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Published on: July 3, 2013
Diastolic dysfunction is associated with low urinary sodium excretion in patients with decompensated cirrhosis
Evangelos Cholongitas1, Ioannis Goulis1, Efstathios Pagourelias2
14th Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
Insights
Diastolic dysfunction in cirrhosis is linked to lower 24-hour urine sodium levels. This study identified pulse rate and urine sodium as key factors, though not directly impacting liver disease severity or survival.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Diastolic dysfunction (DD) in cirrhosis pathogenesis and clinical impact are not fully understood.
- Patients with decompensated cirrhosis awaiting liver transplantation are a vulnerable population.
- Understanding factors associated with DD is crucial for managing these patients.
Purpose of the Study:
- To investigate factors associated with diastolic dysfunction in patients with decompensated cirrhosis.
- To identify predictors of DD in liver transplant candidates.
- To clarify the clinical impact of DD in this cohort.
Main Methods:
- Prospective evaluation of 115 consecutive patients with decompensated cirrhosis undergoing transplant assessment.
- Diagnosis of DD using Doppler echocardiography, classified per current guidelines.
- Multivariable logistic regression analysis to identify independent predictors of DD.
Main Results:
- Diastolic dysfunction was present in 57.3% of patients.
- Pulse rate and lower 24-hour urine sodium (UNa24h) were independently associated with DD.
- Patients with DD showed higher levels of interleukin-6 compared to those without DD.
Conclusions:
- Diastolic dysfunction in decompensated cirrhosis is independently associated with lower 24-hour urine sodium.
- No correlation was found between DD and liver disease severity (Child-Pugh/MELD scores) or patient survival.
- Further research is warranted to fully elucidate the implications of DD in cirrhosis.
Background/Aim:
The pathogenesis and the clinical impact of diastolic dysfunction (DD) in cirrhosis remain unclear. Our aim was to investigate the factors significantly associated with the presence of DD in patients with decompensated cirrhosis on the waiting list for liver transplantation.
Material And Methods:
consecutive patients with decompensated cirrhosis, who admitted for transplant assessment, were prospectively evaluated. We assessed the independent factors associated with the presence of DD, while their discriminative ability was evaluated by AUC curve. The diagnosis of DD was based on Doppler echocardiography and classified into three categories according to the current guidelines.
Results:
we evaluated 115 consecutive patients. Sixty six patients (57.3%-group 1) had DD and 49 (42.7%-group 2) had not DD. The 2 groups had similar Child-Pugh/MELD scores and survival. In multivariable logistic regression analysis, pulse rate (OR: 1.082, 95% CI: 1.03-1.15, p = 0.004), and UNa24h (OR: 0.98, 95% CI: 0.97- 0.99, p = 0.004) were the only variables independently associated with the presence of DD. In the subgroup of consecutive patients (n = 31) with evaluation of cytokines, those (n = 22) with DD, compared to those (n = 9) without DD, had significantly higher levels of inteleukin-6 [145 (45-2000) vs. 56 (10-149)pg/mL, p = 0.043].
Conclusions:
We found that DD was independently associated with lower 24-hour urine sodium. Although no correlation was found between DD and severity of liver disease or survival, further studies are needed for final conclusions.
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