Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004 Sep;19(3):165-70.
doi: 10.3904/kjim.2004.19.3.165.

Relationship of hemodynamic indices and prognosis in patients with liver cirrhosis

Soon Koo Baik  1 , Myeong Gwan Jee, Phil Ho Jeong, Jae Woo Kim, Sang Won Ji, Hyun Soo Kim, Dong Ki Lee, Sang Ok Kwon, Young Ju Kim, Joong Wha Park, Sei Jin Chang
Affiliations

Relationship of hemodynamic indices and prognosis in patients with liver cirrhosis

Soon Koo Baik et al. Korean J Intern Med. 2004 Sep.

Abstract

Background: Hyperdynamic circulation due to reduced peripheral vascular resistance and increased cardiac output, and the development of portal hypertension are the hemodynamic changes observed in patients with liver cirrhosis. Such hemodynamic abnormalities appear in patients with late stage liver cirrhosis. Therefore, hemodynamic indices, which represent hyperdynamic circulation and portal hypertension, are significant for the prognosis of patients with liver cirrhosis. The aim of this study was to determine the hemodynamic indices associated with the prognosis of patients with liver cirrhosis.

Methods: A total of 103 patients diagnosed with liver cirrhosis between December 1999 and June 2003, with a mean follow-up period of 73 weeks, ranging from 7 to 168 weeks, were recruited. Using Child-Pugh classification, the mean arterial pressure, heart rate and hepatic venous pressure gradient (HVPG) were measured. The indices of Doppler ultrasonography, including the portal and splenic venous flows, and the resistance of the hepatic, splenic, and renal arteries were also measured using the arterial pulsatility index (PI). The prognostic values of these indices were determined by their comparison with the patient survivals.

Results: Significant hemodynamic indices for a bad prognosis were high HVPG (> or = 15 mmHg) and renal arterial PI (> or = 1.14)(p<0.05). A Child-Pugh score > or = 10 was important for a poor prognosis (p<0.05).

Conclusion: Severe portal hypertension (HVPG > or = 15 mmHg) and high renal arterial resistance (PI +/- 1.14) were valuable hemodynamic indices for the prognosis of patients with liver cirrhosis. Therefore, it was concluded that the measurement of these hemodynamic indices, in addition to the Child-Pugh classification, is helpful in the prognosis of patients with liver cirrhosis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Measurement of the hepatic venous pressure gradient by right hepatic vein catheterization. Seven French balloon catheters were placed in the right hepatic vein to measure the free hepatic venous pressure (A), and the wedged hepatic venous pressure was measured by inflating the balloon catheter at the right hepatic vein (B).
Figure 2.
Figure 2.
In a Child-Pugh class A cirrhotic patient, Doppler ultrasonography shows a pulsatility index of 0.778 (A). In a Child-Pugh class C cirrhotic patient, Doppler ultrasonography shows a pulsatility index of 1.763 (B).
Figure 3.
Figure 3.
Comparison of the cumulative survival rates of a Child-Pugh (A) with a score of 10 and a model for end stage liver disease (MELD) with a score of 11 (B).
Figure 4.
Figure 4.
Comparison of the cumulative survival rates of a hepatic venous pressure gradient (HVPG) of 15 mmHg (A) and a renal arterial pulsatility index (PI) of 1.14 (B).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D’Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–470. - PubMed
    1. Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, Krom RA, Kim WR. MELD and PELD: application of survival models to liver allocation. Liver Transpl. 2001;7:567–580. - PubMed
    1. Jeong EM, Hwang SG, Park HH, Park JH, Kim HT, Oh SW, Kho KH, Hong SP, Park PW, Rim GS, Kim SH. The anayisis of mortality rate according to CTP sand MELD score in patients with liver cirrhosis. Korean J Hepatol. 2003;9:98–106. - PubMed
    1. Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig F, Pidlicb J, Mendel H, Pichler L, Wichlas M, Kreil A, Schmid M, Ferlitsch A, Lipinski E, Brunner H, Lammer J, Ferenci P, Gangl A, Peck-Radosavljevic M. Child-Pugh versus MELD score in predicting survival in patients undergoing transjuguiar intrahepatic portosystemic shunt. Gut. 2003;52:879–885. - PMC - PubMed
    1. Lee DH, Son JH, Kim TW. New scoring systems for severity outcome of liver cirrhosis and hepatocellular carcinoma: current issues concerning the Child-Turcotte-Pugh score and the Model of End-Stage Liver Disease (MELD) score. Korean J Hepatol. 2003;9:167–179. - PubMed