Steady-State Extrarenal Sorbitol Clearance as a Measure of Hepatic Plasma Flow

Zeeh, Joachim; Lange, H. F.; Bosch, Jaime; Pohl, Susanne; H, Loesgen; Eggers, Robert; Navasa, Miquel; Chesta, J; Bircher, J

doi:10.1016/s0016-5085(88)80024-6

Cited by 101 publications

(66 citation statements)

References 36 publications

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“…More importantly, since the changes of the hepatic microcirculation in cirrhosis influence the progression of the disease, such a technique would be of greater value in hepatology. Various methods exist for the determination of hepatic microcirculation in clinical practice [12][13][14][15] . Most of them, however, are invasive or of controversial significance [12,16] .…”

Section: Discussionmentioning

confidence: 99%

“…PS: Controls vs compensated, P = 0.25; controls vs decompensated, P = 0.001; compensated vs decompensated, P = 0.139. Reports have shown that the hepatic microcirculation can be estimated by the hepatic clearance of sorbitol [8,13] due to its high extraction fraction in normal subjects. The clearance of sorbitol is flow-limited and reflects hepatic microcirculation through functional sinusoids.…”

Section: Groupmentioning

confidence: 99%

“…Some early studies almost exclusively depended on ex vivo evaluations using the same multiple indicator dilution technique described previously [8,13] . A study [25] on MTT had already relied upon CT, and its results were in agreement with the findings of the indicator dilution techniques.…”

Section: Groupmentioning

confidence: 99%

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Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

Chen¹,

Zeng²,

Huo³

et al. 2009

WJG

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AIM:To assess the hepatic microvascular parameters in patients with liver cirrhosis by perfusion computed tomography (CT). METHODS:Perfusion CT was performed in 29 patients without liver disease (control subjects) and 39 patients with liver cirrhosis, including 22 patients with compensated cirrhosis and 17 patients with decompensated cirrhosis, proved by clinical and laboratory parameters. CT cine-scans were obtained over 50 s beginning with the injection of 50 mL of contrast agent. Hepatic microvascular parameters, mean transit time (MTT) and permeability surface area product (PS) were obtained with the Perfusion 3 software (General Electric, ADW 4.2). RESULTS:The overall differences of MTT and PS between control subjects, patients with compensated cirrhosis and those with decompensated cirrhosis were statistically significant (P = 0.010 and P = 0.002, respectively). MTT values were 15.613 ± 4.1746 s, 12.592 ± 4.7518 s, and 11.721 ± 4.5681 s for the three groups, respectively, while PS were 18.945 ± 7.2347 mL/min per 100 mL, 22.767 ± 8.3936 mL/min per 100 mL, and 28.735 ± 13.0654 mL/min per 100 mL. MTT in decompensated cirrhotic patients were significantly decreased compared to controls (P = 0.017), whereas PS values were remarkably increased (P = 0.001). CONCLUSION:The hepatic microvascular changes in patients with liver cirrhosis can be quantitatively assessed by perfusion CT. Hepatic microvascular parameters (MTT and PS), as measured by perfusion CT, were significantly altered in decompensated cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Section: Groupmentioning

confidence: 99%

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Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

Chen¹,

Zeng²,

Huo³

et al. 2009

WJG

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“…21 The TIPS procedure lasted 125 Ϯ 45 minutes. All patients were infused with 500 mL Ringer' s lactate during the procedure.…”

Section: Methodsmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt: Short–Term and Long–Term Effects on Hepatic and Systemic Hemodynamics in Patients With Cirrhosis

