Prognostic value of free-water peritoneal clearance in decompensated cirrhosis: a 3 year prospective follow-up

Alessandro Milani, Antonella M. Ciammella, Marinella Mazzone, Adele Valle, Lodovico Rossi
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Abstract

Patients, 38, with decompensated cirrhosis were enrolled in a 3 year prospective follow-up to investigate the long-term prognostic value of free-water peritoneal clearance (FWPC) and intraabdominal pressure (IAP). All patients were ‘a priori’ divided into different subgroups, according to the basal values of FWPC (methylene-blue dilution method) and IAP (direct manometry). Arbitrarily chosen cut-off levels (90 ml/min for FWPC and 17 cm H2O for IAP) were adopted. The cumulative 3 year mortality was significantly lower in the subgroup of patients with FWPC above 90 ml/min than in those with FWPC below 90 ml/min (P < 0.05, Kaplan Meier method and log-rank test). No significant difference was found between the cumulated survivals of the subgroups discriminated by means of the IAP cut-off. Our results suggest that FWPC has an intrinsic prognostic value in patients with decompensated cirrhosis. Therefore, FWPC may be helpfully considered in a multivariate prognostic model for the estimate of the individual survivals in ascitic patients.

游离水腹膜清除率对失代偿肝硬化的预后价值:3年前瞻性随访
38例失代偿性肝硬化患者参与了一项为期3年的前瞻性随访,以研究游离水腹膜清除率(FWPC)和腹内压(IAP)的长期预后价值。根据亚甲蓝稀释法(FWPC)和直接测压法(IAP)的基础值,将所有患者“先验地”分为不同的亚组。采用任意选择的截止水平(FWPC为90 ml/min, IAP为17 cm H2O)。FWPC高于90 ml/min的亚组患者累积3年死亡率显著低于FWPC低于90 ml/min的亚组(P <0.05, Kaplan Meier方法和log-rank检验)。通过IAP截止值区分的亚群的累积存活率之间没有发现显著差异。我们的研究结果表明,FWPC对失代偿性肝硬化患者具有内在的预后价值。因此,在评估腹水患者个体生存的多变量预后模型中,FWPC可能被认为是有帮助的。
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