Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
SPLANCHNIC DETERMINANTS OF THE HYPERDYNAMIC CIRCULATION AND CENTRAL HYPOVOLAEMIA IN CIRRHOSIS
L. Hobolth1, E. Christensen2, C.W. Dumcke3, F. Bendtsen1, S. Moeller4*
Background: Patients with advanced cirrhosis often develop a hyperdynamic circulation with increased cardiac output (CO), central hypovolaemia, and low systemic vascular resistance (SVR). The initiating factors for the coupling between abnormalities in the liver and the systemic haemodynamics are still unclear.
Multivariate regression analyses showed that higher CO was independently associated with higher HVPG and higher HBF (p< 0.00001). Higher HR was independently associated with presence of ascites, absence of varices, and higher HVPG (p< 0.0001). CBV and CCT were independently associated with higher HBF and lower postsinusoidal resistance, respectively (p< 0.0001). SVR was independently associated with lower HVPG (p< 0.0001).
The final Cox proportional-hazards model showed that decreased survival was independently associated with higher age (p=0.003), lower blood haemoglobin concentration (p=0.0006), higher plasma creatinine (p=0.01), higher plasma alkaline phosphatase (p=0.007), lower right atrial pressure (p=0.004), and higher HR (p=0.002). P of model < 0.00001.
Conclusion: Survival in patients with cirrhosis is determined by a combination of hepatic, renal and haemodynamic variables. Development of the hyperdynamic circulation and central hypovolaemia are mainly explained by changes in portal pressure and hepatic blood flow. These results support experimental findings that shear stress in the liver due to increased splanchnic inflow may be an important link between the splanchnic and systemic circulation.