Cisterna chyli as an optimal marker of tolvaptan response in severe cirrhotic ascites

Abstract

For patients with cirrhosis, no definitive predictor of the efficacy and prognosis of tolvaptan treatment exists. We assessed the cisterna chyli's utility as an optimal marker. We retrospectively enrolled 172 patients with cirrhosis. The effect of tolvaptan was evaluated using post-treatment survival time. The overall response to tolvaptan was 52.3%. The median cisterna chyli diameter was 4.1 mm. Of 172 patients, 100 were included in the pilot set and 72 in the validation set. According to the Youden index, the cisterna chyli diameter's cutoff value was 4 mm, with a sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of 92%, 83%, 86%, 91%, 5.43, and 0.09, respectively, in the pilot set. The area under the curve of the cisterna chyli diameter for evaluating tolvaptan's effect was 0.911 and 0.988 in the pilot and validation sets, respectively. During multivariate analysis, cisterna chyli narrowing and furosemide treatment were significant predictive factors for tolvaptan's insufficient effect. Cumulative liver transplantation-free survival rates were significantly higher in patients with cisterna chyli dilatation than in those without (p = 0.028). Our findings suggest a strong association of cisterna chyli with tolvaptan treatment response in patients with cirrhosis and hepatic edema.

Figure 1

Study design.

Figure 2

Cumulative liver transplantation-free survival rate. (A) Cumulative liver transplantation-free survival rates were significantly higher in the group achieving body weight reduction than in the group with incomplete body weight reduction. (B) Cumulative liver transplantation-free survival rates were significantly higher in the group that responded to tolvaptan than in the group not responding to tolvaptan.

Figure 3

Cisterna chyli patterns. (A) Dilatated cisterna chyli (at measure point). (B) Narrowing cisterna chyli.