Can non-invasive measurements aid clinical assessment of volume in patients with cirrhosis?

doi:10.4254/wjh.v5.i8.433

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Hepatol. Aug 27, 2013; 5(8): 433-438
Published online Aug 27, 2013. doi: 10.4254/wjh.v5.i8.433

Table 1 Demographics and standard biochemistry and haematology results in the stable cirrhotic and the acutely decompensated cirrhotic patients

	Compensated	Decompensated
Age (yr)	53.4 ± 1.5	53.9 ± 2.7
Male sex	60%	64%
Weight (kg)	75.2 ± 1.9	76.1 ± 3.2
Sodium (mmol/L)	135.8 ± 1.4	135.9 ± 1.3
Urea (mmol/L)	4.8 (3.4-6.7)	6.1 (2.9-13.4)
Creatinine (μmol/L)	70 (48-81)	65 (45-116)
Albumin (g/L)	32 (31-40.5)	30 (27-33)^b
Bilirubin (μmol/L)	36.5 (21-98)	41 (27.5-100.5)
ALT (U/L)	44 (26-55)	31 (19-51)
AST (U/L)	65 (44-98)	63 (46-112)
GGT (U/L)	63 (30-188)	118 (41-263)
ALP (U/L)	117.8 ± 9.4	132.7 ± 14.8
Haemoglobin (g/L)	119 ± 6	101 ± 2^a
WBC (× 10⁹/L)	5.31 ± 0.4	9.5 ± 1.5^a
Platelets (× 10⁹/L)	92.5 (57.5-134)	84 (53.5-143)
INR	1.58 ± 0.11	1.72 ± 0.08
aPTT s	36.7 ± 2.9	36.3 ± 1.6
Cortisol (μmol/L)	361 (180-483)	361 (208-611)
Synacthen 30 min cortisol (μmol/L)	614 (411-719)	518 (399-767)

Results expressed as mean ± SE, or as percentage, or median (interquartile range).

^aP < 0.05,

^bP < 0.01 vs compensated cirrhotic group. ALT: Alanine aminotranferease; AST: Aspartate aminotransferase; GGT: Gamma glutamyl transpeptidase; ALP: Alkaline phosphatase; WBC: White blood cells; INR: International normalized ratio.

Table 2 Blood pressure and echocardiographic findings in stable cirrhotic and the acutely decompensated cirrhotic patients

	Compensated	Decompensated
Systolic blood pressure (mmHg)	122.4 ± 5.3	101.8 ± 4.3^b
Diastolic blood pressure (mmHg)	68.8 ± 3.1	58.4 ± 4.1^a
Heart rate min^-1	74.7 ± 3.4	100.3 ± 6.7^b
Right atrial pressure (mmHg)	6.1 ± 0.5	5.0 ± 0.1
Ejection fraction (%)	59.1 ± 1.0	59.6 ± 0.9
RVESP (mmHg)	31.1 ± 2.3	32.2 ± 2.5
PVFV (m/s)	1.24 ± 0.1	1.22 ± 0.1
LVEDV (mL)	165.5 ± 10.3	149.9 ± 12.9
Vaortic (m/s)	1.54 ± 0.06	1.60 ± 0.09

Right ventricular end systolic pressure (RVESP) normal, 25 mmHg, pulmonary valve flow velocity (PVFV), left ventricular end diastolic volume (LVEDV) normal 78-128 mL, aortic valve flow velocity (Vaortic). Results expressed as mean ± SE,

^aP < 0.05,

^bP < 0.01 vs compensated cirrhotic group.

Table 3 Multi-frequency bioelectrical impedance analysis data in the stable cirrhotic and the acutely decompensated cirrhotic patients

	Compensated	Decompensated
Total body water ICW (L)	39.2 ± 1.9	40.7 ± 1.9
ICW (L)	23.6 ± 1.2	23.9 ± 1.1
ECW (L)	15.7 ± 0.7	16.8 ± 0.8
Total body ECW/TBW	0.399 ± 0.004	0.412 ± 0.003
R arm ECW/TBW	0.385 ± 0.001	0.388 ± 0.002
L arm ECW/TBW	0.386 ± 0.002	0.387 ± 0.003
Trunk ECW/TBW	0.404 ± 0.005	0.420 ± 0.004^a
R leg ECW/TBW	0.398 ± 0.003	0.410 ± 0.003^a
L leg ECW/TBW	0.399 ± 0.003	0.412 ± 0.003^a

Mean extracellular water (ECW)/total body water (TBW) ratio for total body, limb and trunk value in normal healthy humans 0.38 (95% confidence limits 0.36-0.4). Results expressed as mean ± SE,

^aP < 0.05 vs compensated cirrhotic group. ICW: Intracellular water.

Table 4 Reliability of multi-frequency bioelectrical impedance assessments

Assessment	1^st	2^nd	3^rd
%ECW/TBW	40.7 ± 0.26	40.8 ± 0.21	40.8 ± 0.22
Bias (95%CI)	0.14 (-0.16-0.44)	0.12 (-0.23-0.46)	-0.03 (-0.16-0.00)
Pearson r	0.81	0.77	0.96
Pearson P	< 0.001	< 0.001	< 0.001

Results expressed as mean ± SE, comparison by Bland Altman bias with 95%CI and Pearson correlation. 1^st assessment vs 2^nd and 3^rd, and 2^ndvs 3^rd. ECW: Extracellular water; TBW: Total body water.

Table 5 Multi-frequency bioelectrical impedance analysis measurements in those patients with no clinically detectable ascites those patients with moderate to severe ascites judged clinically

	No ascites	Moderate/severe ascites
Weight (kg)	75.1 ± 3.9	75.4 ± 3.0
Total body water (L)	39.4 ± 1.8	37.9 ± 1.9
ICW (L)	23.71 ± 0.66	22.29 ± 1.12
ECW (L)	15.66 ± 0.66	15.65 ± 0.76
Total body ECW/TBW	0.399 ± 0.004	0.413 ± 0.003^a
R arm ECW/TBW	0.384 ± 0.002	0.386 ± 0.002
L arm ECW/TBW	0.385 ± 0.0021	0.385 ± 0.003
Trunk ECW/TBW	0.403 ± 0.005	0.421 ± 0.003^a
R leg ECW/TBW	0.398 ± 0.004	0.410 ± 0.003^a
L leg ECW/TBW	0.400 ± 0.004	0.413 ± 0.003^a

Results expressed as mean ± SE,

^aP < 0.05 vs No ascites group. ICW: Intracellular water; ECW: Extracellular water; TBW: Total body water.

Citation: Davenport A, Agarwal B, Wright G, Mantzoukis K, Dimitrova R, Davar J, Vasianopoulou P, Burroughs AK. Can non-invasive measurements aid clinical assessment of volume in patients with cirrhosis? World J Hepatol 2013; 5(8): 433-438
URL: https://www.wjgnet.com/1948-5182/full/v5/i8/433.htm
DOI: https://dx.doi.org/10.4254/wjh.v5.i8.433