Prognostic value of indocyanine green and lidocaine kinetics for survival and chronic hepatic encephalopathy in cirrhotic patients following elective end-to-side portacaval shunt

Abstract

The objective of this study was to assess the prognostic value of spontaneous portosystemic shunting and liver function for survival and spontaneous hepatic encephalopathy after end-to-side portacaval shunt in cirrhotic patients. One hundred ninety-eight patients with variceal hemorrhage as shown by endoscopy were evaluated. Forty-five were excluded because of uncontrollable hemorrhage; 84 were rejected because they were poor operative risk, had portal vein thrombosis or had been previously treated with beta-blockers, sclerotherapy or surgery. The remaining 69 patients were enrolled in this prospective study. There were 43 patients with alcoholic cirrhosis, 23 with cryptogenic cirrhosis and three with primary biliary cirrhosis. The severity of liver disease was assessed according to the Pugh classification: 37 patients (54%) had Pugh's score 5 to 7, 26 (38%) had 8 to 10 and six (8%) had 11 to 12. Indocyanine green intrinsic clearance was used as a probe of preoperative liver function and lidocaine systemic availability as an index of spontaneous preoperative shunting. All the patients underwent an elective end-to-side portacaval shunt. The length of minimal follow-up was 40 months. One-year survival was 76% and 5-year survival was 46%. During follow-up, 25 patients died from their liver disease and 11 patients died from various causes unrelated to their liver disease. Spontaneous chronic encephalopathy occurred in 16 patients (23%). Age, Pugh's score, active alcoholism, indocyanine green intrinsic clearance and lidocaine systemic availability were tested as prognostic factors in a multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies

“…Of these, 685 were excluded because they were irrelevant or did not meet inclusion criteria by reading title and abstract. Five papers were unobtainable [17][18][19][20][21] and eight more were excluded after reading the paper because they did not meet inclusion criteria [22][23][24][25][26][27][28][29]. Therefore, 117 studies met inclusion and exclusion criteria and constitute the basis of this investigation.…”

“…Compensated cirrhosis was 0 12 24 defined by the absence of ascites, jaundice, portal-systemic encephalopathy or variceal bleeding. Correspondingly, decompensated cirrhosis was defined by the presence of any of these complications.…”

Predictors of one-year pretransplant survival in patients with cirrhosis

“…Because of the curvilinear shape of the survival curve, single-point measurements of prognostic variables during early stages of the disease are of relatively little value in the assessment of pretransplant survival. It is therefore not surprising that flow-dependent dynamic liver function tests gave less favorable results with regard to long-term prognoses (17,18). As far as short-term prognosis in transplant candidates is concerned, serial measurements of prognostic variables seem to be essential.…”

Hepatic Encephalopathy

“…In non-alcoholic cirrhosis, persistent encephalopathy is more often seen with non-selective central shunts (end-to-side and side-to-side portocaval anastomoses, mesocaval shunt) than with selective derivations (distal splenorenal shunts) [267]. No single hepatic or neurological test has emerged as a clear predictor of encephalopathy after shunt surgery [268,269]. In the case of TIPS, the procedure is employed in older subjects, and this has emerged as a risk factor [264,270].…”