Hepatofugal portal flow is highly predictive of acute-on-chronic liver failure: A new hemodynamic patho-physiological hypothesis

医学 肝移植 慢性肝病 门静脉血栓形成 内科学 肝病 门脉高压 病因学 胃肠病学 血流动力学 并发症 血栓形成 心脏病学 肝硬化 移植
作者
Michele Bevilacqua,De Marco Leonardo,Sandra Roberta,Carlo Maria De Filippo,Mirko Zoncapè,Paon Veronica,Donatella Ieluzzi,Andrea Dalbeni,David Sacerdoti
出处
期刊:Digestive and Liver Disease [Elsevier]
标识
DOI:10.1016/j.dld.2024.01.190
摘要

Background and aims Acute-on-chronic liver failure (ACLF) is a severe complication of advanced liver disease. A significant number of ACLF patients have not clear precipitating factors. The aim of the study was to investigate the role of alterations in porto-hepatic hemodynamics, especially non-forward portal flow (NFPF), in ACLF and liver-related mortality. Methods 233 cirrhotic patients were included in the study with a median follow-up of 24 months. Color-Doppler ultrasound was used to assess portal vein patency, flow direction and significant porto-systemic collaterals (>8 mm). Patients with active cancer, both at baseline and during follow-up and severe non liver-related comorbidities were excluded. ACLF and liver-related mortality were recorded during follow-up. Results Fifty-six patients (24%) developed ACLF; 24 (10,3%) had baseline NFPF. In survival analysis, NFPF, but not portal vein thrombosis, was independently associated with ACLF development (HR 2.85 95% C.I. [1.49–5.42], p = 0.001) and liver-related mortality (HR 2.24 95% C.I. [1.16–4.28], p = 0.015), even after adjustment for liver disease severity scores, age and etiology of liver disease. Conclusion NFPF is independently associated with ACLF development and liver-related mortality, regardless of etiology, severity disease scores and portal vein thrombosis. Although there is no specific measure to reverse NFPF, patients with NFPF should receive prompt intensive management and urgent prioritization for liver transplantation. Clinical trial number 2730 CESC
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