Effects of TIPS on global end-diastolic volume and cardiac output and renal resistive index in ICU patients with advanced alcoholic cirrhosis
Journal Title: Annals of Hepatology - Year 2010, Vol 9, Issue 1
Abstract
The transjugular porto-systemic stent-shunt (TIPS) reduces portal pressure in cirrhotic patients and is used as a nonsurgical treatment for refractory ascites, recurrent variceal hemorrhage or hepatorenal syndrome. There are concerns regarding a negative impact on cirrhotic cardiomyopathy and deterioration of hyperkinetic circulatory dysfunction. We analyzed a prospectively maintained database containing hemodynamic data on cirrhotic ICU patients. Hemodynamic monitoring was performed using transpulmonary thermodilution (PiCCO, Pulsion Medical Systems, Munich, Germany). Renal perfusion was assessed by Doppler ultrasound during studies of portal and TIPS perfusion before and after the procedure. Complete data sets of 8 patients (4 male, 4 female, age 60 years (52-67), Child-Pugh-Turcotte score 10 (8-12)) were available. After TIPS, there was a substantial increase of GEDVI (646 ml/m2 (580-737) to 663 mL/m2 (643-792); p=0.036) that was even more pronounced at 24 hours (716 mL/m2 (663-821); P=0.012). CI increased from 3.3 L/min/m2 (3.1-4.2) to 3.9 L/min/m2 (3.6-5.3) (p=0.012) and 3.9 L/min/m2 (3.7-5.2) (p=0.017), respectively. There was a significant decrease of renal RI from 0.810 (0.781-0.864) to 0.746 (0.710-0.798) (p=0.028) and a transient increase of fractional excretion of sodium. SVRI (1737 dyn s/cm5/m2 (1088 . 2115) vs. 1917 dyn s/cm5/m2 (1368-2177) was not significantly altered immediately after TIPS but decreased to 1495 dyn s/cm5/m2 (833- 1765) at 24 hours (p=0.036). There were no significant changes of mean arterial pressure (MAP). In conclusion, TIPS resulted in a pronounced increase of central blood volume. The observed hemodynamic effects are compatible with a preload driven increase of cardiac output and secondary decreases in SVRI and RI.
Authors and Affiliations
Andreas Umgelter, Wolfgang Reindl, Fabian Geisler, Bernd Saugel, Hermann Berger, Roland Schmid
Keywords
Related Articles
- EP ID EP77908
- DOI -
- Views 105
- Downloads 0
Metastatic lymphoepithelioma-like hepatocellular carcinoma: a potential diagnostic pitfall and demonstration of PD-L1 expression
Ongoing alcohol consumptions counteracts the benefits of sustained virological response in patients with well compensated hepatitis C cirrhosis: an observational study
Imaging surveillance and multidisciplinary review improves curative therapy access and survival in HCC patients
Introduction. Imaging surveillance and multidisciplinary conference (MDC) review can potentially improve survival in patients with hepatocellular carcinoma (HCC) by increasing access to liver transplantation. Geographic...
Differences in hepatic expression of iron, inflammation and stress-related genes in patients with nonalcoholic steatohepatitis
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. We have previously shown that hepatic reticuloendothelial system (RES) iron deposition is associated with an advanced...
Platelet count/spleen diameter ratio as a predictor of esophageal varices in cirrhotic patients