Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites

Llach, Josep; Ginès, Pere; Arroyo, Vicente; Rimola, Antoni; Titó, Llúcia; Badalamenti, Salvatore; Jiménez, Wladimiro; Gaya, Joan; Rivera, Francisca; Rodés, Joan

doi:10.1016/0016-5085(88)90441-6

Cited by 432 publications

(247 citation statements)

References 33 publications

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“…22 Hemodynamic parameters, such as degree of portal hypertension evaluated by hepatic venous gradient, have been shown to have a prognostic value in cirrhosis. 23 In our study, survival appears to be dependent solely on markers of hepatic and renal dysfunction even if hepatic venous gradient was a significant parameter in the univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Predictive models of short- and long-term survival in patients with nonbiliary cirrhosis

Longheval

Vereerstraeten

Thiry

et al. 2003

Liver Transplantation

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The limited number of donor organs has placed a burden on the medical community to improve patient selection and timing of liver transplantation (LT). We aim to evaluate short-and long-term survival of 124 consecutive patients with a diagnosis of nonbiliary cirrhosis. Seventeen clinical, biochemical, functional, and hemodynamic parameters were computed. Patient survival was evaluated in the short term (3 months) by logistic regression, and the predictive power of the model was evaluated using receiver operating characteristic curves and the log likelihood ratio. For the long-term (up to 5 years) prognosis, the Cox proportional model was used. During follow-up, 54 patients died and 20 patients underwent LT. In the short-term study, the Model for End-Stage Liver Disease score (including bilirubin level, international normalized ratio [INR], and creatinine level) was as predictive as our score, which contained only two independent indicators (bilirubin and creatinine levels). In the long-term study, three independent variables (albumin level, INR, and creatinine level) emerged from the Cox model, and patients were classified into three survival-risk groups according to a prognostic index (PI): ؊1.039 ؋ albumin (grams per deciliter) ؉ 1.909 ؋ log e INR ؉ 1.207 ؋ log e serum creatinine (milligrams per deciliter). Survival probabilities at 1 and 5 years were 89% and 80%, 63% and 52%, and 23% and 10% with a low, medium, and high PI, respectively. The validation study using the split-sample technique and data from independent patients confirmed that a high PI (>؊2.5) identifies patients with a poor prognosis within 5 years. We thus have shown and validated that risk for death at the short and long term of patients with nonbiliary cirrhosis can be predicted with great accuracy using models containing a few simple and easily obtained objective variables, and these survival models are useful tools in clinical decision making, especially in deciding to list patients for LT and prioritization on the liver waiting list. (Liver Transpl 2003;9:260-267.)

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Section: Discussionmentioning

confidence: 99%

Predictive models of short- and long-term survival in patients with nonbiliary cirrhosis

Longheval

Vereerstraeten

Thiry

et al. 2003

Liver Transplantation

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“…Estudo desenvolvido em nosso meio (26) , avaliando a sobrevida do paciente cirrótico com ascite, demonstrou ser a PBE a terceira causa de morte neste grupo. Dados semelhantes foram encontrados no estudo de LLACH et al (21) .…”

Section: Discussionunclassified

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

Coral

Mattos

Damo

et al. 2002

Arq. Gastroenterol.

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RESUMO -Racional -A peritonite bacteriana espontânea é complicação freqüente nos pacientes com cirrose e ascite, apresentando taxa de recurrência em 1 ano próxima de 70%. Objetivos -Avaliar a prevalência da peritonite bacteriana espontânea em pacientes com ascite por hepatopatia crônica e o impacto da sua presença na sobrevida dos mesmos. INTRODUÇÃOEstudos demonstram que 30% a 50% dos cirróticos apresentam infecções bacterianas na admissão hospitalar ou a desenvolvem durante a mesma (5,40) . Estas são responsáveis por até 25% das mortes nesta população de pacientes (5,28) .Dentre as infecções que acometem os pacientes com hepatopatia crônica, a de maior importância é a peritonite bacteriana espontânea (PBE) (5) .Entende-se por PBE a infecção do fluido de ascite sem haver um foco intra-abdominal aparente causal da infecção (15) .A PBE tem prevalência ao redor de 15% (1,5,18,44) , possuindo taxa de recurrência em 1 ano próxima de 70% (2,42) . Por outro lado, traz ao paciente cirrótico com ascite um empobrecimento no prognóstico tanto a curto, quanto a longo prazo, determinando mortalidade hospitalar, nos dias atuais, em torno de 20% (22,28,43) .Diante da escassez de estudos (5,14) que analisam a evolução dos pacientes com PBE em nosso País e também as diferenças regionais existentes, entende-se que esta infecção merece ser avaliada em nosso meio, com o intuito de observar seu comportamento nos dias atuais, permitindo assim, a busca de novas estratégias que visem melhorar seu prognóstico. Portanto, teve-se como objetivo principal, avaliar a prevalência da PBE e sua implicação na mortalidade hospitalar de pacientes com ascite secundária à hepatopatia crônica internados em um hospital geral.

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“…[3][4][5][6][7] The related factors for mortality prediction in patients with ascites include hyponatremia, high serum creatinine and low arterial blood pressure. [3][4][5][6][7][8][9] These patients also have high risk for other complications such as spontaneous bacterial peritonitis (SBP), hyponatremia and hepatorenal syndromes, which increase the risk of fatal outcome. 1,3,[7][8][9][10][11][12][13][14][15][16] Several scores have been developed in order to predict severity of the disease and prognosis in order to consider liver transplantation as a potential treatment option.…”

Section: Introductionmentioning

confidence: 99%

In-hospital mortality risk factors in patients with ascites due to cirrhosis

Vicco¹,

Rodeles²,

Ferini³

et al. 2015

Rev. Assoc. Med. Bras.

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Conflict of interest: noneIntroduction: ascites is one of the most common complications of cirrhosis associated with a high rate of mortality. Although several scores have been developed in order to assess the prognosis of the disease, they were designed for predicting liver transplantation requirements and mortality in the short term, but not while in hospital. The aim of this study was to weigh risk factors for in-hospital mortality in adult patients with ascites due to alcoholic cirrhosis. Material and methods: we performed a cross-sectional study in 180 adult patients with diagnosis of cirrhosis with portal hypertension associated with high alcohol intake. The diagnosis of cirrhosis was made by liver echography and portal hypertension was defined by clinical features plus serum-ascites albumin gradient. Sampled individuals were subjected to complete clinical examination. Child Pugh and the MELD scores were applied in all the patients. Results: nineteen patients died while in-hospital. Mortality was associated with increased levels of serum white blood cell, urea, creatinine, prolonged prothrombin time, aspartate aminotransferase and alanine aminotransferase. We conducted a multiple binary logistic to predict in-hospital mortality which yielded that serum urea, creatinine and prothrombin time made a significant contribution to prediction with an OR 14 (95% CI 12.8 -16.7 p = 0.03), 2 (95% CI 0.5 -3.47, p = 0.04), and 2 (95% CI 1.03 -2.31, p = 0.01) linearly-related. Conclusions: our results suggest that acute renal failure and prolonged prothrombin time are predictors of in-hospital mortality in patients with portal hypertension due to alcoholic cirrhosis.

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Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites

Cited by 432 publications

References 33 publications

Predictive models of short- and long-term survival in patients with nonbiliary cirrhosis

Predictive models of short- and long-term survival in patients with nonbiliary cirrhosis

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

In-hospital mortality risk factors in patients with ascites due to cirrhosis

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