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Non-invasive diagnosis of hepatic cirrhosis by levovist
Category 2: Cirrhosis and its complications, pathophysiology and clinical aspects ~']
LITHIUM CLEARANCE (CILI) AND ITS PREDICTIVE VALUE ON ASCITES-RELATED COMPLICATIONS IN HEPATIC CIRRHOSIS
Silvano Fasolato, Paolo Angeli, Raffaella Craighero, Andrea Quarello, Alessandra Galioto, Giovanna Serianni, Virna Daila Libera, Antonietta Sticca, Franco Del Piccolo, Angelo Gatta. Department of
Clinical and Experimental Medicine - University of Padua, Italy The development of ascites in the setting of hepatic cirrhosis is always expression of severe liver disease and represents the conditio sine qua non for developing complications as hyponatremia, refractory ascites, hepatorenal syndrome and SBP. Some evidences are available on the independent predictive value that parameters related to systemic and renal haemodynamic have on survival and development of ascites-related complications. CILi allows to quantify the delivery to the distal tubules which is the main mechanism involved in sodium retention and development of ascites in these patients. Purpose of our study was to evaluate the predictive value of C1Li on ascites-related complications and survival. Our study included 124 cirrhotic patients with ascites in absence of renal impairment. Diuretic therapy was discontinued; baseline systemic and renal haemodynamic and function were assessed. Univariate analysis was performed on ten biochemical and clinical variables. Multivariate analysis showed that only C1Li independently predicted both survival and development of ascitesrelated complications, with a different stratification according to a cut-off level of 19 ml/min (p < 0.01). In conclusion, these results support the role of C1Li in the prognostic evaluation of cirrhotic patients with ascites.
DIAGNOSIS OF HEPATIC CIRRHOSIS BY • 7NON-INVASIVE LEVOVIST Giuseppe Feliciangeli 1, Giulio Argalia 2, Luca Marucci 1, Teresa Abbatista 2, Martina Urbani:, Antonio Benedetti 1. IDepartment of
Gastroenterology - University of Ancona, Ancona; 21nstitute of Radiology - University of Ancona, Ancona, Italy Background: Hepatic cirrhosis (HC) is accompained by hyperdynamic circulatory state. Aim: To assess whether quantitative dynamic ultrasonography of hepatic veins after an intravenous bolus injection of ultrasound microbubble contrast agent (Levovist) can be used to analyzed haemodynamic changes in pat with HC. Methods: 65 pat (35 males, mean age 58.4 years) were enrolled: 24 pat with HC; 28 pat with non-cirrhotic chronic liver disease; 13 patients without liver disease. 4 pat were excluded: 2 pat with HC because they are taking vasoactive drugs; 1 pat with non-cirrhotic liver disease and 1 pat without liver disease for poor quality of doppler signal. 2.5 gr of Levovist (300 mg/ml) was injected at 1 ml/sec in an antecubital vein. The intensity of the doppler trace of middle hepatic vein was recordered from 10 sec before to 2 min after Levovist injection. To evaluate the liver first-passage of Levovist, we analyzed the arrival time of the contrast; time to peak enhancement of doppler signal; absolute peak and rise rate of doppler signal. Results: Arrival time and time to peak enhancement were lower in HC group compared with non-cirrhotic pat (with or without chronic liver disease): (11.54 + 4.03 sec vs 26.91 ± 9.55 sec, p < 0.001) and (41.76 417.39 sec vs 69.08 4- 28.60 sec, p < 0.005) respectively. No significant differences were found between pat with or without non-cirrhotic chronic liver disease. Conclusions: Analysis of liver first-passage of Levovist could be an useful non-invasive tool to evaluate development of HC in pat with chronic liver disease
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51
HEMODYNAMIC EFFECTS OF ALBUMIN ADMINISTRATION IN SPONTANEOUS BACTERIAL PERITONITIS
Javier Fernandez z, Miquel Navasa 1, Juan Gonzalez-Abraldes 1, J.C. Garcia-Pagan I , Wladimiro Jimenez 2, Jaime Bosch 1, Juan Rod6s I .
