Premium
Cardiodynamic state is associated with systemic inflammation and fatal acute‐on‐chronic liver failure
Author(s) -
Praktiknjo Michael,
Monteiro Sofia,
Grandt Josephine,
Kimer Nina,
Madsen Jan L.,
Werge Mikkel P.,
William Peter,
Brol Maximilian J.,
Turco Laura,
Schierwagen Robert,
Chang Johannes,
Klein Sabine,
Uschner Frank E.,
Welsch Christoph,
Moreau Richard,
Schepis Filippo,
Bendtsen Flemming,
Gluud Lise L.,
Møller Søren,
Trebicka Jonel
Publication year - 2020
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14433
Subject(s) - hyperdynamic circulation , medicine , cirrhosis , portal hypertension , cardiology , hemodynamics , heart failure , portal venous pressure , cardiac index , cardiac output
Background & Aims Acute‐on‐chronic liver failure (ACLF) is characterized by high short‐term mortality and systemic inflammation (SI). Recently, different cardiodynamic states were shown to independently predict outcomes in cirrhosis. The relationship between cardiodynamic states, SI, and portal hypertension and their impact on ACLF development remains unclear. The aim of this study was therefore to evaluate the interplay of cardiodynamic state and SI on fatal ACLF development in cirrhosis. Results At inclusion, hemodynamic measures including cardiac index (CI) and hepatic venous pressure gradient of 208 patients were measured. Patients were followed prospectively for fatal ACLF development (primary endpoint). SI was assessed by proinflammatory markers such as interleukins (ILs) 6 and 8 and soluble IL‐33 receptor (sIL‐33R). Patients were divided according to CI (<3.2; 3.2‐4.2; >4.2 L/min/m 2 ) in hypo‐ (n = 84), normo‐ (n = 69) and hyperdynamic group (n = 55). After a median follow‐up of 3 years, the highest risk of fatal ACLF was seen in hyperdynamic (35%) and hypodynamic patients (25%) compared with normodynamic (14%) ( P = .011). Hyperdynamic patients showed the highest rate of SI. The detectable level of IL‐6 was an independent predictor of fatal ACLF development. Conclusions Cirrhotic patients with hyperdynamic and hypodynamic circulation have a higher risk of fatal ACLF. Therefore, the cardiodynamic state is strongly associated with SI, which is an independent predictor of development of fatal ACLF.