Zipprich A, Seufferlein T, Dollinger M M
First Department of Internal Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
Z Gastroenterol. 2012 Sep;50(9):996-1001. doi: 10.1055/s-0031-1299446. Epub 2012 Sep 10.
Clinical detection of ascites is a sign of decompensation and correlates with shorter survival in patients with cirrhosis. However, the prognostic relevance of sole detection of ascites by ultrasound (subclinical ascites) is not investigated so far. The aim of the study was to investigate the prognostic relevance of subclinical ascites detected by ultrasound in comparison to absent or clinically detectable ascites in patients with cirrhosis.
Between 11/1995 and 11/2004 a total of 729 patients with cirrhosis underwent sonographic and hemodynamic (including measurement of HVPG) evaluation. The mean follow up time was 47 months (range: 0.13 - 131). Kaplan-Meier survival curves and multivariate analysis were used to investigate differences.
443 patients were included in the final investigation - 153 patients without ascites, 38 with subclinical ascites and 252 patients with clinical ascites. Kaplan Meier survival curves were significantly different between the three groups (p < 0.001). Interestingly, patients with subclinical ascites had similar values compared to patients with clinical ascites regarding parameters of portal hypertension (HVPG) and liver dysfunction (INR), while parameters of systemic and renal dysfunction (heart beat, creatinin, serum sodium) were similar to patients without ascites. MELD, Child-Pugh score and ascites were independent predictors of mortality in the entire group, while Child-Pugh score and HVPG were independent factors in the subclinical ascites group.
Detection of subclinical ascites by ultrasound allows the identification of a group of cirrhotic patients with intermediary survival compared to patients without or with clinical ascites. This group of patients is characterized by severe portal hypertension but absence of systemic and renal dysfunction.
腹水的临床检测是失代偿的标志，与肝硬化患者较短的生存期相关。然而，迄今为止尚未研究超声单独检测到的腹水（亚临床腹水）的预后相关性。本研究的目的是调查与无腹水或临床可检测到腹水的肝硬化患者相比，超声检测到的亚临床腹水的预后相关性。
在1995年11月至2004年11月期间，共有729例肝硬化患者接受了超声和血流动力学评估（包括肝静脉压力梯度测量）。平均随访时间为47个月（范围：0.13 - 131个月）。采用Kaplan-Meier生存曲线和多变量分析来研究差异。
443例患者纳入最终研究——153例无腹水患者，38例有亚临床腹水患者，252例有临床腹水患者。三组之间的Kaplan-Meier生存曲线有显著差异（p < 0.001）。有趣的是，亚临床腹水患者在门静脉高压参数（肝静脉压力梯度）和肝功能障碍参数（国际标准化比值）方面与临床腹水患者相似，而全身和肾功能障碍参数（心跳、肌酐、血清钠）与无腹水患者相似。终末期肝病模型（MELD）、Child-Pugh评分和腹水是整个组死亡率的独立预测因素，而Child-Pugh评分和肝静脉压力梯度是亚临床腹水组的独立因素。
通过超声检测亚临床腹水可识别出一组与无腹水或有临床腹水患者相比生存期处于中间水平的肝硬化患者。这组患者的特征是严重门静脉高压但无全身和肾功能障碍。
