Daniel Segna , Fabio Brazerol , Pompilia Radu , Gerard Angeles Fite , Jaime Bosch , Annalisa Berzigotti
{"title":"Point-of-care ultrasound of the inferior vena cava for intravascular volume assessment during intravenous albumin infusion in patients with cirrhosis","authors":"Daniel Segna , Fabio Brazerol , Pompilia Radu , Gerard Angeles Fite , Jaime Bosch , Annalisa Berzigotti","doi":"10.1016/j.jhepr.2025.101559","DOIUrl":null,"url":null,"abstract":"<div><h3>Background & Aims</h3><div>Current guidelines recommend intravenous (i.v.) albumin for different indications in decompensated cirrhosis, but iatrogenic hypervolemia following i.v. albumin is increasingly reported. We aimed to characterize intravascular volume status using point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) during passive leg raise (PLR) and i.v. albumin, potentially facilitating clinical management and adjustment of albumin dosage.</div></div><div><h3>Methods</h3><div>This prospective pilot cohort included patients with decompensated cirrhosis requiring i.v. albumin. We assessed changes in minimal and maximal IVC diameters (IVC<sup>min</sup> and IVC<sup>max</sup>, respectively) and collapsibility index (IVCCI) during PLR and after i.v. albumin. We defined severe intravascular volume overload as IVC<sup>max</sup> >2.1 cm and IVCCI <20%. Clinical outcomes were recorded until 3 months after POCUS.</div></div><div><h3>Results</h3><div>We included 81 measurements in 55 patients (70.9% men; median age 62 years; 58.2% alcohol-related cirrhosis; median Child-Pugh score 9 points; 89.1% paracentesis; median 40 g i.v. albumin; 5.5 L ascites)<strong>.</strong> We found a significant increase in IVC diameters both during PLR (change in mean [Δ] IVC<sup>min</sup> +20.7%, Δ IVC<sup>max</sup> +14.1%, <em>p</em> <0.01) and after i.v. albumin (Δ IVC<sup>min</sup> +58.8%, Δ IVC<sup>max</sup> +48.2%, <em>p</em> <0.01). There was a significant decrease in IVCCI during PLR (relative Δ -11.1%, <em>p</em> <0.01) and after i.v. albumin (relative Δ -18.0%, <em>p</em> <0.01). Potential severe intravascular volume overload occurred on 17 occasions (21%) after i.v. albumin, more frequently in women than in men (40% <em>vs.</em> 15.7%, <em>p</em> <0.01), and showed higher cumulative incidence rates in variceal bleeding after 1 (16.7% <em>vs.</em> 0%, <em>p</em> = 0.01) and 3 months (18.2% <em>vs.</em> 0%, <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Potential severe intravascular volume overload after i.v. albumin was detected in every fifth patient with decompensated cirrhosis. Thus, there is a need to develop strategies for individualizing volume management in patients with decompensated cirrhosis.</div></div><div><h3>Impact and implications</h3><div>Iatrogenic volume overload after albumin infusions in patients with cirrhosis is a potentially harmful side effect, but no policy for monitoring intravascular volume overload using non-invasive tools has been suggested so far. New-onset potential volume overload was detected in almost one out of five men and four out of 10 women and was associated with increases in N-terminal prohormone of brain natriuretic peptide, lower mean arterial pressure during albumin infusion, and higher serum sodium levels. Our results from this proof-of-concept study emphasize the need for larger prospective cohort studies to validate our findings and introduce strategies for individualizing volume management in patients with decompensated cirrhosis.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 11","pages":"Article 101559"},"PeriodicalIF":7.5000,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JHEP Reports","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589555925002381","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background & Aims
Current guidelines recommend intravenous (i.v.) albumin for different indications in decompensated cirrhosis, but iatrogenic hypervolemia following i.v. albumin is increasingly reported. We aimed to characterize intravascular volume status using point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) during passive leg raise (PLR) and i.v. albumin, potentially facilitating clinical management and adjustment of albumin dosage.
Methods
This prospective pilot cohort included patients with decompensated cirrhosis requiring i.v. albumin. We assessed changes in minimal and maximal IVC diameters (IVCmin and IVCmax, respectively) and collapsibility index (IVCCI) during PLR and after i.v. albumin. We defined severe intravascular volume overload as IVCmax >2.1 cm and IVCCI <20%. Clinical outcomes were recorded until 3 months after POCUS.
Results
We included 81 measurements in 55 patients (70.9% men; median age 62 years; 58.2% alcohol-related cirrhosis; median Child-Pugh score 9 points; 89.1% paracentesis; median 40 g i.v. albumin; 5.5 L ascites). We found a significant increase in IVC diameters both during PLR (change in mean [Δ] IVCmin +20.7%, Δ IVCmax +14.1%, p <0.01) and after i.v. albumin (Δ IVCmin +58.8%, Δ IVCmax +48.2%, p <0.01). There was a significant decrease in IVCCI during PLR (relative Δ -11.1%, p <0.01) and after i.v. albumin (relative Δ -18.0%, p <0.01). Potential severe intravascular volume overload occurred on 17 occasions (21%) after i.v. albumin, more frequently in women than in men (40% vs. 15.7%, p <0.01), and showed higher cumulative incidence rates in variceal bleeding after 1 (16.7% vs. 0%, p = 0.01) and 3 months (18.2% vs. 0%, p = 0.01).
Conclusions
Potential severe intravascular volume overload after i.v. albumin was detected in every fifth patient with decompensated cirrhosis. Thus, there is a need to develop strategies for individualizing volume management in patients with decompensated cirrhosis.
Impact and implications
Iatrogenic volume overload after albumin infusions in patients with cirrhosis is a potentially harmful side effect, but no policy for monitoring intravascular volume overload using non-invasive tools has been suggested so far. New-onset potential volume overload was detected in almost one out of five men and four out of 10 women and was associated with increases in N-terminal prohormone of brain natriuretic peptide, lower mean arterial pressure during albumin infusion, and higher serum sodium levels. Our results from this proof-of-concept study emphasize the need for larger prospective cohort studies to validate our findings and introduce strategies for individualizing volume management in patients with decompensated cirrhosis.
期刊介绍:
JHEP Reports is an open access journal that is affiliated with the European Association for the Study of the Liver (EASL). It serves as a companion journal to the highly respected Journal of Hepatology.
The primary objective of JHEP Reports is to publish original papers and reviews that contribute to the advancement of knowledge in the field of liver diseases. The journal covers a wide range of topics, including basic, translational, and clinical research. It also focuses on global issues in hepatology, with particular emphasis on areas such as clinical trials, novel diagnostics, precision medicine and therapeutics, cancer research, cellular and molecular studies, artificial intelligence, microbiome research, epidemiology, and cutting-edge technologies.
In summary, JHEP Reports is dedicated to promoting scientific discoveries and innovations in liver diseases through the publication of high-quality research papers and reviews covering various aspects of hepatology.