Cardiac Output in End-Stage Liver Disease Increases Proportional to the Degree of Liver Dysfunction

Abstract Background End-stage liver disease is associated with significant systemic and haemodynamic alterations that affect cardiac function. Cirrhotic cardiomyopathy remains an ill-defined entity among cardiologists. Understanding the complex interplay between liver dysfunction and cardiac function can lead to a better understanding of the compensatory mechanisms of the heart in liver failure. Purpose To investigate whether severity of liver disease affects baseline cardiac output in a large contemporary cohort of patients undergoing liver transplant work-up. Methods Consecutive patients that underwent pre-liver transplant (LT) workup between 2010–2017 were included. All patients underwent a resting echocardiogram. Cardiac output (CO) was prospectively recorded at baseline by pulsed-wave Doppler examination of the left ventricular outflow tract from the apical window and systemic vascular resistance (SVR) was calculated as 80 x (mean arterial pressure (MAP)/CO). Severity of liver disease was characterized by the model of end-stage liver disease (MELD) and Child-Pugh scores. Results 560 patients were included (mean age 57.5±7.7, 74.8% male). Mean MELD score was 19±7 and Child-Pugh Score was 9±3. There was an inverse linear relationship between the severity of liver disease by the MELD score and baseline SVR (rho 0.40, P<0.001). As SVR reduced, there was also a significant rise in baseline CO with a strong inverse correlation between the two variables (rho 0.86, p<0.001). There was a significant linear correlation between the severity of liver disease and baseline CO with both the scores (MELD Score rho 0.42, p<0.001; Child Pugh rho 0.44, p<0.001) (Figure). Baseline CO in LT Patients by Severity Conclusions Baseline CO increased with the severity of liver dysfunction due to a reduced afterload. A higher resting CO may lead to patients encroaching on their cardiac reserve at rest. This provides a pathophysiological insight suggesting a limited role for beta-blockers, particularly in patients with advanced liver cirrhosis.

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Liver Dysfunction Assessed by Model for End-Stage Liver Disease Excluding INR (MELD-XI) Scoring System Predicts Adverse Prognosis in Heart Failure

PLoS ONE ◽

10.1371/journal.pone.0100618 ◽

2014 ◽

Vol 9 (6) ◽

pp. e100618 ◽

Cited By ~ 35

Author(s):

Satoshi Abe ◽

Akiomi Yoshihisa ◽

Mai Takiguchi ◽

Takeshi Shimizu ◽

Yuichi Nakamura ◽

...

Keyword(s):

Heart Failure ◽

Liver Disease ◽

Liver Dysfunction ◽

Scoring System ◽

End Stage Liver Disease ◽

End Stage

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ALBI and Child-Pugh score in predicting mortality in chronic liver disease patients secondary to alcohol - A retrospective comparative study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i5.23171 ◽

2019 ◽

Vol 10 (5) ◽

pp. 33-36

Author(s):

B S Nagaraja ◽

R Madhumathi ◽

S B Sanjeet ◽

K J Umesh ◽

S Kumar Nandish

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Liver Dysfunction ◽

Age Distribution ◽

Roc Curves ◽

Meld Score ◽

Chronic Liver ◽

End Stage Liver Disease ◽

Retrospective Comparative Study ◽

End Stage

Background: The severity of liver dysfunction in chronic liver disease is often estimated with Child-Pugh (CTP) classification or model for end-stage liver disease (MELD) score. The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction, which is simple and more objective. Aims and Objective: The present study was aimed to retrospectively compare the performance of ALBI score with Child-Pugh score for predicting the mortality in patients with chronic liver disease. Materials and Methods: Data of patients with chronic Liver disease irrespective of etiology were retrospectively reviewed. Child Pugh score and ALBI score were calculated for the patients and results from ROC curves were analysed. Results: Study conducted on 299 patients of chronic liver disease, age distribution was between 20-85 years with mean age of patients being 45.7+/-10.94 years, sex ratio male: female is 265:34 with mortality rate of 19.73%.The area under curves of ROC of ALBI and Child pugh are 0.586 and 0.549 respectively. Conclusion: Ability of ALBI score for predicting mortality was comparable with that of Child Pugh score but Child pugh score of more than 10 has got better performance of predicting mortality as compared to ALBI score.

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Defining the severity of liver dysfunction in patients with hepatocellular carcinoma by the model for end-stage liver disease-derived systems

Digestive and Liver Disease ◽

10.1016/j.dld.2012.04.018 ◽

2012 ◽

Vol 44 (10) ◽

pp. 868-874 ◽

Cited By ~ 10

Author(s):

Yun-Hsuan Lee ◽

Chia-Yang Hsu ◽

Cheng-Yuan Hsia ◽

Yi-Hsiang Huang ◽

Chien-Wei Su ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Liver Dysfunction ◽

End Stage Liver Disease ◽

End Stage

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Aspartate transaminase to platelet ratio index and Model for End-Stage Liver Disease scores are associated with morbidity and mortality after endovascular aneurysm repair among patients with liver dysfunction

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.10.101 ◽

2020 ◽

Vol 72 (3) ◽

pp. 904-909

Author(s):

Sara L. Zettervall ◽

Kirsten Dansey ◽

Nicholas J. Swerdlow ◽

Peter Soden ◽

Amy Evenson ◽

...

Keyword(s):

Liver Disease ◽

Liver Dysfunction ◽

Endovascular Aneurysm Repair ◽

Morbidity And Mortality ◽

Aspartate Transaminase ◽

End Stage Liver Disease ◽

End Stage ◽

Aneurysm Repair

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Liver Dysfunction by Model for End-Stage Liver Disease Score Improves Mortality Prediction in Injured Patients With Cirrhosis

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31822311c5 ◽

2011 ◽

Vol 71 (1) ◽

pp. 6-11 ◽

Cited By ~ 7

Author(s):

Michael G. Corneille ◽

Susannah Nicholson ◽

Jacqueline Richa ◽

Colin Son ◽

Joel Michalek ◽

...

Keyword(s):

Liver Disease ◽

Liver Dysfunction ◽

Mortality Prediction ◽

Disease Score ◽

End Stage Liver Disease ◽

End Stage ◽

Injured Patients

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Evaluation and Treatment of Cognitive-Linguistic Deficits in Liver Disease Patients in the Acute Rehabilitative Phase

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld25.2.78 ◽

2015 ◽

Vol 25 (2) ◽

pp. 78-88

Author(s):

Kara Maharay ◽

Kelly Salmon

Keyword(s):

Cognitive Impairment ◽

Liver Disease ◽

Liver Dysfunction ◽

Daily Living ◽

Compensatory Strategies ◽

Case Examples ◽

End Stage Liver Disease ◽

Cognitive Linguistic ◽

End Stage ◽

Acute Rehabilitation

Liver disease, which can range from mild liver dysfunction to End-Stage Liver Disease (ESLD), is a condition that may have potentially significant implications for cognitive-linguistic function and an individual's ability to participate in activities of daily living (ADLs). This article will outline the multiple, complex, and often interrelated factors that are present in this patient population and contributors to cognitive dysfunction. Pharmacological regimens specific to management of liver disease and their potential to cause cognitive-linguistic dysfunction are discussed. Case examples are included to highlight how the severity of liver disease, medication protocols, and the resulting cognitive impairment may impact an individual's disposition at the time of discharge from the acute rehabilitation setting. Therapy techniques, approaches, and compensatory strategies addressed in the acute rehabilitation environment identified and explained.

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