Interlobar Artery Resistive Index predicts Acute-on-Chronic Liver Failure Syndrome in Cirrhotic Patients with Acute Decompensation

Pablo A. Solís-Muñoz; Christopher Willars; Julia Wendon; George Auzinger; Michael A. Heneghan; Maria De la Flor-Robledo; José A. Solís-Herruzo

doi:10.1055/s-0042-120258

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

Ultraschall Med 2018; 39(01): 39-47
DOI: 10.1055/s-0042-120258

Original Article

Interlobar Artery Resistive Index predicts Acute-on-Chronic Liver Failure Syndrome in Cirrhotic Patients with Acute Decompensation

Interlobärer arterieller resistiver Index als Prädiktor für akut-auf-chronisches Leberversagen bei zirrhotischen Patienten mit akuter Dekompensation

Pablo A. Solís-Muñoz

¹Institute of Liver Studies, King's College Hospital, London, United Kingdom of Great Britain and Northern Ireland. Angloamerican Medical Unit. Gastroenterology and Hepatology. Madrid. Spain.

⁵Gastroenterology and Hepatology Research. Biomedical Research Unit. University Hospital "12 de Octubre". Complutense University, School of Medicine, Madrid, Spain

,

Christopher Willars

²Institute of Liver Studies. LITU. King's College Hospital, London, United Kingdom of Great Britain and Northern Ireland

,

Julia Wendon

²Institute of Liver Studies. LITU. King's College Hospital, London, United Kingdom of Great Britain and Northern Ireland

,

George Auzinger

²Institute of Liver Studies. LITU. King's College Hospital, London, United Kingdom of Great Britain and Northern Ireland

,

Michael A. Heneghan

³Institute of Liver Studies, Hepatology King's College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Maria De la Flor-Robledo

⁴Anesthesiology, University Hospital Severo Ochoa, Leganes (Madrid), Spain

,

José A. Solís-Herruzo

⁵Gastroenterology and Hepatology Research. Biomedical Research Unit. University Hospital "12 de Octubre". Complutense University, School of Medicine, Madrid, Spain

› Institutsangaben

Abstract

Introduction Patients with acutely decompensated (AD) cirrhosis are at risk for developing acute-on-chronic liver failure (ACLF) syndrome. This syndrome is associated with a high short-term mortality rate. The aim of our study was to identify reliable early predictors of developing ACLF in cirrhotic patients with AD.

Patients and Methods We assessed 84 cirrhotic patients admitted for AD without ACLF on admission. We performed routine blood testing and detailed ultrasound Doppler studies of systemic arteries and mayor abdominal veins and arteries. We also calculated liver-specific and intensive care unit predictive scores. The area under the ROC curve (AUROC) was calculated for all variables that were significantly different between patients who developed ACLF and those who did not. Sensitivity, specificity, positive and negative predictive values, as well as diagnostic accuracy predicting the short-term development of ACLF were determined.

Results of the 84 patients, 23 developed ACLF whereas 61 did not. In the univariate analysis, serum levels of creatinine and urea, prothrombin time ratio, MELD score, portal vein and femoral artery flow velocity as well as the renal and interlobar artery resistive indices (RI) were associated with the short-term development of ACLF. However, only interlobar artery RI had independent predictive value in the multivariate analysis. The AUROC value for RI of the interlobar arteries was 0.9971.

Conclusion On the first day of admission, ultrasound measurement of the RI of the interlobar arteries recognizes with high predictive accuracy those cirrhotic patients admitted with AD who will develop ACLF during hospital admission.

Zusammenfassung

Einleitung Bei Patienten mit akut dekompensierter (AD) Zirrhose besteht ein Risiko für Ausprägung eines akut-auf-chronischen Leberversagens (ACLF). Dieses Syndrom ist mit einer hohen Kurzzeit-Mortalitätsrate assoziiert. Ziel der Studie ist die Ermittlung von frühen Prädiktoren einer beginnenden ACLF bei zirrhotischen Patienten mit AD.

Patienten und Methoden Wir bewerteten 84 zirrhotische Patienten mit AD bei Aufnahme jedoch ohne ACLF. Wir führten Routine-Blutbilder und eine detaillierte dopplersonografische Untersuchung der systemischen Arterien und der abdominalen Hauptvenen und Arterien durch. Wir berechneten auch die prädiktiven leberspezifischen und intensivmedizinischen Scores. Die „area under the ROC curve“ (AUROC) wurde für alle Variablen errechnet, die signifikante Unterschiede zwischen den Patienten, die eine ACLF entwickelten und solchen die keine bekamen, aufwiesen. Sensitivität, Spezifität, positive und negative Vorhersagewerte, sowie die diagnostische Treffsicherheit für die Vorhersage einer sich innerhalb kurzer Zeit entwickelnden ACLF wurden bestimmt.

Ergebnisse Bei 23 von 84 Patienten entwickelte sich eine ACLF, während 61 keine bekamen. In der univariaten Analyse waren die Serumspiegel für Kreatin und Harnstoff, die Prothrombin-Zeit, der MELD-Score und die arterielle Flussgeschwindigkeit der Pfortader und der femoralen Arterie sowie die renalen und interlobären arteriellen resistiven Indizes (RI) mit einer sich demnächst entwickelnden ACLF assoziiert. Allerdings zeigte in der multivariaten Analyse nur der interlobäre arterielle RI einen unabhängigen Vorhersagewert. Der AUROC-Wert des RI der interlobären Arterien betrug 0,9971.

Schlussfolgerung Am ersten Tag der Aufnahme in das Krankenhaus erkennt die sonografische Messung des RIs der interlobären Arterien mit hoher Vorhersagekraft diejenigen zirrhotischen Patienten mit AD, die im Laufe ihres Aufenthalts eine ACLF entwickeln werden.

Key Words

ultrasonography - acute-on-chronic liver failure - cirrhosis - decompensated cirrhosis - interlobar artery resistive index

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Referenzen

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