Background and Aims: The main stages of cirrhosis (compensated and decompensated) have been substaged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient, HVPG) features. Vasodilation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage with inflammation being currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C reactive protein, CRP) among the different substages of cirrhosis and to investigate their interrelationship and prognostic relevance. Methods: Single center, prospective cohort of patients with cirrhosis undergoing per protocol hepatic and right-heart catheterization and CRP measurement, classified into recently defined prognostic stages (PS) of compensated (PS1: HVPG ≥6mmHg but <10mmHg; PS2: HVPG ≥10 mmHg without gastroesophageal varices; PS3: patients with gastroesophageal varices) and decompensated (PS4: diuretic-responsive ascites; PS5: refractory ascites) disease. Cardiodynamic states based on cardiac index (L/min/m2) were created: relatively-hypodynamic (<3.2), normodynamic (3.2-4.2) and hyperdynamic (>4.2). Results: 238 patients, 151 compensated (PS1=25; PS2=36; PS3=90), 87 decompensated (PS4=48; PS5=39). Mean arterial pressure decreased progressively from PS1 to PS5, cardiac index increased progressively from PS1-to-PS4 but decreased in PS5. HVPG, MELD, and CRP increased progressively from PS1-to-PS5. Among compensated patients, age, HVPG, relatively-hypodynamic/hyperdynamic state and CRP were predictive of decompensation. Among patients with ascites, MELD, relatively-hypodynamic/hyperdynamic state, post-capillary pulmonary hypertension, and CRP were independent predictors of death/liver transplant. Conclusions: Our study demonstrates that, in addition to known parameters, cardiopulmonary hemodynamics and CRP are predictive of relevant outcomes in patients with both compensated and decompensated cirrhosis.

PROGRESSIVE ALTERATIONS IN SYSTEMIC AND CARDIOPULMONARY HEMODYNAMICS OCCUR IN PATIENTS WITH CIRRHOSIS AND PREDICT DEATH IN DECOMPENSATED CIRRHOSIS / Turco, L; Garcia-Tsao, G; Magnani, I; Bianchini, M; Costetti, M; Rossi, R; Villa, E; Schepis, F. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 64:(2016), pp. S270-S271. (Intervento presentato al convegno EASL International Liver Congress tenutosi a Barcelona, SPAIN nel 13-17 APRILE 2016) [10.1016/S0168-8278(16)00314-7].

PROGRESSIVE ALTERATIONS IN SYSTEMIC AND CARDIOPULMONARY HEMODYNAMICS OCCUR IN PATIENTS WITH CIRRHOSIS AND PREDICT DEATH IN DECOMPENSATED CIRRHOSIS

Turco, L
Conceptualization
;
Garcia-Tsao, G
Conceptualization
;
Magnani, I
Membro del Collaboration Group
;
Rossi, R
Membro del Collaboration Group
;
Villa, E
Membro del Collaboration Group
;
Schepis, F
Conceptualization
2016

Abstract

Background and Aims: The main stages of cirrhosis (compensated and decompensated) have been substaged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient, HVPG) features. Vasodilation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage with inflammation being currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C reactive protein, CRP) among the different substages of cirrhosis and to investigate their interrelationship and prognostic relevance. Methods: Single center, prospective cohort of patients with cirrhosis undergoing per protocol hepatic and right-heart catheterization and CRP measurement, classified into recently defined prognostic stages (PS) of compensated (PS1: HVPG ≥6mmHg but <10mmHg; PS2: HVPG ≥10 mmHg without gastroesophageal varices; PS3: patients with gastroesophageal varices) and decompensated (PS4: diuretic-responsive ascites; PS5: refractory ascites) disease. Cardiodynamic states based on cardiac index (L/min/m2) were created: relatively-hypodynamic (<3.2), normodynamic (3.2-4.2) and hyperdynamic (>4.2). Results: 238 patients, 151 compensated (PS1=25; PS2=36; PS3=90), 87 decompensated (PS4=48; PS5=39). Mean arterial pressure decreased progressively from PS1 to PS5, cardiac index increased progressively from PS1-to-PS4 but decreased in PS5. HVPG, MELD, and CRP increased progressively from PS1-to-PS5. Among compensated patients, age, HVPG, relatively-hypodynamic/hyperdynamic state and CRP were predictive of decompensation. Among patients with ascites, MELD, relatively-hypodynamic/hyperdynamic state, post-capillary pulmonary hypertension, and CRP were independent predictors of death/liver transplant. Conclusions: Our study demonstrates that, in addition to known parameters, cardiopulmonary hemodynamics and CRP are predictive of relevant outcomes in patients with both compensated and decompensated cirrhosis.
2016
EASL International Liver Congress
Barcelona, SPAIN
13-17 APRILE 2016
Turco, L; Garcia-Tsao, G; Magnani, I; Bianchini, M; Costetti, M; Rossi, R; Villa, E; Schepis, F
PROGRESSIVE ALTERATIONS IN SYSTEMIC AND CARDIOPULMONARY HEMODYNAMICS OCCUR IN PATIENTS WITH CIRRHOSIS AND PREDICT DEATH IN DECOMPENSATED CIRRHOSIS / Turco, L; Garcia-Tsao, G; Magnani, I; Bianchini, M; Costetti, M; Rossi, R; Villa, E; Schepis, F. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 64:(2016), pp. S270-S271. (Intervento presentato al convegno EASL International Liver Congress tenutosi a Barcelona, SPAIN nel 13-17 APRILE 2016) [10.1016/S0168-8278(16)00314-7].
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