Kosak Lopez Esteban, Wattanachayakul Phuuwadith, Martinez Manzano Jose Manuel, Geller Andrew, Jarrett Simone A, Malin John, Leguizamon Raul, John Tara A, Khan Rasha, McLaren Ian, Prendergast Alexander, Lo Kevin Bryan, Azmaiparashvili Zurab
Department of Medicine; Jefferson Einstein Philadelphia Hospital Sidney Kimmel Medical College Philadelphia Pennsylvania USA.
Division of Pulmonary and Critical Care Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA.
JGH Open. 2025 Jun 2;9(6):e70195. doi: 10.1002/jgh3.70195. eCollection 2025 Jun.
Estimated plasma volume status (ePVS) correlates with intravascular congestion and prognosis in patients with heart failure. The ePVS relationship with invasive hemodynamic profiling and clinical outcomes in patients with liver cirrhosis (LC) remains unclear.
This single-center retrospective cohort study included LC patients who underwent right heart catheterization (RHC) between 2018 and 2023. Estimated plasma volume status (ePVS) was calculated using the Strauss-derived Duarte formula, with patients classified into high (> 5.5%) and low-ePVS (≤ 5.5%) groups. Cox-multivariable analysis was used to determine if ePVS was associated with all-cause mortality within 1 year post-RHC among transplant-free patients.
Of the 353 patients with LC (median age 59 years, 59% male, 45% Caucasian, and 29% African American), 79% were classified into the high-ePVS group. Compared to the low-ePVS group, the high-ePVS group had significantly higher right atrial pressure (9 vs. 6 mmHg, = 0.01), pulmonary arterial wedge pressure (14 vs. 11 mmHg, = 0.014), cardiac output (9.8 vs. 6.4 L/min, < 0.0001), and cardiac index (5 vs. 3.1 L/min/m, < 0.0001). Additionally, the high-ePVS group exhibited a higher prevalence of cirrhosis-related complications, including ascites, splenomegaly, and varices, and a greater likelihood of receiving orthotopic liver transplantation within 1 year (38% vs. 11%, < 0.0001). Among transplant-free patients, ePVS was independently associated with all-cause mortality at 1 year (HR 1.15, 95% CI: 1.00-1.32, = 0.048).
Our study demonstrated that ePVS was associated with intravascular congestion, hyperdynamic circulation, and cirrhosis complications. Furthermore, ePVS was independently associated with all-cause mortality among transplant-free LC patients.
估计血浆容量状态（ePVS）与心力衰竭患者的血管内充血及预后相关。ePVS与肝硬化（LC）患者有创血流动力学分析及临床结局之间的关系尚不清楚。
这项单中心回顾性队列研究纳入了2018年至2023年间接受右心导管检查（RHC）的LC患者。使用施特劳斯推导的杜阿尔特公式计算估计血浆容量状态（ePVS），将患者分为高ePVS（>5.5%）和低ePVS（≤5.5%）组。采用Cox多变量分析确定在无移植患者中，ePVS是否与RHC后1年内的全因死亡率相关。
在353例LC患者中（中位年龄59岁，59%为男性，45%为白种人，29%为非裔美国人），79%被归类为高ePVS组。与低ePVS组相比，高ePVS组的右心房压力显著更高（9 vs. 6 mmHg，P = 0.01）、肺动脉楔压更高（14 vs. 11 mmHg，P = 0.014）、心输出量更高（9.8 vs. 6.4 L/min，P < 0.0001）以及心脏指数更高（5 vs. 3.1 L/min/m²，P < 0.0001）。此外，高ePVS组肝硬化相关并发症的患病率更高，包括腹水、脾肿大和静脉曲张，且在1年内接受原位肝移植的可能性更大（38% vs. 11%，P < 0.0001）。在无移植患者中，ePVS与1年时的全因死亡率独立相关（HR 1.15，95%CI：1.00 - 1.32，P = 0.048）。
我们的研究表明，ePVS与血管内充血、高动力循环和肝硬化并发症相关。此外，ePVS与无移植LC患者的全因死亡率独立相关。
