TITLE:
Degree of Hyper-Dynamic Circulation Correlates with the Severity of Liver Disease and Predicts Poor Outcome in Spontaneous Bacterial Peritonitis Patients in Intensive Care Unit
AUTHORS:
Mohamed Hamdi Saleh, Ahmed Hamdy, Moataz Elhalag
KEYWORDS:
Spontaneous Bacterial Peritonitis, Acute Kidney Injury, AKIN Criteria
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.7 No.3,
March
29,
2017
ABSTRACT: Background:
Circulatory dysfunction is known in spontaneous bacterial peritonitis (SBP)
patients. We aimed to determine whether degree of hyper-dynamic circulation is
significantly correlated with severity of liver disease and poor outcome in
these patients or not. Methods: 61 patients diagnosed to have SBP were
enrolled. In addition to routine laboratory investigation, Child Pugh and
APACHE II scores were calculated for all patients. Degree of renal impairment
was defined using Acute Kidney Injury Network (AKIN) criteria. Stroke volume
(SV) was measured by M mode and 2-dimensional Doppler echocardiography. Cardiac output (CO) and Systemic vascular
resistance (SVR) were also calculated. All data were statistically
analyzed. Results: SV, CO, SVR were significantly correlated with Child Pugh
score, p value 0.001, respectively. In 46 (75.4%) patients who had AKI,
degree of kidney injury using AKIN criteria is significantly correlated with
SVR, SV, and CO. Inpatient mortality occurred in 10 (16.4%) patients.
Non-survivors had lower SVR and higher SV and CO compared to survivors (1805 ± 105 dyn·sec/cm2, 80.3 ± 11.2 ml, and 6.7 ± 1.1 L/min vs 1936 ± 504, 67.6 ± 12.7, and 5.7 ± 0.9, p value 0.029, 0.005, 0.007 respectively). Using the Receiver
Operating Characteristics (ROC) curve, the cut-off value of CO that predicts mortality was 5.89 L/min with sensitivity and specificity measuring 80%, 70.6%
respectively. The area under the curve (AUC) is 0.767 with 95% confidence
interval (CI) is 0.566 to 0.968, p value 0.008. At this value, the odds ratio (OR) is 7.33 with p
value 0.012. Conclusion: Degree of hyper-dynamic circulation is
significantly correlated with the severity of liver disease and predicts poor
outcome in SBP patients.