New classification with prognostic value in cirrhotic patients.
We evaluated a group of 21 cirrhotic patients with a standard 20 ml/kg water load. The patients segregated into three classes: class I (n = 6) had normal water load excretion, i.e. greater than 80% excretion over 5 h (mean 82.3 +/- 0.8%); class II (n = 8) had 20-80% excretion (mean 38.6 +/- 4.2%); and class III (n = 7) had less than 20% excretion (mean 12.9 +/- 1.2%). The patients in class III, who had profound impairment of water load excretion, were found to have a higher frequency of tense ascites, lower serum sodium concentrations, diuretic resistance, impairment of urinary sodium excretion, lower inulin and p-aminohippurate clearances, and elevations of plasma arginine vasopressin, aldosterone and norepinephrine concentrations. However, class III could only be distinguished from class II on the basis of excretion of a standard water load. No significant differences were found among the classes in liver function tests. We prospectively followed these patients. Classes I and II patients appear to have a good prognosis, if they avoid ethanol (4 of 5 patients still alive 42-56 months after evaluation). Class III patients have a poor prognosis independent of ethanol intake (all lived less than 5 months, except 1 patients who received a peritoneovenous shunt). Class I patients were found to tolerate continued ethanol consumption better than class II patients. Thus, an early intervention, such as the peritoneovenous shunt, may prolong survival among class III patients; however, this possibility needs to be evaluated in a larger prospective study.
Cosby
R L
RL
Department of Medicine, University of Colorado School of Medicine, Denver.
Yee
B
B
Schrier
R W
RW
D000328:Adult; D000450:Aldosterone / Q000097:blood; D001810:Blood Volume; D004231:Diuresis; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000145:classification / Q000401:mortality*; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D012083:Renin / Q000097:blood; D012964:Sodium / Q000097:blood / Q000652:urine; D014667:Vasopressins / Q000097:blood
D014667:Vasopressins; D000450:Aldosterone; D012964:Sodium; D012083:Renin; D009638:Norepinephrine