1Liver Unit, Hospital Clinic Barcelona; 2Hormonal Laboratory, Hospital Clinic Barcelona, Spain Albumin administration in cirrhotic patients with SBP reduces the incidence of renal impairment and improves survival. However, the mechanisms involved in these effects are unknown. Aims: To characterize the effects on systemic, splanchnic and renal hemodynamics and in the inflammatory response induced by albumin administration. Methods: Study of systemic, splanchnic and renal hemodynamics and assessment of plasma levels of plasmatic renin activity (PRA), noradrenalin (NA), nitric oxide (NO), and interleukin-6 (IL-6) at diagnosis and resolution of infection in 22 patients with SBP (11 treated with ceftriaxone, Group I and 11 treated with albumin plus ceftriaxone, Group II). Results: There were no differences between groups neither in hemodynamic parameters nor in the levels of hormones, vasoactive mediators and cytokines at infection diagnosis. At infection resolution, Group II patients presented a higher cardiac index (4.7 + 1 vs. 3.9 + 0.7 1/min/m2, p < 0.05) and stroke work (8770 + 1642 vs. 6564 + 1189 ml.mrnHg, p < 0.05) than patients from Group I. These effects were followed by an inactivation of the vasoconstrictor systems (PRA: 1.5 -4- 1.5 vs. 8.2 4- 11.5 ng.ml/h; NA: 310 -4- 210 vs. 593 ± 398 pg/ml in Groups II and I respectively, p < 0.1), by a decrease in NO levels (52 ± 38 vs. 109 ± 90 pg/ml in Groups II and I respectively, p < 0.1) and by an improvement in renal function (1.0 4- 0.3 vs. 1.4 -4- 0.8 mg/dl in Groups II and I respectively, p < 0.05). Albumin administration did not affect the portal pressure gradient (18.3 4- 3.1 vs. 20.5 -4- 8.4 mmHg in Groups II and I respectively, p = ns). Conclusions: Albumin administration prevents renal impairment by improving cardiac function; without increasing portal pressure.
•]
HEMODYNAMIC EFFECTS OF ALBUMIN ADMINISTRATION IN SPONTANEOUS BACTERIAL PERITONITIS
J. Fernandez 1, M. Navasa 1, J.C. Garcia-Pagan I , W. Jimenez 2, J. Bosch I , J. Rod6s 1. l Servicio de Hepatologia, Institut de Malalties Digestives,"
2Servicio de Hormonal, Hospital Clinic Barcelona, Spain Intravenous albumin administration in cirrhotic patients with SBP reduces the incidence of renal impairment and improves survival. However, the mechanisms involved in these effects are unknown. Aims: To characterize the effects on systemic, splanchnic and renal hemodynamics and in the inflammatory response induced by albumin administration. Methods: Study of systemic, splanchnic and renal hemodynamics and assessment of plasma levels of plasmatic renin activity (PRA), nq~drenalin (NA), neuropeptide Y (NY), nitric oxide (NO), a n d diagnosis and resolution of infection in 22 patients only with ceftriaxone, Group I and 11 treated _witl~ ceftriaxone, Group II). Group I a
a
GroupIIb
p as
SW(mlxmmI-Ig) 7 ~ l [ 8 ~ y MAP(mmHg ,~ SVR (dyn.cm r ~ 3 6 ~ b890:t:204 HVPG ( n ~ b.7:tI$9 20.54-8.4 RRI , ~ 4-0.04 0.744-0.06 PRA IInN I 5.55:3.7 8.2±11.5 NA (pg/m 3955:202 5934-398 NO 74-4-49 1094-90 IL-6 (pg/ml) 1615:154 43::t:41 Cr (mg/dl) 1.44-0.6 1.34-0.8
0.03 74314-1655 8770-I-1642& 0.0l ns 74-4-11 814-11 0.04 ns 6464-182 7624-237 0.03 ns 18.24-2.7 18.34-3.1 ns ns 0.774-0.05 0.744-0.05 0.0l ns 4.04-3.6 1.54-1.5$ 0.001 0.04 4224-188 3104-105 0.04 0.05 504-24 524-385 ns 0.02 5804-876 344-41 0.03 ns 1.44-0.7 1.04-0.3 0.009
a: at diagnosis, b: at resolution ~: p < 0.05, S:p < 0.1 Group II vs. Group I.
