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Prognostic factors in cirrhotics with ascites
WP-D 7
PROGNOSTIC FACTORS IN CIRRHOTICS WITH ASCITES. J. Llach, P. Gin@s, LI. Tit6, J. Gaya, F. Rivera, V. Arroyo, J. Rod,s. Liver Unit. Hospital Clinic i Provincial. University of Barcelona. Spain.
To investigate prognostic factors in cirrhosis with ascites, 42 variables selected from 141 patients admitted to our Unit between 1980 and 1985 for the treatment of an episode of ascites were correlated with survival using univariate analysis (survival curves according to the Kaplan-Meier's method and compared by the test of Mantel-Cox). Variables reaching prognostic value in the univariate analysis were introduced in a multivariate analysis (Cox's regression model) to identify independent predictors of survival. At the time of the analysis of the results (January 1986), 70 patients had died, 66 were alive and 5 were lost to follow-up. Variables associated to a poor prognosis in the univariate analysis were: previous episodes of ascites and encephalopathy, absence of hepatomegaly, poor nutritional status, serum cholesterol< 130 mg/dl, serum bilirubin> 2 mg/dl, serum a l b u m i n < 2 8 g/l, ascitic protein concentration~l g/dl, renal failure, GFR<50 ml/min, serum creatinine>l.5 mg/dl, BUN>30 mg/dl, serum sodium<133 mEq/l, urinary sodium~l.5 mEq /day, urinary p o t a s s i u m ~ 22 mEq/day, mean arterial pressure < 80 mmHg, plasma renin activity > 5 ng/ml/hr, plasma norepinephrine concentration>600 pg/ml, plasma epinephrine>lO0 pg/ml, and plasma d o p a m i n e > 6 3 pg/ml. However, in the multivariate analysis only 6 variables were found to be independent predictors of survival: mean arterial pressure (p=O.O001) plasma norepinephrine (p=O.O001), ascitic protein concentration (p=O.O02), urinary sodium excretion (p=O.O05), BUN (p=O.O09), and serum albumin (p=O.O18). Conclusion: in cirrhotics with ascites, parameters estimating systemic hemodynamics and renal function are better predictors of survival than those routinely used to estimate hepatic funcion.
WP-D 8
DIURETICRESISTANCE IN CIRRHOSIS WITH ASCITES: EVIDENCE OF ALTEREDFUROSEMIDE PHARMACOKINETICS. M.Pinzani*, G.Daskalopoulos°, G.Laffi*, P.Gentilini* and R.D.Zipser**. *Clin. Med.IV University of Florence, I t a l y ; **Dept. of Medicine, Harbor U.C.L.A., Torrance and °U.S.C. Liver Unit, Downey, California, U.S.A..
The natriuretic and diuretic response to furosemide (F) can be markedly variable in patients with chronic l i v e r disease complicated by ascites and edema. F is actively secreted in the proximal tubule acting from the luminal side of the thick ascending limb of the loop of Henle. To elucidate the mechanisms of the diuretic resistance in some patients we measured PAH and inulin clearances, urinary excretion of elecrolytes, prostaglandin E2 and plasma and urinary F following intravenous F (80 mg) in 26 patients. Dietary sodium was 88 mEq/day. The natriuretic response was variable (3.3 to 172 mEq/h) and was unrelated to basal sodium excretion (
$56
PROGNOSTIC FACTORS IN CIRRHOTICS WITH ASCITES. J. Llach, P. Gin@s, LI. Tit6, J. Gaya, F. Rivera, V. Arroyo, J. Rod,s. Liver Unit. Hospital Clinic i Provincial. University of Barcelona. Spain.
To investigate prognostic factors in cirrhosis with ascites, 42 variables selected from 141 patients admitted to our Unit between 1980 and 1985 for the treatment of an episode of ascites were correlated with survival using univariate analysis (survival curves according to the Kaplan-Meier's method and compared by the test of Mantel-Cox). Variables reaching prognostic value in the univariate analysis were introduced in a multivariate analysis (Cox's regression model) to identify independent predictors of survival. At the time of the analysis of the results (January 1986), 70 patients had died, 66 were alive and 5 were lost to follow-up. Variables associated to a poor prognosis in the univariate analysis were: previous episodes of ascites and encephalopathy, absence of hepatomegaly, poor nutritional status, serum cholesterol< 130 mg/dl, serum bilirubin> 2 mg/dl, serum a l b u m i n < 2 8 g/l, ascitic protein concentration~l g/dl, renal failure, GFR<50 ml/min, serum creatinine>l.5 mg/dl, BUN>30 mg/dl, serum sodium<133 mEq/l, urinary sodium~l.5 mEq /day, urinary p o t a s s i u m ~ 22 mEq/day, mean arterial pressure < 80 mmHg, plasma renin activity > 5 ng/ml/hr, plasma norepinephrine concentration>600 pg/ml, plasma epinephrine>lO0 pg/ml, and plasma d o p a m i n e > 6 3 pg/ml. However, in the multivariate analysis only 6 variables were found to be independent predictors of survival: mean arterial pressure (p=O.O001) plasma norepinephrine (p=O.O001), ascitic protein concentration (p=O.O02), urinary sodium excretion (p=O.O05), BUN (p=O.O09), and serum albumin (p=O.O18). Conclusion: in cirrhotics with ascites, parameters estimating systemic hemodynamics and renal function are better predictors of survival than those routinely used to estimate hepatic funcion.
WP-D 8
DIURETICRESISTANCE IN CIRRHOSIS WITH ASCITES: EVIDENCE OF ALTEREDFUROSEMIDE PHARMACOKINETICS. M.Pinzani*, G.Daskalopoulos°, G.Laffi*, P.Gentilini* and R.D.Zipser**. *Clin. Med.IV University of Florence, I t a l y ; **Dept. of Medicine, Harbor U.C.L.A., Torrance and °U.S.C. Liver Unit, Downey, California, U.S.A..
The natriuretic and diuretic response to furosemide (F) can be markedly variable in patients with chronic l i v e r disease complicated by ascites and edema. F is actively secreted in the proximal tubule acting from the luminal side of the thick ascending limb of the loop of Henle. To elucidate the mechanisms of the diuretic resistance in some patients we measured PAH and inulin clearances, urinary excretion of elecrolytes, prostaglandin E2 and plasma and urinary F following intravenous F (80 mg) in 26 patients. Dietary sodium was 88 mEq/day. The natriuretic response was variable (3.3 to 172 mEq/h) and was unrelated to basal sodium excretion (
$56