Systemic vascular resistance and fluid status in patients with decompensated liver cirrhosis with or without functional renal failure in Egypt

Ashraf Abd El-Khalik Barakat; Fatma Mohammad Nasr; Amna Ahmed Metwaly; Maged El-Ghannam

doi:10.14661/2015.1174-1182

Systemic vascular resistance and fluid status in patients with decompensated liver cirrhosis with or without functional renal failure in Egypt

Electron Physician. 2015 Aug 10;7(4):1174-82. doi: 10.14661/2015.1174-1182. eCollection 2015 Aug.

Authors

Ashraf Abd El-Khalik Barakat¹, Fatma Mohammad Nasr¹, Amna Ahmed Metwaly¹, Maged El-Ghannam²

Affiliations

¹ Intensive Care Department, Theodor Bilharz Research Institute, Giza, Egypt.
² Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Giza, Egypt.

Abstract

Background: Functional renal failure and cardiovascular dysfunction are common complications of liver cirrhosis. This study aimed to evaluate cardiac performance, systemic vascular resistance (SVR) and fluid status in patients with decompensated liver cirrhosis either with or without functional renal failure.

Methods: Sixty patients diagnosed as having decompensated liver cirrhosis were divided into two groups. Group 1 included 30 patients with decompensated liver cirrhosis with ascites and with creatinine values ≤ 1.5 mg/dl. Group 2 included 30 azotemic decompensated cirrhotic patients with diagnostic criteria of hepatorenal syndrome (HRS). Also, 20 healthy subjects, of matched age and sex to the Group 1 and Group 2 patients, were included in the study as the control group. All patients and normal controls were subjected to clinical examination, laboratory evaluation, ECG, abdominal ultrasonography and echocardiographic studies.

Results: The echocardiographic and ECG data showed significant increase in LAD (P<0.01, P<0.01), AoD (P<0.05, P<0.01), interventricular septum thickness (IVST) (P<0.01, P<0.01), posterior wall thickness (PWT) (P<0.01, P<0.01), EDD (P<0.01, P<0.01), ESD (P<0.05, P<0.01), left ventricular (LV) mass (P<0.01, P<0.01), and Corrected QT (QTc) (P<0.01, P<0.01) interval with significant decrease in SVR (P<0.01, P<0.01). Additionally, there was significant decrease in IVC diameter in both patients groups compared to the control group (P<0.01, P<0.01).

Conclusion: Patients with decompensated liver cirrhosis have low SVR, and Doppler echocardiography provides an easy noninvasive tool to assess this finding. Also, these patients demonstrate small inferior vena cava (IVC) diameter with normal collapsibility, which indicates low effective plasma volume. Measuring IVC diameter and collapsibility are of value in the prediction of intravascular fluid status in liver cirrhosis. This is especially true with renal dysfunction. Early addition of oral vasoconstrictors in decompensated patients may correct the SVR and circulatory dysfunction and hinder HRS occurrence.

Keywords: Fluid status; Hepatorenal syndrome (HRS); Inferior vena cava (IVC) collapsibility; Liver cirrhosis; Systemic vascular resistance (SVR).