Age Dependency of Regional Impedance Indices Regardless of Clinical Stage in Patients with Cirrhosis of the Liver

Zusammenfassung

Ziel: Feststellung des Einflusses des Patientenalters auf die Veränderungen der Widerstand-Indizes (Widerstands- und Pulsatilitätsindizes) in den Aa. hepaticae, lienales, mesent. sup. und renales bei Patienten mit Leberzirrhose. Material und Methoden: 78 nacheinander vorgestellte Patienten mit Zirrhose (41 Männer, 37 Frauen, Child-Pugh-Score 7 [Bereich 5 – 12]) wurden mit Farbdoppler-Sonografie untersucht. Widerstandsindex (RI) und Pulsatilitätsindex (PI) in der A. hepatica communis, intraparenchymalen Ästen der Aa. hepaticae, lienales, renales und in der A. mesent. sup. wurden bestimmt; gleichzeitig wurden die klinischen Daten registriert. Es wurde eine logistische Regressionsanalyse durchgeführt, um den relativen Einfluss von Alter, Schwere der Lebererkrankung und anderer relevanter Parameter auf die Zunahme der Widerstandindizes zu untersuchen. Eine lineare Regressionsanalyse wurde angewendet, um einen Koeffizienten herauszufinden, mithilfe dessen die RI und PI an das Alter angepasst werden können. Ergebnisse: Widerstands- und Pulsatilitäts-Indizes aller untersuchten Gefäße bis auf die A. mesent. sup. wiesen eine direkte Korrelation mit dem Alter auf (RI A. lienalis: R = 0,520, p < 0,0001), und korrelierten am stärksten mit dem Child-Pugh-Score (PI rechte A. renalis: R = 0,462, p < 0,0001). Das Alter wies eine unabhängige Korrelation auf mit einem erhöhten PI und RI in den Bereichen der A. hepatica, lienalis und renalis. In diesen Gefäßen kann die Schwelle der Normalwerte des RI an die Altersdekade mit einem Korrekturfaktor von 0,03 angepasst werden. Schlussfolgerung: Das Altern selbst verursacht eine Zunahme der hepatischen, lienalen und renalen Widerstandsindizes bei zirrhotischen Patienten. Die Normalitätsschwelle sollte entsprechend dem Alter des Patienten angepasst werden.

Abstract

Purpose: To prospectively assess if ageing itself induces modifications of the impedance indices (resistance and pulsatility indexes) of hepatic, splenic, superior mesenteric and renal arteries in patients with liver cirrhosis. Materials and Methods: 78 consecutive patients with cirrhosis (41 males, 37 females, Child-Pugh score 7 [range 5 – 12]) were studied by colour-Doppler ultrasound. The resistance index (RI) and pulsatility index (PI) were determined in the main hepatic artery, intraparenchymal branches of hepatic, splenic, and renal arteries, and superior mesenteric artery; clinical data were simultaneously collected. Logistic regression analysis was performed to assess the relative impact of age, severity of liver disease and other relevant variables on the increase of impedance indices. Linear regression analysis was used to identify a coefficient to adjust RIs and PIs to age. Results: Resistance and pulsatility indices of all the vessels studied except of the superior mesenteric artery showed a direct correlation with age (e. g. splenic artery RI: R = 0.520, p < 0.0001), and correlated most strongly with Child-Pugh score (e. g. right renal artery PI: R = 0.462, p < 0.0001). Age was associated independently with increased PI and RI in hepatic, splenic and renal arterial districts. In these vessels, the RI threshold of normality can be adjusted to the decade of age adding a correction of 0.03. Conclusion: Ageing itself induces an increase of hepatic, splenic and renal impedance indices in cirrhotic patients. The threshold of normality for these indices in cirrhosis should be adjusted according to the patients’ age.

Key words

abdomen - ultrasound-color doppler - liver cirrhosis

References

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