Systemic, Renal, and Hepatic Hemodynamic Derangement in Cirrhotic Patients With Spontaneous Bacterial Peritonitis

• DOI: 10.1053/jhep.2003.50447
• Publication Date: 2003-10-23T14:25:20Z
• Authors: Luis Ruiz-del-Arbol; Jesús Urman; Javier Fernández; Mónica González; Miguel Navasa; Alberto Monescillo; Agustín Albillos; Wladimiro Jiménez; Vicente Arroyo
• Keywords: Hepatic Encephalopathy; Spontaneous bacterial peritonitis; Hyperdynamic circulation; Mean arterial pressure; Plasma renin activity; Blood urea nitrogen

Spontaneous bacterial peritonitis (SBP) is frequently associated with renal failure. This study assessed if systemic and hepatic hemodynamics are also affected by this condition. Standard laboratory tests, tumor necrosis factor alpha (TNF-alpha) in plasma ascitic fluid, renin activity (PRA) norepinephrine (NE), were determined 23 patients SBP at diagnosis after resolution of infection. Eight developed failure during treatment. At infection, developing showed significantly higher values TNF-alpha, blood urea nitrogen (BUN), PRA NE, peripheral vascular resistance, venous pressure gradient (HVPG) lower cardiac output than not During treatment, a significant reduction arterial increase HVPG, Child-Pugh score observed the first group but second. Peripheral resistance remained unmodified both groups. Changes NE correlated inversely changes directly BUN, score, HVPG. Five encephalopathy, 6 died. In without failure, none encephalopathy or expired. conclusion, develop rapidly progressive impairment hemodynamics, leading to severe aggravation portal hypertension, death. occurs despite rapid infection an extremely poor prognosis.