ .01). A strict association between IAH and liver dysfunction was not found. Most likely, low levels of IAH, although able to reduce liver blood flow, are not per se sufficient to produce a real dysfunction; however, a correlation between the degree of IAH and the degree of hyperbilirubinemia exists. IAH does not seem to be an "on-off" phenomenon, but produces liver alterations for increasing levels of its severity.
Abdominal perfusion pressure in critically ill cirrhotic patients: a prospective observational study
Introduction In critical patients, abdominal perfusion pressure (APP) has been shown to correlate with outcome. However, data from decompensated cirrhotic patients and acute-on-chronic liver failure (ACLF) is scarce. Objectives We aimed to characterize APP in critically ill cirrhotic patients, analyze the prevalence and risk factors of developing abdominal hypoperfusion (AhP) and impact on outcome. Methods A prospective cohort study in a general ICU specialized in liver disease at a tertiary hospital center. Consecutive cirrhotic patients were recruited between October 2016 and December 2021. Results The study included 101 patients, with a mean age of 57.2 (±10.4) years and a female gender proportion of 23.5%. The most frequent etiology of liver disease was alcohol related (51.0%), and infection (37.3%) was the common precipitant leading to ICU admission. ACLF grading (1-3) proportion was 8.9%, 26.7% and 52.5%, respectively. A total of 1274 measurements were performed. At admission,...
Hepatic blood flow plays an important role in ischemia-reperfusion injury
Liver Transplantation, 2011
Severe ischemia/reperfusion (IR) injury is associated with poor hepatic microperfusion. The aim of this study was to investigate the role of hepatic artery flow (HAF) and portal vein flow (PVF) in IR injury. From January 2004 to June 2008, 566 patients underwent orthotopic liver transplantation (OLT). The data were retrospectively reviewed via the transplant database. Patients with hepatic artery (HA) or portal vein (PV) thrombosis and retransplant patients were excluded. Intraoperative PVF and HAF values and graft weights were measured routinely, and the central venous pressure, mean arterial pressure, cardiac output, and cardiac index were recorded with hepatic blood flow measurements. Complete data were available for 312 primary OLT recipients (215 males and 97 females; mean age ¼ 54 6 10 years). The patients' follow-up ranged from 215 to 1746 days (705 6 408 days). IR injury was defined by the aspartate aminotransferase (AST) level on postoperative day (POD) 2, and the patients were divided into 3 groups: (1) mild IR injury [AST < 500 U/L; n ¼ 160 (51%)], (2) moderate IR injury [AST ¼ 500-1000 U/L; n ¼ 85 (27%)], and severe IR injury [AST > 1000 U/L; n ¼ 67 (21%)]. The demographics and pre-OLT variables (the Model for End-Stage Liver Disease score (MELD), platelet counts, PV thrombosis, transjugular intrahepatic portosystemic shunts, and shunts on computed tomography scans) were similar in all groups. The graft survival rate was 99% in group 1, 95.2% in group 2 (P ¼ 0.02), and 92.3% in group 3 (P ¼ 0.016). The patient survival rates were similar in the 3 groups. The cold ischemia time (CIT) was significantly higher in group 3 versus group 1 (P < 0.007). In the statistical analysis, low HAF, PVF, total liver blood flow (TLBF), and augmented HAF values were associated with a greater likelihood of elevated AST levels on POD 2. The strongest univariate predictors of AST were reduced augmented HAF (mL/minute/100 g) values (P < 0.001) and reduced TLBF (mL/minute/100 g) values (P < 0.001). In a covariate analysis with adjustments for CIT and donor variables, the blood flow parameters remained important predictors of graft function. In conclusion, this report demonstrates for the first time that reduced hepatic blood flow is a significant finding in patients with severe hepatic IR injury.