[Prognostic value of hepatic clearance of indocyanine green in patients with liver cirrhosis and hemorrhage of esophageal varices].
BACKGROUND
The prognostic value of the quantitative tests of hepatocellular function are not clearly established. Although these tests have significantly correlated with the Child-Pugh classification, it has not been demonstrated that they are better than the same in regards to prognosis.


METHODS
The present study was aimed at investigating the prognostic values of hepatic clearance and the intrinsic clearance of indocyanine green (ICG) in 91 cirrhotic patients who had presented hemorrhage due to rupture of the esophageal varices. The clinical and biochemical data, portal pressure determined during suprahepatic vein catheterization, and the clearance, intrinsic clearance, extraction and hepatic blood flow measured during continual infusion of ICG were included in the analysis. All these data were obtained following the stabilization of the patients once over the hemorrhagic episode.


RESULTS
The mean survival of the series was 48 months. During follow up (25 +/- 17, interval 1-58 months) 3 of the 32 patients died (9%) of group A of the Child-Pugh classification, 17 of the 52 patients of group B (33%) and 6 of the 7 patients of group C (85%). The Child-Pugh classification was the only variable with an independent predictive value in the multivariate analysis in the Cox model. On exclusion of the 7 patients pertaining to group C, whose survival was clearly inferior to that of the rest of the series, the variables with independent predictive value were, hepatic clearance of less than 240 ml/min and the presence of ascites, while the Child-Pugh classification had no independent predictive value on survival.


CONCLUSIONS
The results of the present study indicate that hepatic clearance of ICG and the presence of ascites may have prognostic value in patients of Child-Pugh classification A and B who have recovered from a hemorrhagic episode due to rupture of esophageal varices.
Navasa
M
M
Unidad de Hepatología, Hospital Clínic i Provincial, Universidad de Barcelona.
García-Pagán
J C
JC
Bosch
J
J
Rodés
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007208:Indocyanine Green; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis
D007208:Indocyanine Green
Valor pronóstico del aclaramiento hepático del verde de indocianina en pacientes con cirrosis hepática y hemorragia por varices esofágicas.