Point-of-care Ultrasonography in Patients with Hepatorenal Syndrome: A Single Center Observational Study.

IF 1.5 Q3 CRITICAL CARE MEDICINE

Indian Journal of Critical Care Medicine Pub Date : 2024-11-01 Epub Date: 2024-10-30 DOI:10.5005/jp-journals-10071-24827

Vedaghosh Amara, Anand V Kulkarni, Anand Gupta, Shantan Venishetty, Shanthi R Sripathi, L Siva K Reddy, Arun Kumar Tirumala, Puja Karandikar, Manasa Alla, Sowmya Iyengar, Mithun Sharma, Padaki N Rao, D Nageshwar Reddy

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Abstract

Aim and background: A combination of terlipressin and albumin is the standard of care for patients with hepatorenal syndrome-acute kidney injury (HRS-AKI). The study aimed to compare the venous congestion using lung ultrasound score (LUS) and radiographic assessment of lung edema (RALE) scores among terlipressin responders and nonresponders and survivors and non-survivors.

Materials and methods: In this single-center, prospective, observational study, we included adult patients with HRS-AKI who had received terlipressin and albumin from 28th April 2022 to 16th October 2022.

Results: Of the 102 patients included, 74.5% (95%CI: 58.7-93.2) responded to terlipressin. The median dose of terlipressin and albumin was 2 (1-8) mg/day and 100 (40-200) g for a duration of 5 (2-10) days. On Kaplan-Meier analysis, survival was 26.9% of patients in the nonresponder group compared to 61.4% in the responder group (p = 0.001). Day 3 LUS score worsened in 76.9% of patients in nonresponders group compared to 52.6% in responder group (p = 0.03). There was a significant increase in RALE score in those who died [6 (-6-48) vs alive: 0 (-4- 30); p < 0.001]. Lung ultrasound score had improved or been maintained in 63.6% of patients who were alive, compared to 14.9% in those who had died (p < 0.001). On multivariable Cox regression analysis, age [HR, 1.02 (1.002-1.05)], terlipressin non-response [HR, 2.8 (1.47-5.34)], APACHE score [HR, 1.07 (1.03-1.12)], duration of terlipressin therapy [HR, 0.37 (0.27-0.5)] and worsening of LUS [HR, 2.9 (1.81-7)] predicted mortality.

Conclusion: Lung ultrasound score and chest X-ray can accurately identify venous congestion in the lungs, which is common in patients with advanced liver disease who receive terlipressin and albumin in the intensive care unit (ICU).

How to cite this article: Amara V, Kulkarni AV, Gupta A, Venishetty S, Sripathi SR, Reddy LSK, et al. Point-of-care Ultrasonography in Patients with Hepatorenal Syndrome: A Single Center Observational Study. Indian J Crit Care Med 2024;28(11):1015-1022.

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肝肾综合征患者的床旁超声检查：单中心观察研究

目的与背景：特利加压素联合白蛋白是肝肾综合征-急性肾损伤（hr - aki）患者的标准治疗方案。本研究旨在比较特利加压素应答者和无应答者、存活者和无存活者之间静脉充血的肺超声评分（LUS）和肺水肿的影像学评估（RALE）评分。材料和方法：在这项单中心、前瞻性、观察性研究中，我们纳入了2022年4月28日至2022年10月16日接受特利加压素和白蛋白治疗的成年HRS-AKI患者。结果：纳入的102例患者中，74.5% （95%CI: 58.7-93.2）对特利加压素有反应。特利加压素和白蛋白的中位剂量分别为2 (1-8)mg/天和100 (40-200)g，持续5（2-10）天。Kaplan-Meier分析显示，无反应组患者的生存率为26.9%，而有反应组为61.4% （p = 0.001）。无反应组患者第3天LUS评分恶化的比例为76.9%，有反应组为52.6% （p = 0.03）。死亡组的RALE评分明显高于活着组[6 (-6-48):0 (-4- 30)]；P < 0.001]。63.6%的存活患者的肺超声评分改善或维持，而死亡患者的这一比例为14.9% （p < 0.001）。多变量Cox回归分析显示，年龄[HR， 1.02(1.002-1.05)]、特利加压素无反应[HR， 2.8(1.47-5.34)]、APACHE评分[HR， 1.07(1.03-1.12)]、特利加压素治疗时间[HR， 0.37(0.27-0.5)]和LUS恶化[HR， 2.9(1.81-7)]预测死亡率。结论：肺部超声评分和胸部x线能准确识别肺部静脉充血，这在重症监护病房（ICU）接受特利加压素和白蛋白治疗的晚期肝病患者中很常见。本文出处：Amara V， Kulkarni AV, Gupta A, Venishetty S, Sripathi SR， Reddy LSK等。肝肾综合征患者的即时超声检查：一项单中心观察研究。中华检验医学杂志；2009;28(11):1015-1022。

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来源期刊

Indian Journal of Critical Care Medicine CRITICAL CARE MEDICINE-

CiteScore

3.50

自引率

10.00%

发文量

299

期刊介绍： Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.