Z Gastroenterol 2020; 58(01): e18
DOI: 10.1055/s-0039-3402148
Poster Visit Session II Clinical Hepatology, Surgery, LTX: Friday, February 14, 2020, 2:40 pm – 3:25 pm, Lecture Hall P1
Georg Thieme Verlag KG Stuttgart · New York

Systemic inflammation is associated with hyperdynamic circulation and predicts acute-on-chronic liver failure

M Praktiknjo
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
S Monteiro
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
2   Hospital Pedro Hispano, Department of Medicine, Matosinhos, Portugal
,
J Grandt
3   Hvidovre Hospital, Gastrounit Medical Division, Copenhagen, Denmark
,
N Kimer
3   Hvidovre Hospital, Gastrounit Medical Division, Copenhagen, Denmark
,
JL Madsen
4   Faculty of Health Sciences Hvidovre Hospital, Department of Clinical Physiology and Nuclear Medicine, 239 Center for Functional and Diagnostic Imaging and Research, Copenhagen, Denmark
,
MP Werge
3   Hvidovre Hospital, Gastrounit Medical Division, Copenhagen, Denmark
,
PW Illiam
3   Hvidovre Hospital, Gastrounit Medical Division, Copenhagen, Denmark
,
M Brol
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
L Turco
5   Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Division of Gastroenterology, Modena, Italy
,
R Schierwagen
6   University of Frankfurt, Department of Internal Medicine 1, Frankfurt, Germany
,
J Chang
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
S Klein
6   University of Frankfurt, Department of Internal Medicine 1, Frankfurt, Germany
,
C Jansen
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
F Uschner
6   University of Frankfurt, Department of Internal Medicine 1, Frankfurt, Germany
,
C Welsch
6   University of Frankfurt, Department of Internal Medicine 1, Frankfurt, Germany
,
R Moreau
7   Hôpital Beaujon, Département Hospitalo-Universitaire, Service d'Hépatologie, Paris, France
,
F Schepis
5   Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Division of Gastroenterology, Modena, Italy
,
F Bendtsen
3   Hvidovre Hospital, Gastrounit Medical Division, Copenhagen, Denmark
,
LL Gluud
3   Hvidovre Hospital, Gastrounit Medical Division, Copenhagen, Denmark
,
S Møller
4   Faculty of Health Sciences Hvidovre Hospital, Department of Clinical Physiology and Nuclear Medicine, 239 Center for Functional and Diagnostic Imaging and Research, Copenhagen, Denmark
,
J Trebicka
6   University of Frankfurt, Department of Internal Medicine 1, Frankfurt, Germany
8   European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2020 (online)

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Background & Aims:

Acute-on-chronic liver failure (ACLF) is characterized by high short-term mortality and systemic inflammation (SI). Recently, different cardiodynamic states were shown as independent predictors of outcomes in cirrhosis. The relationship between cardiodynamic states, SI and portal hypertension and their impact on ACLF development have not been fully studied. The aim of the present study was therefore to evaluate the interplay of cardiodynamic state, fatal ACLF development and SI in liver cirrhosis.

Approach & Results:

At inclusion, haemodynamic measures including the cardiac index (CI) and hepatic venous pressure gradient (HVPG) of 208 cirrhotic patients were measured. Patients were followed prospectively for fatal ACLF (primary endpoint). SI was assessed measuring the levels of proinflammatory interleukins (ILs) 6 and 8 and IL-33 receptor – soluble ST2.

Patients were divided according to CI (< 3.2; 3.2 – 4.2; > 4.2 L/min/m2) in hypo- (n = 84), normo- (n = 69) and hyperdynamic group (n = 55). After a median follow up of 3 years, the highest risk of fatal ACLF was seen in hyperdynamic (35%) and hypodynamic patients (25%) compared to normodynamic (14%) (p = 0.011). Hyperdynamic state showed highest rate of SI. The detectable level of IL-6 was an independent predictor of fatal ACLF development.

Conclusions:

Cirrhotic patients with hyperdynamic and hypodynamic circulation, have a higher risk of fatal ACLF. Hyperdynamic state is strongly associated with elevated markers of systemic inflammation, which independently predict fatal ACLF development.