The Study Of Cardiac Hemodynamics And Renal Function In Patients With Cirrhosis

Object: To observe the change of Cardiac Hemodynamics Indicators in Patients with hepatic cirrhosis and investigate its significance. To analyse the relationship between renal impairment and clinical indicators. To explore the risk factors of renal impairment.Methods: 1. 124 patients with hepatic cirrhosis(the trial group) and 129 patients with chronic hepatitis B(CHB)(the control group) form January 2012 to June 2013 were retrospective analysed. Mean arterial pressure(MAP), stroke index(SI), stroke volume(SV), cardiac output(CO), cardiac index(CI), left heart work(LCW) and left heart index(LCWI) were detected by non-invasive cardiac hemodynamic monitor records,then to compare cardiac hemodynamic index changes between cirrhosis group and control group, and to detect the relationship between the index changes of cardiac hemodynamic and clinical parameters. 2.200 cases of hospitalized patients with cirrhosis form January 2013 to October 2014 were retrospective analysed.The GFR was estimated by the MDRD equation.To investigate the relationship between Child-Pugh grading and prevelance of renal function impairment.Logistic regression analyses were performed to assess the risk factors of renal impairment. 3.Statistics were analysed by SPSS 19.0(SPSS Inc., Chicago, IL). For normal distribution statistics were expressed as means and deviation( x ±s). For continuous variables, one way ANOVA and Kruskal-Wallis H tests were used for between group comparisons. For categorical variable, Chi-square tests were used for between group comparisons. A P-value less than 0.05 was considered to be statistically significant.Results: 1.Compared with control group, liver cirrhosis group MAP decreased;As in patients with cirrhosis liver function classification by Child-Pugh A to C, CO and CI gradually increased;.Hemodynamics SV, SI, CO, CI, LCW and LCWI all showed a trend of increase with increased liver stiffness;Comparison of the degree of esophageal varices in patients,F0-1 group CI was significantly less than F2-3 group; Ascites group CO, CI were significantly higher than those without ascites;the differences were statistically significant, P <0.05.2. 200 cases of renal function in patients with liver cirrhosis were analysed, there were 33 cases of impaired renal function, the prevalence of renal impairment was 16.5%; Child- Pugh A group prevalence of renal impairment was 2.04%, Child-Pugh B group the prevalence of renal impairment was 20.97%, Child-Pugh C group the prevalence of renal impairment was 45%, the differences between the groups statistically significant( Χ2= 39.351, P <0.001); The study of the relationship between impaired renal function and clinical indicators indicated that age, Child-Pugh classification, ALB, TBIL, UA, β2 microglobulin and ascites were risk factors on impaired renal function. Child-Pugh classification, age, ascites and β2-microglobulin were independent risk factors by multivariate Logistic regression analysis.Conclusion: Cardiac hemodynamic indexes easily changed in cirrhotic patients, especially CO, CI, the changes related to the Child-Pugh classification, liver stiffness, ascites and esophageal varices. Independent risk factors for impaired renal function in cirrhotic patients were Child-Pugh classification, age, ascites and β2 microglobulin. Therefore, the function of heart and kidneys should be monitored while detection of liver function, in order to take appropriate measures to reduce mortality in patients with cirrhosis.