Correlation of Internal Jugular Vein Collapsibility With Central Venous Pressure in Patients With Liver Cirrhosis

Abstract

We aimed to compare internal jugular vein and inferior vena cava ultrasonography as predictors of central venous pressure in cirrhotic patients. We performed ultrasound assessments of the internal jugular vein (IJV) and the inferior vena cava and then invasively measured central venous pressure (CVP). We then compared their correlation with CVP and performed area under the receiver operating characteristic curves to determine which had best sensitivity and specificity. IJV crosssectional area collapsibility index at 30°correlated better with CVP (r 5 20.56, P < 0.001), and an IJV AP-CI at 30°£ 24.8% was better at predicting a CVP ‡8 mm Hg, with 100% sensitivity and 97.1% specificity. Thus, IJV point-of-care ultrasound might be superior than inferior vena cava point-of-care ultrasound as a predictor of CVP in cirrhotic patients.

Seeing beneath the surface: Harnessing point-of-care ultrasound for internal jugular vein evaluation

“…The IJV-CI is calculated by its respiratory variation, (IJVmax – IJVmin)/IJVmax expressed in percentage (Figure 3 ). The actual RAP cannot be quantified, but studies[ 13 , 21 , 22 ] have shown that an IJV-CI of approximately ≤ 30% signifies an elevated CVP of ≥ 8 mmHg, demonstrating good sensitivity and specificity. Worthy of particular mention, in a study by Leal-villarreal et al [ 21 ] in patients with cirrhosis, IJV-CI (anteroposterior diameter 2 cm above the sternoclavicular joint) ≤ 24.8% was better at predicting a CVP ≥ 8 mmHg with 100% sensitivity and 97.1% specificity outperforming IVC POCUS.…”

“…The actual RAP cannot be quantified, but studies[ 13 , 21 , 22 ] have shown that an IJV-CI of approximately ≤ 30% signifies an elevated CVP of ≥ 8 mmHg, demonstrating good sensitivity and specificity. Worthy of particular mention, in a study by Leal-villarreal et al [ 21 ] in patients with cirrhosis, IJV-CI (anteroposterior diameter 2 cm above the sternoclavicular joint) ≤ 24.8% was better at predicting a CVP ≥ 8 mmHg with 100% sensitivity and 97.1% specificity outperforming IVC POCUS. In this cohort, IVC POCUS was unattainable in 18% of the cases correlating with our real-life experience in cirrhotic patients.…”

A Clinician’s Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice

“…Excellent examples would include urinary bladder in order to check a post-void residual volume, jugular venous pressure for those patients in whom an intravascular volume assessment is difficult, a knee (or other joint) exam to perform ultrasound guided injections, or hand joints to assess for synovitis. 34 - 40 …”

Acute kidney injury and point-of-care ultrasound in liver cirrhosis: redefining hepatorenal syndrome

“…However, IVC insonation may be misleading in patients with cirrhosis due to hepatic fibrosis and intra-abdominal hypertension due to ascites, and cannot be performed in 20% of patients [ 19–21 ]. A recent observational study conducted with 44 patients evidenced that the internal jugular vein (IJV) collapsibility index ≤24.8%, determined at the 30° body position, showed the best performance in predicting a central venous pressure ≥8 mmHg, with a sensitivity of 100% and a specificity of 97.1% [ 22 ].…”