Prognostic indicators in compensated cirrhosis.

In an attempt to identify variables predicting prognosis, 100 consecutive patients with compensated cirrhosis of the liver were followed for a mean of 4.9 (SD 0.7) yr. Fifty-one patients belonged to Child-Pugh class A, 49 to class B. At entry, five laboratory parameters were considered, together with sex, the grade of esophageal varices, and seven variables measured by ultrasonography (liver and spleen volume and the calibers of the splanchnic vessels). In a subgroup of 56 patients, the galactose elimination capacity also was determined. Forty-six patients were alive at the end of follow-up. Survival was analyzed according to Cox's model. Six parameters were able to predict survival (albumin, bilirubin, liver volume, prothrombin activity, cholesterol, varices). However, step-wise Cox regression analysis identified only four variables that independently correlated with survival: albumin, bilirubin, cholesterol, and liver volume. Galactose elimination failed to add any significance to routine liver function tests. This prospective study confirms the ability of routine liver function tests in predicting survival in compensated cirrhosis. The measurement of liver volume, easily obtained by ultrasonography, is also significant for prognosis, and may be introduced into clinical practice.

Prevalence and significance of abdominal lymphadenopathy in patients with chronic liver disease: an ultrasound study.

Enlarged abdominal, mainly periportal, lymph nodes were detected by real time ultrasonography in 19% (42 of 227) of patients with chronic liver disease who had no evidence of tumor, upper gastrointestinal carcinoma, or lymphoproliferative disorder. Computed tomography, performed in 15 cases, always confirmed the sonographic findings. Lymph node biopsies from two patients showed reactive hyperplasia. Lymphadenopathy occurred more frequently in autoimmune (primary biliary cirrhosis, autoimmune, and liver-kidney microsomal antibody-positive chronic hepatitis: 33, 25, and 22% of cases, respectively) than nonautoimmune disease (cryptogenic, alcoholic, and hepatitis B virus-related chronic hepatitis: 16, 12, and 10% of cases, respectively) (p less than 0.005). Four of five patients with mixed polyclonal cryoglobulinemia or monoclonal gammopathy had lymphadenopathy. In 125 patients, including 25 with lymphadenopathy, who were monitored for a median period of 25 months, the ultrasonographic pattern remained unchanged. Abdominal, presumably benign, lymphadenopathy may accompany chronic liver disease, especially when prominent immunological features coexist. This should be kept in mind for the correct interpretation of such an ultrasound finding.

Ultrasonographic follow-up of liver cirrhosis.

Ultrasonography and upper gastrointestinal endoscopy were prospectively used to study 100 consecutive patients with liver cirrhosis. After a period of 20 months to 55 months, 21 patients had died, 23 were lost at follow-up, and 56 patients were reevaluated. In the patients who died during follow-up, the entry liver volume, measured by means of the hepatic volumetric index, was lower as compared to the 56 cirrhotics who survived. During the study period, liver volume significantly decreased to values similar to those observed, at entry, in patients who died. Moreover, esophageal varices increased in size, and the splanchnic veins enlarged. Abdominal ultrasonography provides data regarding the natural history of liver cirrhosis, which might be used, in addition to tests of liver function and endoscopy, as prognostic factors in cirrhotic patients.

Portal venous flow in response to acute beta-blocker and vasodilatatory treatment in patients with liver cirrhosis.

The drugs currently under investigation in the prevention of recurrent gastrointestinal bleeding in cirrhosis are likely to decrease the portal pressure by means of a primary reduction of portal blood flow. The hemodynamic effects of beta-blocking agents and vasodilatory drugs were noninvasively measured in eight patients with cirrhosis by means of pulsed echo-doppler equipment. Portal caliber, blood velocity and flow were recorded hourly after a single dose of propranolol (40 mg p.o.) or atenolol (100 mg p.o.), and every 5 min after treatment with isosorbide dinitrate (5 mg sublingually). The drugs were administered at random with an interval of 2 days or more. The portal caliber decreased after atenolol, but did not change after propranolol and isosorbide. The blood velocity decreased by 29 +/- 2% 3 hr after propranolol, by 26 +/- 2% 3 hr after atenolol and by 31 +/- 3% 15 min after isosorbide. The portal blood flow decreased by 0.29 +/- 0.03 liters per min after propranolol, by 0.34 +/- 0.06 after atenolol and by 0.26 +/- 0.03 after isosorbide, without any difference among the various treatments. beta-blockers and vasodilatory drugs have comparable effects on portal blood flow. beta 1-selective and nonselective beta-blockers are similarly effective in keeping with the hypothesis that changes in portal blood flow are mainly due to the block of beta 1-receptors.

Echo-Doppler measurement of splanchnic blood flow in control and cirrhotic subjects.

Blood flow in the splanchnic veins was studied in cirrhotics and matched controls by means of a system that combines a mechanical sector scanner with a pulsed Doppler. The measurements were validated in an in vitro model. Echo-doppler studies could be carried out reproducibly in only approximately two-thirds of cases because of poor echo transmission or incomplete cooperation. Portal blood velocity was significantly reduced in cirrhotics (10.5 +/- 0.6 cm/s versus 16.0 +/- 0.5 in controls; p less than 0.001), but portal blood flow was normal because of enlarged portal caliber. A complete hemodynamic evaluation of the splenic and superior mesenteric veins was possible in only a few subjects. In selected patients the technique may prove relevant in the study of hemodynamic effects of drugs and surgery on portal blood flow.

Splanchnic vein measurements in patients with liver cirrhosis: a case-control study.

The portal venous system was evaluated by real-time ultrasonography in 100 consecutive cirrhotic patients and 100 pair-matched controls to assess the sensitivity and specificity of ultrasound findings in detecting or excluding cirrhosis. The best discriminant findings were the expiration diameters of the superior mesenteric and the splenic vein and, chiefly, their sum corrected by body surface. In cirrhotics the calibers of the splanchnic veins significantly increase in relation to the extent of esophageal varices, but in individual patients this increase cannot predict the extent of varices, which are the main determinant of the bleeding risk.