Association of Estimated Plasma Volume Status With Invasive Hemodynamics and All-Cause Mortality in Patients With Liver Cirrhosis

Abstract

Background

Estimated plasma volume status (ePVS) correlates with intravascular congestion and prognosis in patients with heart failure. The ePVS relationship with invasive hemodynamic profiling and clinical outcomes in patients with liver cirrhosis (LC) remains unclear.

Methods

This single-center retrospective cohort study included LC patients who underwent right heart catheterization (RHC) between 2018 and 2023. Estimated plasma volume status (ePVS) was calculated using the Strauss-derived Duarte formula, with patients classified into high (> 5.5%) and low-ePVS (≤ 5.5%) groups. Cox-multivariable analysis was used to determine if ePVS was associated with all-cause mortality within 1 year post-RHC among transplant-free patients.

Results

Of the 353 patients with LC (median age 59 years, 59% male, 45% Caucasian, and 29% African American), 79% were classified into the high-ePVS group. Compared to the low-ePVS group, the high-ePVS group had significantly higher right atrial pressure (9 vs. 6 mmHg, p = 0.01), pulmonary arterial wedge pressure (14 vs. 11 mmHg, p = 0.014), cardiac output (9.8 vs. 6.4 L/min, p < 0.0001), and cardiac index (5 vs. 3.1 L/min/m², p < 0.0001). Additionally, the high-ePVS group exhibited a higher prevalence of cirrhosis-related complications, including ascites, splenomegaly, and varices, and a greater likelihood of receiving orthotopic liver transplantation within 1 year (38% vs. 11%, p < 0.0001). Among transplant-free patients, ePVS was independently associated with all-cause mortality at 1 year (HR 1.15, 95% CI: 1.00–1.32, p = 0.048).

Conclusion

Our study demonstrated that ePVS was associated with intravascular congestion, hyperdynamic circulation, and cirrhosis complications. Furthermore, ePVS was independently associated with all-cause mortality among transplant-free LC patients.