Retrospective analysis of ultrasound and dopplerographic parameters of liver hemodynamics in prognosis of mortality in patients with severe concomitant injury

Purpose. According to the assessment of liver hemodynamics, to determine the criteria for the probability of death in patients with severe concomitant injury and to establish the decisive time range in which these indicators are prognostic.Material and methods. The analysis of ultrasound (US) indicators in 57 patients with severe concomitant trauma was carried out in order to identify criteria for the probability of death and determine the time range in which these indicators have a prognostic character. All patients were divided into two groups: the first group of 40 surviving patients; the second of 17 dead. For comparison, three values were taken for each ultrasound indicator on the 1st, 3rd, 5th, 7th days from the moment of admission to the hospital. Comparison of the first and second groups of patients by these parameters revealed signs characterizing the violation of liver hemodynamics. The Mann-Whitney test, correlation analysis and stepwise logistic regression were used to study the relationships. Differences were considered statistically significant at a significance level of p < 0.05. Correlation was considered strong when R > 0.5. The best reliable regression model was chosen according to the highest value of the Akaike criterion.Results. In the first three days after trauma in patients of the first and second groups, the most significant were such ultrasound signs as a decrease in the diameter of the own hepatic artery (OHA), a decrease in the linear blood flow velocity (LBFV) along the SPA to 27–38 cm/s, and a decrease in volumetric blood flow in OHA, an increase in the index of resistance (IR) in OHA of more than 0.7, in combination, indicate liver dysfunction in patients in a state of traumatic shock. From the 5th day in the second group of patients, an increase in LBFV in the OHA (100–135 cm/s), an increase of 0.70–0.84, a decrease in volumetric blood flow less than 270 ml/min indicate violations of liver hemodynamics during the formation of organ dysfunction. On the 5–7th day, due to edema of the liver parenchyma against the background of an increase in the size of the liver and spleen and the formation of portal hypertension, arterialization of blood circulation occurs, which is characterized by a significant increase in LBFV in the OHA, a decrease in LBFV and volumetric blood flow in the portal vein. The third-fifth day after the injury can be considered a turning point – the correlation of most of the indicators with the fact of death and significant differences in the criterion in 9 out of 11 indicators indicate significant differences in all indicators in patients of the first and second groups. At the same time, not only dopplerographic indicators of hepatic blood flow, but also linear indicators of the size of the liver, spleen, signs of portal hypertension characterize the severity of the patient’s condition. Findings. 1). Carrying out an ultrasound of the liver with the use of Doppler ultrasound allows in the first 3 days from the moment of injury to conclude that there is liver dysfunction against the background of traumatic shock. 2). Statistical analysis of Doppler parameters of liver hemodynamics makes it possible to identify patients with a poor prognosis, severe liver dysfunction in the first 3–5 days from the moment of injury, as well as with developing multiple organ failure. 3). The obtained ultrasound results, indicating liver dysfunction in the early post-traumatic period, are confirmed by autopsy data.

Calibration of an Electrical Analog Model of Liver Hemodynamics in Fontan Patients

Fontan associated liver disease is a common complication in patients with Fontan circulation, who were born with a single functioning heart ventricle. The hepatic venous pressure gradient (HVPG) is used to assess liver health and is a surrogate measure of the pressure gradient across the entire liver (portal pressure gradient (PPG)). However, it is thought to be inaccurate in Fontan patients. The main objectives of this study were (1) to apply an existing detailed lumped parameter model (LPM) of the liver to Fontan patients using patient-specific clinical data and (2) to determine whether HVPG is a suitable measurement of PPGs in these patients. An existing LPM of the liver blood circulation was applied and tuned to simulate patient-specific liver hemodynamics. Geometries were collected from seven adult Fontan patients and used to evaluate model parameters. The model was solved and tuned using waveform measurements of flows, inlet and outlet pressures. The predicted ratio of portal to hepatic venous pressures is comparable to in vivo measurements. The results confirmed that HVPG is not suitable for Fontan patients, as it would underestimate the portal pressures gradient by a factor of 3 to 4. Our patient-specific liver model provides an estimate of the pressure drop across the liver, which differs from the clinically used metric HVPG. This work represents a first step toward models suitable to assess liver health in Fontan patients and improve its long-term management.

