INTRODUCTION AND OBJECTIVES: Hepatic transit times measured by the contrast enhanced ultrasonography and liver elasticity were found to predict a clinically significant portal hypertension. However, these modalities we not yet sufficiently evaluated in predicting adverse clinical outcome in patients with clinically diagnosed cirrhosis (D´Amico stages > 1), having a clinically significant portal hypertension. The aim of our study was to assess the predictive power of the liver transit times and the liver elasticity on an adverse clinical outcome of clinically diagnosed cirrhosis compared with the MELD score. METHODS: The study group included 48 consecutive outpatients with cirrhosis in the 2., 3. and 4. DAmico stages. Patients with stage 4 could have jaundice, patients with other complications of portal hypertension were excluded. Transit times were measured from the time of intravenous administration of contrast agent (Sonovue) to a signal appearance in a hepatic vein (hepatic vein arrival time, HVAT) or time difference between the contrast signal in the hepatic artery and hepatic vein (hepatic transit time, HTT) in seconds. Elasticity was measured using the transient elastography (Fibroscan). The transit times and elasticity were measured at baseline and patients were followed for up for 1 year. Adverse outcome of cirrhosis was defined as the appearance of clinically apparent ascites and/or hospitalization for liver disease and/or death within 1 year. RESULTS: The mean age was 61 years, with female/male ratio 23/25. At baseline, the median Child-Pugh score was 5 (IQR 5.0-6.0), MELD 9.5 (IQR 7.6 to 12.1), median HVAT was 22 s (IQR 19-25) and HTT 6 (IQR 5-9). HTT and HVAT negatively correlated with Child-Pugh (-0.351 and -0.441, p = 0.002) and MELD (-0.479 and -0.388, p = 0.006) scores. The adverse outcome at 1-year was observed in 11 cases (22.9 %), including 6 deaths and 5 hospitalizations. Median HVAT in those with/without the adverse outcome was 20 seconds (IQR 19.3-23.5) compared with 22 s (IQR 19-26, p = 0.32). Cases with adverse outcome had significantly higher MELD (12.9 vs 8.5), Child-Pugh score (7.0 vs 5.0) and the liver elasticity (52.5 vs 21.5 kPa) (p < 0.05). The AUROC of the HVAT, liver elasticity and MELD for the prediction of the adverse outcome was 0.60 (95% CI 0.414 to 0.785), 0.767 (0.56 to 0.98) and 0.813 (0.66 to 0.97). Unlike HVAT, the liver elasticity > 35.3 kPa increased the risk of the adverse outcome 10.3-times and MELD score > 11 points 8.5-times. CONCLUSION: In patients with clinically diagnosed cirrhosis having a clinically significant portal hypertension hepatic transit times do not predict the 1-year adverse clinical outcome. However, the liver elasticity > 35.3 kPa appears clinically useful with a prognostic value comparable with MELD. KEY WORDS: clinically diagnosed cirrhosis - hepatic transit times - liver elasticity - MELD - portal hypertension.
- MeSH
- arteria hepatica diagnostické zobrazování patofyziologie MeSH
- ascites etiologie MeSH
- jaterní cirhóza komplikace diagnostické zobrazování patofyziologie MeSH
- játra patofyziologie MeSH
- kontrastní látky MeSH
- lidé středního věku MeSH
- lidé MeSH
- portální hypertenze etiologie MeSH
- prognóza MeSH
- pružnost MeSH
- stupeň závažnosti nemoci MeSH
- ultrasonografie MeSH
- venae hepaticae diagnostické zobrazování patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- kontrastní látky MeSH
INTRODUCTION: Hepatic vein catheterisation and portal hypertension assessment using the value of portal hepatic gradient (HVPG) is currently a method of choice. METHODOLOGY: In our paper we shall compare HVPG with the so called direct gradient - using the difference in pressure in the portal vein and free hepatic vein in 5 groups of patients with liver cirrhosis. RESULTS: Hepatic vein catheterisation is reliable for assessing the portal hypertension in the group of patients with liver cirrhosis of ethylic etiology. In patients with liver cirrhosis resulting from hepatitis B, Wilsons disease or primary biliary cirrhosis, a statistically significant difference between HVPG and the direct gradient has been found. In patients with liver cirrhosis resulting from hepatitis C the obtained values differed but without statistical significance. CONCLUSION: In catheterisation of hepatic veins the HVPG value in liver cirrhosis with a presinusoidal component may be reduced, which has to be primarily taken into account when assessing the relationship to some critical values of the portal hepatic gradient.
