Published online Aug 27, 2013. doi: 10.4254/wjh.v5.i8.433
Revised: June 14, 2013
Accepted: August 4, 2013
Published online: August 27, 2013
Processing time: 249 Days and 13 Hours
AIM: To evaluate the non-invasive assessments of volume status in patients with cirrhosis.
METHODS: Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable and 25 acutely decompensated patients with cirrhosis.
RESULTS: Both groups had similar clinical assessments, cortisol response and total body water (TBW), however the ratio of extracellular water (ECW)/TBW was significantly greater in the trunk (0.420 ± 0.004 vs 0.404 ± 0.005), and limbs (R leg 0.41 ± 0.003 vs 0.398 ± 0.003, P < 0.05, and L leg 0.412 ± 0.003 vs 0.399 ± 0.003) with decompensated cirrhosis compared to stable cirrhotics, P < 0.05). Echocardiogram derived right atrial and ventricular filling and end diastolic pressures and presence of increased left ventricular end diastolic volume and diastolic dysfunction were similar in both groups. The decompensated group had lower systemic blood pressure, mean systolic 101.8 ± 4.3 vs 122.4 ± 5.3 and diastolic 58.4 ± 4.1 mmHg vs 68.8 ± 3.1 mmHg respectively, P < 0.01, and serum albumin 30 (27-33) vs 32 (31-40.5) g/L, P < 0.01.
CONCLUSION: Decompensated cirrhotics had greater leg and truncal ECW expansion with lower serum albumin levels consistent with intravascular volume depletion and increased vascular permeability.
Core tip: Despite peripheral oedema and ascites patients with cirrhosis may be intravascularly volume deplete and require parenteral fluids to prevent acute kidney injury. We assessed whether non-invasive measurements with multifrequency bioimpedance and echocardiography aided clinical assessment of volume status. Multifrequency bioimpedance showed that patients with decompensated cirrhosis had similar total body water to stable cirrhotics, but with an expanded extracellular volume, suggesting increased vascular permeability. Echocardiography was not helpful in assessing volume status in the two groups, and neither echocardiography nor multifrequency bioimpedance could aid assessment of intravascular volume.