Hepatic and systemic hemodynamic derangements predict early mortality and recovery in patients with acute-on-chronic liver failure

Background and Aims Acute‐on‐chronic liver failure (ACLF) is a clinical entity where there is a potential for reversibility of hepatic dysfunction once the acute hepatic insult resolves. The portal and systemic hemodynamics in ACLF patients to study its relevance in determining the clinical outcomes...

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Bibliographic Details
Published in:Journal of gastroenterology and hepatology 2013-08, Vol.28 (8), p.1361-1367
Main Authors: Garg, Hitendra, Kumar, Ashish, Garg, Vishal, Kumar, Manoj, Kumar, Ramesh, Sharma, Barjesh Chander, Sarin, Shiv Kumar
Format: Article
Language:English
Subjects:
ACLF
acute-on-chronic liver failure
Adolescent
Adult
Aged
Aorta
Blood pressure
End Stage Liver Disease - mortality
End Stage Liver Disease - physiopathology
End Stage Liver Disease - therapy
Female
Follow-Up Studies
Forecasting
Hemodynamics
Hepatic encephalopathy
hepatic venous pressure gradients
Humans
Liver
Liver - blood supply
Liver Failure, Acute - mortality
Liver Failure, Acute - physiopathology
Liver Failure, Acute - therapy
Male
Middle Aged
Mortality
Patients
Portal Pressure
Portal System - physiopathology
Prognosis
Prospective Studies
Pulmonary Circulation
pulmonary hemodynamics
systemic hemodynamics
Time Factors
Vascular Resistance
Young Adult
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Summary:Background and Aims Acute‐on‐chronic liver failure (ACLF) is a clinical entity where there is a potential for reversibility of hepatic dysfunction once the acute hepatic insult resolves. The portal and systemic hemodynamics in ACLF patients to study its relevance in determining the clinical outcomes was studied. Methods Clinical, laboratory, portal, and systemic hemodynamic assessments were done at admission and after 3 months. Standard medical care was given to all the patients. Results Fifty‐seven patients with ACLF were enrolled, and they underwent baseline hepatic venous pressure gradient (HVPG) measurement. Twenty‐six (46%) patients died during the 3‐month follow‐up. Presence of high HVPG and hepatic encephalopathy were found to be independent baseline predictors of mortality. Of the 31 surviving patients, 24 consented for a repeat HVPG. The baseline HVPG reduced from 16 (range 12–30) to 13 (range 6–21) mmHg; (P 
ISSN:0815-9319
1440-1746
DOI:10.1111/jgh.12191