- MeSH
- alkoholická cirhóza jater komplikace MeSH
- hepatitida B komplikace MeSH
- hepatitida C komplikace MeSH
- hepatolentikulární degenerace komplikace MeSH
- jaterní cirhóza etiologie MeSH
- katetrizace metody MeSH
- lidé MeSH
- portální hypertenze diagnóza etiologie patofyziologie MeSH
- venae hepaticae patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Bleeding from esophageal varices is a major complication of liver cirrhosis. Non-selective beta-blockers exert an influence on the functional part of portal hypertension, thereby reducing the risk of bleeding. Direct measurement of this functional part is not possible; nevertheless, pro-inflammatory markers as well as parameters of endothelial dysfunction might serve as surrogate markers. The aim of study was to assess the correlation between the therapeutic efficacy of carvedilol and markers of endothelial dysfunction and systemic inflammation in patients with liver cirrhosis and portal hypertension. MATERIAL AND METHODS: Thirty-six patients with cirrhosis and portal hypertension were given carvedilol, 25 mg q.i.d. for 30 days. Hepatic venous pressure gradient (HVPG) and biochemical determinations were performed prior to and after the treatment. Eight healthy individuals served as controls for comparison of biochemical markers. RESULTS: In the whole group of cirrhotic patients, HVPG decreased from 17.7+/-3.8 to 14.9+/-4.8 mmHg (p<0.001). Complete response was seen in 15 patients (42%). Baseline serum levels of E-selectin were significantly higher in responders than in non-responders (119.8+/-70.6 versus 52.6+/-25.7 ng/ml; p=0.023) and in controls (28.8+/-22.2 ng/ml; p=0.004). Furthermore, baseline TNF-alpha levels were significantly higher in responders than in non-responders (22.8+/-15.7 versus 7+/-8.9; p=0.047) and in controls (5.5+/-5.9 pg/ml; p=0.005). Serum levels of ICAM-1 showed the same trend (4360+/-2870 versus 2861+/-1577 versus 651+/-196 ng/ml), although differences did not reach statistical significance. CONCLUSIONS: Markers of systemic inflammation and endothelial dysfunction seem to predict the hypotensive effect of carvedilol on portal hypertension in patients with liver cirrhosis and may be useful in the assessment of the efficacy of the therapy.
- MeSH
- beta blokátory terapeutické užití MeSH
- biologické markery krev MeSH
- cévní endotel patofyziologie MeSH
- E-selektin krev MeSH
- jaterní cirhóza patofyziologie MeSH
- karbazoly terapeutické užití MeSH
- karvedilol MeSH
- lidé středního věku MeSH
- lidé MeSH
- mezibuněčná adhezivní molekula-1 krev MeSH
- portální hypertenze farmakoterapie patofyziologie MeSH
- propanolaminy terapeutické užití MeSH
- TNF-alfa krev MeSH
- venae hepaticae patofyziologie MeSH
- venózní tlak fyziologie MeSH
- zánět patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- beta blokátory MeSH
- biologické markery MeSH
- E-selektin MeSH
- karbazoly MeSH
- karvedilol MeSH
- mezibuněčná adhezivní molekula-1 MeSH
- propanolaminy MeSH
- TNF-alfa MeSH
- MeSH
- dospělí MeSH
- jaterní cirhóza patofyziologie MeSH
- kaptopril aplikace a dávkování farmakologie MeSH
- kojenec MeSH
- krevní tlak účinky léků MeSH
- lidé středního věku MeSH
- lidé MeSH
- portální systém účinky léků patofyziologie MeSH
- regionální krevní průtok účinky léků MeSH
- rychlost toku krve účinky léků MeSH
- venae hepaticae patofyziologie MeSH
- venózní tlak účinky léků MeSH
- Check Tag
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- kaptopril MeSH
