Division of Gastroenterology & Hepatology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada .
Am J Gastroenterol. 2022 Aug 1;117(8):1242-1243. doi: 10.14309/ajg.0000000000001848. Epub 2022 Jun 3.
Hemodynamic abnormalities are the hallmarks of advanced cirrhosis. An increased cardiac output maintains hemodynamic stability until the very late stage of cirrhosis, when the cardiac output starts to fall, which has been attributed to the development of renal dysfunction in these patients. The study by Daniesen showed that cardiac output was increased rather than decreased in patients with hepatorenal syndrome-acute kidney injury, potentially conflicting with previous understanding. It is possible that the authors were only assessing 1 aspect of cardiac dysfunction in a group of patients who were not at the very end stage of cirrhosis. Their unexpected findings will certainly stimulate further research into the role of cardiac dysfunction in the pathogenesis of acute kidney injury in cirrhosis.
血流动力学异常是肝硬化晚期的特征。心输出量增加可维持血流动力学稳定，直到肝硬化的晚期，此时心输出量开始下降，这归因于这些患者肾功能的发展。Daniesen 的研究表明，肝肾综合征-急性肾损伤患者的心输出量增加而不是减少，这与之前的认识相矛盾。可能作者只评估了一组并非处于肝硬化终末期患者的心脏功能的一个方面。他们出乎意料的发现无疑将进一步刺激对心脏功能障碍在肝硬化急性肾损伤发病机制中的作用的研究。