The effects of terlipressin and direct portacaval shunting on liver hemodynamics following 80% hepatectomy in the pig

Liver failure is the major cause of death following liver resection. Post-resection portal venous pressure (PVP) predicts liver failure, is implicated in its pathogenesis, and when PVP is reduced, rates of liver dysfunction decrease. The aim of the present study was to characterize the hemodynamic, biochemical, and histological changes induced by 80% hepatectomy in non-cirrhotic pigs and determine if terlipressin or direct portacaval shunting can modulate these effects. Pigs were randomized (n=8/group) to undergo 80% hepatectomy alone (control); terlipressin (2 mg bolus + 0.5–1 mg/h) + 80% hepatectomy; or portacaval shunt (PCS) + 80% hepatectomy, and were maintained under terminal anesthesia for 8 h. The primary outcome was changed in PVP. Secondary outcomes included portal venous flow (PVF), hepatic arterial flow (HAF), and biochemical and histological markers of liver injury. Hepatectomy increased PVP (9.3 ± 0.4 mmHg pre-hepatectomy compared with 13.0 ± 0.8 mmHg post-hepatectomy, P<0.0001) and PVF/g liver (1.2 ± 0.2 compared with 6.0 ± 0.6 ml/min/g, P<0.0001) and decreased HAF (70.8 ± 5.0 compared with 41.8 ± 5.7 ml/min, P=0.002). Terlipressin and PCS reduced PVP (terlipressin = 10.4 ± 0.8 mmHg, P=0.046 and PCS = 8.3 ± 1.2 mmHg, P=0.025) and PVF (control = 869.0 ± 36.1 ml/min compared with terlipressin = 565.6 ± 25.7 ml/min, P<0.0001 and PCS = 488.4 ± 106.4 ml/min, P=0.002) compared with control. Treatment with terlipressin increased HAF (73.2 ± 11.3 ml/min) compared with control (40.3 ± 6.3 ml/min, P=0.026). The results of the present study suggest that terlipressin and PCS may have a role in the prevention and treatment of post-resection liver failure.

Antiviral therapy effectively improves liver hemodynamics as evidenced by serum biomarker and contrast-enhanced ultrasound examinations in patients with hepatitis B cirrhosis

Background and Aims To prospectively evaluate the effects of antiviral therapy on liver hemodynamics in patients with hepatitis B cirrhosis. Methods Seventy consecutive eligible HBV-related cirrhotic inpatients were enrolled in the prospective study. Fifty-two received different nucleoside analogs monotherapy and 18 denied antiviral therapy. Their liver biochemistry profiles and HBV-DNA were measured at the baseline and every 3 months. Peripheral blood vWF and sCD163, as well as liver ultrasound Doppler parameters including portal vein diameter (PVD), portal vein velocity (PVV), portal vein congestion index (PV-CI), hepatic vein damping index (HV-DI), hepatic arterial arrival time (HAAT), hepatic vein arrival time (HVAT) and intrahepatic cycle time (HV-HA), were measured at the baseline and the follow-up periods. Results In the antiviral group, all patients achieved complete virologic and liver biochemical responses after 3-month antiviral treatment. Furthermore, the response states were maintained till the follow-up endpoint. However, in the non-antiviral group, HBV DNA replication resulted in higher levels of ALT and AST compared to the baseline values (P < 0.05). In the antiviral group, PVD, PV-CI, HV-DI, vWF-Ag and sCD163 were all significantly reduced than the baseline values (P < 0.05), and PVV was significantly increased than the baseline value (P < 0.05). Conclusions Antiviral therapy could effectively suppress hepatocyte inflammation and alleviate the dysfunction of intrahepatic vascular endothelial and hepatic macrophages, which might improve hepatic hemodynamic function in HBV-related cirrhosis.

Role of Colour Doppler in Evaluation of Hemodynamic Changes in Chronic Hepatitis C Infection

Objective: The objective of this study is to determine the role of colour flow Doppler ultrasound examination for detection of change in liver hemodynamic in hepatitis C positive chronic liver disease.Materials and Methods: This study was conducted in Department of Radiology, Mayo Hospital Lahore from 2012 to 2013. Hundred diagnosed case of Hepatitis C by serology were included in this study. Patient were examined for liver and spleen size, texture and presence and absence of ascites before Doppler study. All the data were coded and analyzed using SPSS version 20.Results: Mean age of the patient was found to be 45.90 ± 12.71 years. The echotexture of liver was normal in 29 patients (29.0%), coarse with smooth margins in 48 patients (48.0%) and coarse with irregularSMO, Department of Radiology, Children Hospital, Lahoremargins in 23 patients (23.0%). Splenic size was enlarged (≥ 13 cm) in 63.0%. Portal vein diameter was enlarged in (≥ 13 mm) in 53.0%. Severity of ascites shows mild ascites in 24.0%, moderate in 24.0% and severe in 19.0% patients. Portal vein velocity shows abnormality (≥ 24cm/sec) in 63.0%. Hepatic vein waveform in 71.0% of patients was triphasic and non-triphasic in 29.0%.Conclusion: In conclusion alterations of liver hemodynamics resulting from inflammation at the tissue level are detectable in Doppler sonography.