LITHIUM CLEARANCE (CILI) AND ITS PREDICTIVE VALUE ON ASCITES-RELATED COMPLICATIONS IN HEPATIC CIRRHOSIS
Silvano Fasolato, Paolo Angeli, Raffaella Craighero, Andrea Quarello, Alessandra Galioto, Giovanna Serianni, Virna Daila Libera, Antonietta Sticca, Franco Del Piccolo, Angelo Gatta. Department of
Clinical and Experimental Medicine - University of Padua, Italy The development of ascites in the setting of hepatic cirrhosis is always expression of severe liver disease and represents the conditio sine qua non for developing complications as hyponatremia, refractory ascites, hepatorenal syndrome and SBP. Some evidences are available on the independent predictive value that parameters related to systemic and renal haemodynamic have on survival and development of ascites-related complications. CILi allows to quantify the delivery to the distal tubules which is the main mechanism involved in sodium retention and development of ascites in these patients. Purpose of our study was to evaluate the predictive value of C1Li on ascites-related complications and survival. Our study included 124 cirrhotic patients with ascites in absence of renal impairment. Diuretic therapy was discontinued; baseline systemic and renal haemodynamic and function were assessed. Univariate analysis was performed on ten biochemical and clinical variables. Multivariate analysis showed that only C1Li independently predicted both survival and development of ascitesrelated complications, with a different stratification according to a cut-off level of 19 ml/min (p < 0.01). In conclusion, these results support the role of C1Li in the prognostic evaluation of cirrhotic patients with ascites.
DIAGNOSIS OF HEPATIC CIRRHOSIS BY • 7NON-INVASIVE LEVOVIST Giuseppe Feliciangeli 1, Giulio Argalia 2, Luca Marucci 1, Teresa Abbatista 2, Martina Urbani:, Antonio Benedetti 1. IDepartment of
Gastroenterology - University of Ancona, Ancona; 21nstitute of Radiology - University of Ancona, Ancona, Italy Background: Hepatic cirrhosis (HC) is accompained by hyperdynamic circulatory state. Aim: To assess whether quantitative dynamic ultrasonography of hepatic veins after an intravenous bolus injection of ultrasound microbubble contrast agent (Levovist) can be used to analyzed haemodynamic changes in pat with HC. Methods: 65 pat (35 males, mean age 58.4 years) were enrolled: 24 pat with HC; 28 pat with non-cirrhotic chronic liver disease; 13 patients without liver disease. 4 pat were excluded: 2 pat with HC because they are taking vasoactive drugs; 1 pat with non-cirrhotic liver disease and 1 pat without liver disease for poor quality of doppler signal. 2.5 gr of Levovist (300 mg/ml) was injected at 1 ml/sec in an antecubital vein. The intensity of the doppler trace of middle hepatic vein was recordered from 10 sec before to 2 min after Levovist injection. To evaluate the liver first-passage of Levovist, we analyzed the arrival time of the contrast; time to peak enhancement of doppler signal; absolute peak and rise rate of doppler signal. Results: Arrival time and time to peak enhancement were lower in HC group compared with non-cirrhotic pat (with or without chronic liver disease): (11.54 + 4.03 sec vs 26.91 ± 9.55 sec, p < 0.001) and (41.76 417.39 sec vs 69.08 4- 28.60 sec, p < 0.005) respectively. No significant differences were found between pat with or without non-cirrhotic chronic liver disease. Conclusions: Analysis of liver first-passage of Levovist could be an useful non-invasive tool to evaluate development of HC in pat with chronic liver disease
~-]
51
HEMODYNAMIC EFFECTS OF ALBUMIN ADMINISTRATION IN SPONTANEOUS BACTERIAL PERITONITIS
Javier Fernandez z, Miquel Navasa 1, Juan Gonzalez-Abraldes 1, J.C. Garcia-Pagan I , Wladimiro Jimenez 2, Jaime Bosch 1, Juan Rod6s I .