1999

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The aim of this prospective, nonrandomized study was to assess the short-and long-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic and systemic hemodynamics and on gastroesophageal collateral flow in patients with cirrhosis and failure of chronic sclerotherapy. Cardiac output (CO), free and wedged pulmonary artery pressure (FPAP and WPAP), systemic vascular resistance (SVR), azygos venous blood flow (AzVBF), and the relative (portal minus vena cava) pressure in the portal vein (rel.PP) were determined immediately before, 30 minutes, 1 week, 3 months, and 1 year after TIPS implantation in 21 patients with alcoholic and biliary cirrhosis with repeated bleeding from esophageal varices despite chronic sclerotherapy. TIPS was inserted when patients were in a stable hemodynamic condition. Palmaz stents were dilated to a 10-mm to 14-mm diameter until gastroesophageal collaterals were no longer visible on direct splenoportography. Relative portal pressure decreased from 21 ؎ 5 mm Hg to 11 ؎ 5 mm Hg 30 minutes after the procedure (P F .001). CO increased from 7.1 ؎ 1.5 L/min at baseline to 8.9 ؎ 2.0 L/min (P F .005) at 30 minutes, 8.2 ؎ 2.0 L/min (P F .01) at 1 week, and 8.0 ؎ 2.0 L/min (P F .01) at 3 months after TIPS, and returned to 7.2 ؎ 1.3 L/min (ns) after 1 year. Before TIPS, SVR was 990 ؎ 285 dyne · sec · cm ؊5 and decreased to 856 ؎ 252 dyne · sec · cm ؊5 (P F .05) and 866 ؎ 267 dyne · sec · cm ؊5 (P F .05) at 30 minutes and 1 week after the procedure, and increased again to 903 ؎ 208 dyne · sec · cm ؊5 (ns) and 1,016 ؎ 260 dyne · sec · cm ؊5 (ns) at 3 months and 1 year, respectively. AzVBF continuously decreased from 474 ؎ 138 mL/min before TIPS to 335 ؎ 116 mL/min, 289 ؎ 147 mL/min, 318 ؎ 157 mL/min, and 250 ؎ 104 mL/min (all P F .005) at 30 minutes, 1 week, 3 months, and 1 year after TIPS. Portal decompression after TIPS is associated with a significant increase of CO for at least 3 months, which is only partly explained by a transient decrease of SVR. After 1 year, CO had returned to baseline levels. Despite an immediate decrease in portal pressure, the reduction of blood flow through gastroesophageal collaterals is delayed and not complete before 1 year after TIPS. In contrast to previous short-term observations, TIPS does not seem to cause long-term aggravation of the hyperkinetic circulation in patients with cirrhosis. (HEPATOLOGY 1999;29:632-639.)

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“…1 The ''gold standard'' method to measure the liver plasma flow rate involves constant infusion of indocyanine green (ICG), which is eliminated only in the bile, 2 with ICG concentration measurements in plasma samples from a peripheral artery and a hepatic vein, and calculation according to Fick' s mass conservation principle. 3 Molino et al [4][5][6] and others 7 proposed the use of sorbitol as a test substance for estimation of liver plasma flow by a clearance method to avoid liver vein catheterization. In individuals with no liver disease, a hepatic sorbitol extraction fraction of 0.90 or higher 5,7 and negligible extrahepatic, extrarenal removal supported the use of extrarenal sorbitol clearance as a measure of liver plasma flow in these individuals.…”

mentioning

confidence: 99%

Sorbitol as a test substance for measurement of liver plasma flow in humans

1998

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The objective of this study was to evaluate whole-body removal kinetics of sorbitol, the use of extrarenal sorbitol clearance to estimate hepatic plasma flow in humans, and to compare measurements of liver flow by Fick's principle using either indocyanine green (ICG) or sorbitol. A sorbitol bolus (5 mmol/kg) was given intravenously to 6 controls for determination of sorbitol elimination capacity (SEC) and distribution volume, V d

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Steady-State Extrarenal Sorbitol Clearance as a Measure of Hepatic Plasma Flow

Cited by 101 publications

References 36 publications

Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

Transjugular Intrahepatic Portosystemic Shunt: Short–Term and Long–Term Effects on Hepatic and Systemic Hemodynamics in Patients With Cirrhosis

Sorbitol as a test substance for measurement of liver plasma flow in humans

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