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心脏动力学状态与全身炎症及致死性慢加急性肝衰竭相关。

Cardiodynamic state is associated with systemic inflammation and fatal acute-on-chronic liver failure.

作者信息

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

机构信息

Department of Internal Medicine I, University of Bonn, Bonn, Germany.

Department of Medicine, Hospital Pedro Hispano, Matosinhos, Portugal.

出版信息

Liver Int. 2020 Jun;40(6):1457-1466. doi: 10.1111/liv.14433. Epub 2020 Mar 30.

DOI:10.1111/liv.14433
PMID:32162397
Abstract

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 ) 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.

摘要

背景与目的

慢加急性肝衰竭(ACLF)的特点是短期死亡率高和全身炎症反应(SI)。最近,不同的心脏动力学状态被证明可独立预测肝硬化的预后。心脏动力学状态、SI和门静脉高压之间的关系及其对ACLF发生发展的影响尚不清楚。因此,本研究的目的是评估心脏动力学状态和SI在肝硬化患者发生致命性ACLF中的相互作用。

结果

纳入研究时,测量了208例患者的血流动力学指标,包括心脏指数(CI)和肝静脉压力梯度。对患者进行前瞻性随访,观察致命性ACLF的发生情况(主要终点)。通过促炎标志物如白细胞介素(IL)-6、IL-8和可溶性IL-33受体(sIL-33R)评估SI。根据CI(<3.2;3.2 - 4.2;>4.2 L/min/m²)将患者分为低动力组(n = 84)、正常动力组(n = 69)和高动力组(n = 55)。中位随访3年后,高动力组(35%)和低动力组(25%)发生致命性ACLF的风险最高,而正常动力组为14%(P = 0.011)。高动力组患者的SI发生率最高。IL-6的可检测水平是致命性ACLF发生的独立预测因素。

结论

高动力和低动力循环的肝硬化患者发生致命性ACLF的风险更高。因此,心脏动力学状态与SI密切相关,而SI是致命性ACLF发生的独立预测因素。

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