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New classification with prognostic value in cirrhotic patients.
R L Cosby1, B Yee, R W Schrier
1Department of Medicine, University of Colorado School of Medicine, Denver.
Mineral and Electrolyte Metabolism
|January 1, 1989
Summary
Cirrhotic patients with impaired water excretion (Class III) show poor prognosis. Early intervention, like a peritoneovenous shunt, may improve survival in these patients with advanced liver disease.
Area of Science:
- Hepatology
- Nephrology
- Endocrinology
Background:
- Cirrhosis frequently leads to fluid retention and electrolyte imbalances.
- Water excretion capacity varies significantly among cirrhotic patients.
- Predicting prognosis in cirrhosis is crucial for clinical management.
Purpose of the Study:
- To classify cirrhotic patients based on water load excretion.
- To identify clinical and biochemical markers associated with impaired water excretion.
- To evaluate the prognostic significance of water excretion capacity in cirrhosis.
Main Methods:
- Twenty-one cirrhotic patients underwent a standard 20 ml/kg water load test.
- Patients were categorized into three classes based on urine output over 5 hours.
- Clinical data, laboratory tests, and survival were prospectively analyzed.
Main Results:
- Class III patients (<20% excretion) exhibited ascites, hyponatremia, diuretic resistance, and hormonal imbalances (vasopressin, aldosterone, norepinephrine).
- Water load excretion capacity was the key differentiator between Class II and Class III.
- Class III patients had a poor prognosis (survival <5 months), irrespective of ethanol intake, while Classes I and II had better survival, especially with ethanol abstinence.
Conclusions:
- Water excretion capacity is a critical indicator of disease severity and prognosis in cirrhosis.
- Class III patients represent a high-risk group requiring closer monitoring and potential intervention.
- Peritoneovenous shunting may offer a survival benefit for Class III cirrhotic patients, warranting further investigation.