1Liver Unit, Hospital Clinic Barcelona; 2Hormonal Laboratory, Hospital Clinic Barcelona, Spain Albumin administration in cirrhotic patients with SBP reduces the incidence of renal impairment and improves survival. However, the mechanisms involved in these effects are unknown. Aims: To characterize the effects on systemic, splanchnic and renal hemodynamics and in the inflammatory response induced by albumin administration. Methods: Study of systemic, splanchnic and renal hemodynamics and assessment of plasma levels of plasmatic renin activity (PRA), noradrenalin (NA), nitric oxide (NO), and interleukin-6 (IL-6) at diagnosis and resolution of infection in 22 patients with SBP (11 treated with ceftriaxone, Group I and 11 treated with albumin plus ceftriaxone, Group II). Results: There were no differences between groups neither in hemodynamic parameters nor in the levels of hormones, vasoactive mediators and cytokines at infection diagnosis. At infection resolution, Group II patients presented a higher cardiac index (4.7 + 1 vs. 3.9 + 0.7 1/min/m2, p < 0.05) and stroke work (8770 + 1642 vs. 6564 + 1189 ml.mrnHg, p < 0.05) than patients from Group I. These effects were followed by an inactivation of the vasoconstrictor systems (PRA: 1.5 -4- 1.5 vs. 8.2 4- 11.5 ng.ml/h; NA: 310 -4- 210 vs. 593 ± 398 pg/ml in Groups II and I respectively, p < 0.1), by a decrease in NO levels (52 ± 38 vs. 109 ± 90 pg/ml in Groups II and I respectively, p < 0.1) and by an improvement in renal function (1.0 4- 0.3 vs. 1.4 -4- 0.8 mg/dl in Groups II and I respectively, p < 0.05). Albumin administration did not affect the portal pressure gradient (18.3 4- 3.1 vs. 20.5 -4- 8.4 mmHg in Groups II and I respectively, p = ns). Conclusions: Albumin administration prevents renal impairment by improving cardiac function; without increasing portal pressure.
•]
HEMODYNAMIC EFFECTS OF ALBUMIN ADMINISTRATION IN SPONTANEOUS BACTERIAL PERITONITIS
J. Fernandez 1, M. Navasa 1, J.C. Garcia-Pagan I , W. Jimenez 2, J. Bosch I , J. Rod6s 1. l Servicio de Hepatologia, Institut de Malalties Digestives,"
2Servicio de Hormonal, Hospital Clinic Barcelona, Spain Intravenous albumin administration in cirrhotic patients with SBP reduces the incidence of renal impairment and improves survival. However, the mechanisms involved in these effects are unknown. Aims: To characterize the effects on systemic, splanchnic and renal hemodynamics and in the inflammatory response induced by albumin administration. Methods: Study of systemic, splanchnic and renal hemodynamics and assessment of plasma levels of plasmatic renin activity (PRA), nq~drenalin (NA), neuropeptide Y (NY), nitric oxide (NO), a n d diagnosis and resolution of infection in 22 patients only with ceftriaxone, Group I and 11 treated _witl~ ceftriaxone, Group II). Group I a
a
GroupIIb
p as
SW(mlxmmI-Ig) 7 ~ l [ 8 ~ y MAP(mmHg ,~ SVR (dyn.cm r ~ 3 6 ~ b890:t:204 HVPG ( n ~ b.7:tI$9 20.54-8.4 RRI , ~ 4-0.04 0.744-0.06 PRA IInN I 5.55:3.7 8.2±11.5 NA (pg/m 3955:202 5934-398 NO 74-4-49 1094-90 IL-6 (pg/ml) 1615:154 43::t:41 Cr (mg/dl) 1.44-0.6 1.34-0.8
0.03 74314-1655 8770-I-1642& 0.0l ns 74-4-11 814-11 0.04 ns 6464-182 7624-237 0.03 ns 18.24-2.7 18.34-3.1 ns ns 0.774-0.05 0.744-0.05 0.0l ns 4.04-3.6 1.54-1.5$ 0.001 0.04 4224-188 3104-105 0.04 0.05 504-24 524-385 ns 0.02 5804-876 344-41 0.03 ns 1.44-0.7 1.04-0.3 0.009
a: at diagnosis, b: at resolution ~: p < 0.05, S:p < 0.1 Group II vs. Group I.