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[Circulatory behavior of patients with liver insufficiency]
Insights
Patients with hepatic failure show increased heart rate and cardiac index, with lower blood pressure and peripheral resistance. Sepsis further decreases blood pressure and cardiac function, impacting oxygen consumption.
Area of Science:
- Cardiology
- Hepatology
- Critical Care Medicine
Background:
- Hepatic failure significantly alters cardiovascular function.
- Understanding these hemodynamic changes is crucial for patient management.
Purpose of the Study:
- To investigate hemodynamic parameters in patients with hepatic failure.
- To compare hemodynamics in patients with and without sepsis.
Main Methods:
- Hemodynamic data collected from 26 intensive care unit patients with hepatic failure.
- Comparison with healthy individuals and subgroup analysis for sepsis.
Main Results:
- Elevated heart rate, cardiac index, and reduced diastolic pressure in hepatic failure patients.
- Sepsis led to decreased systolic and diastolic blood pressure, and lower total peripheral resistance.
- Sepsis patients exhibited reduced left ventricular performance and increased oxygen consumption with diminished extraction.
Conclusions:
- Hepatic failure causes significant hemodynamic alterations, including a hyperdynamic state.
- Concurrent sepsis exacerbates cardiovascular compromise and alters metabolic response.
- These findings highlight the complex interplay between liver disease, sepsis, and circulatory function.
Abstract:
Haemodynamic data were obtained in 26 patients with hepatic failure admitted to the intensive care unit of the First Department of Medicine, Vienna University. There was a significant increase in heart rate (101 vs 78 beats/min) and decreased diastolic pressure (56 vs 71 mm Hg) as compared with healthy persons. The cardiac index was elevated (5.1 vs 3.5 l/m2) and the total peripheral resistance was lowered (621 vs 1130 dyn/sec/cm-5). The systolic blood pressure was within the normal range except in 8 patients whose illness was complicated by sepsis. In those 8 patients the systolic blood pressure (86 vs 128 mm Hg), the diastolic blood pressure (42 vs 61 mm Hg) and the total peripheral resistance (434 vs 764 dyn. sec. cm-5) were all decreased as compared with patients with hepatocellular disease without sepsis. The decreased total peripheral resistance, however, was not associated with a further increase in the heart rate or stroke volume. On the contrary, in these 8 patients the left ventricular performance was lowered. The increase in cardiac output was not associated with an increase in oxygen consumption in patients without sepsis. Oxygen consumption was increased in patients with hepatocellular insufficiency and sepsis (157 ml/m2 vs 123 ml/m2) and this was accompanied by a diminished oxygen extraction rate (16% vs 26% in these 8 patients.