Doppler assessment of splanchnic arterial flow in patients with liver cirrhosis: correlation with ammonia plasma levels and MELD score

J Clin Ultrasound. 2014 Jun;42(5):264-9. doi: 10.1002/jcu.22135. Epub 2014 Jan 22.

Abstract

Purpose: To assess the clinical significance of blood flow velocity and resistance index (RI) in the visceral arteries of patients with liver cirrhosis with respect to plasma ammonia (NH3) level and liver function.

Methods: We included 80 patients with liver cirrhosis (58 men) and 20 healthy controls (11 men). Duplex Doppler ultrasonography was used to assess flow velocity and RI in the hepatic (HA), right (RRA), and left renal (LRA), and splenic (SA) (LA) artery. Plasma NH3 was measured by biochemistry. Liver function was assessed by MELD score (model of end-stage liver disease).

Results: HA, LRA, and SA systolic flow velocities were greater, whereas RRA diastolic velocity was lower in patients with liver cirrhosis than in controls RI was higher in LRA, RRA, SA, and HA in patients with liver cirrhosis than in controls. NH3 levels were significantly elevated in all patients with liver cirrhosis (p < 0.05) and significantly correlated with RI of RRA, LRA, and SA.

Conclusion: We found greater renal, hepatic, and LA RI in patients with liver cirrhosis than in healthy controls. The correlation we found between elevated renal artery RI (≥0.70) and MELD score emphasizes the risk of renal dysfunction during progression of liver cirrhosis.

Keywords: MELD score; ammonia level; duplex Doppler ultrasonography; liver cirrhosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ammonia / metabolism*
  • Blood Flow Velocity / physiology
  • End Stage Liver Disease / blood
  • End Stage Liver Disease / diagnostic imaging
  • End Stage Liver Disease / physiopathology
  • Female
  • Hepatic Artery / diagnostic imaging*
  • Hepatic Artery / physiopathology
  • Humans
  • Liver / blood supply
  • Liver / diagnostic imaging
  • Liver / physiopathology
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Function Tests / methods
  • Liver Function Tests / statistics & numerical data
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Artery / diagnostic imaging*
  • Renal Artery / physiopathology
  • Severity of Illness Index
  • Splanchnic Circulation / physiology
  • Splenic Artery / diagnostic imaging*
  • Splenic Artery / physiopathology
  • Ultrasonography, Doppler, Duplex / methods*
  • Vascular Resistance / physiology

Substances

  • Ammonia