Prognostic significance of hepatic veins waveforms study by doppler ultrasonography in cirrhotic patients with portal hypertension

ABSTRACT

Doppler Ultrasonographic [U/S] waveform changes in the hepatic veins can be found in chronic parenchymal liver disease, especially in the late stages. In this prospective study, 150 Egyptian bilharzial cirrhotic patients with portal hypertension but without hepatocellular carcinoma [HCC] in addition to 20 age and sex matched apparently healthy control were studied. Diagnosis was confirmed with liver biopsy in 121 patients [those with prolonged prothrombin time 3 seconds more than control and platelet count less than 90000 per mm were excluded]. Doppler wave form patterns in patients were classified into 4 types [I, II, III and IV], while we found that all the control group was of type I Doppler waveform Prognostic value of the hepatic veins waveforms together with clinical and biochemical parameters were evaluated with their relation to the outcome of our patients. Out of 150 of our patients 112 were male and 38 were females, their ages ranged between 29-65 years [with mean +/- SD = 47.08 +/- 7.70 years]. All were experienced variceal bleeding. Most of the patients [130] were HCV positive. By the end of the follow up period [18 months] 23 [153%] patients have died, all due to liver cell failure. A univariate analysis that followed by a multivariate one showed that flat Doppler waveform [type IV] changes in the right hepatic vein with the following characteristics of patients [rebleeding varices, presence of encephalopathy, increase s.billrubin and decrease prothrombin%] were independently related to survival. Doppler U/S study [which is a non-invasive maneuver] of the right hepatic vein has improved the prognostic accuracy in patients with cirrhosis and portal hypertension. Moreover type IV [flat waveform with fluttering] was associated with bad prognosis and poor survival