Point-of-care Ultrasonography in Patients with Hepatorenal Syndrome: A Single Center Observational Study
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
Citation Information :
Amara V, Kulkarni AV, Gupta A, Venishetty S, Sripathi SR, Reddy LS, Tirumala AK, Karandikar P, Alla M, Iyengar S, Sharma M, Rao PN, Reddy DN. Point-of-care Ultrasonography in Patients with Hepatorenal Syndrome: A Single Center Observational Study. Indian J Crit Care Med 2024; 28 (11):1015-1022.
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).
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