Validity of Mini-Fluid Challenge for Predicting Fluid Responsiveness Following Liver Transplantation

Abstract

Background Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. However, mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant. Methods Fifty patients receiving living donor liver transplant were included in the analysis. Mini-fluid challenge composed of 150 ml of albumin 5% administered over 1 min in three consecutive 50-ml fluid boluses. An additional 350 ml was then infused at a constant rate over 15 min (for a total of 500 ml). Stroke volume (SV) was measured as the product of the subaortic velocity time integral (VTI) and left ventricular outflow tract (LVOT) area. Fluid responsiveness was defined as an increase in SV by ≥15% after the infusion. Results Fifty patients were enrolled in the study. Fourteen patients were classified with Child A, 15 patients with Child B, and 21 patients with Child C cirrhosis. Thirty four patients were fluid responders and 16 patients were fluid non-responders. After 150 ml of albumin 5%, the SV increased significantly in our cohort. The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5–0.8, P = 0.005). In subgroup analysis, the SV increased significantly after mini fluid challenge in the Child A group (P = 0.017) but not Child B or C groups (P = 0.3 and 0.29, respectively). The AUROC for mini-fluid challenge in the Child A group was 0.86 (95% confidence interval [CI] 0.6–0.9, P = 0.0004), while mini-fluid challenge failed to discriminate between responders and non-responders in Child B and C groups. Conclusion A mini-fluid challenge of 150 ml albumin 5% can predict fluid responsiveness in liver transplant patients with fair sensitivity and specifiicty. Subgroup analyis revealed that minifluid challenge can predict fluid responsiveness in patients with Child A cirrhosis but not patients with Child B or C cirrhosis Trial Registration Number NCT03396159. (Prospective registered). Initial registration date was 10/01/2018

Existing fluid responsiveness studies using the mini‐fluid challenge may be misleading: Methodological considerations and simulations

“…Others have since investigated and validated the MFC, and a recent systematic review including seven MFC studies (368 fluid challenges in 324 patients) 1,4–9 identified a pooled AUROC of 0.91 for the MFC method 10 . Since the systematic review, more MFC studies have been published, all pointing to the same compelling conclusion: that the method is accurate in predicting fluid responsiveness 11–15 …”

“…10 Since the systematic review, more MFC studies have been published, all pointing to the same compelling conclusion: that the method is accurate in predicting fluid responsiveness. [11][12][13][14][15] In 2018, we published a correspondence debating the way MFC studies were designed. 16 The correspondence raised clinical and statistical issues with the most adopted methodology.…”