title: Relationships between haemodynamic alterations and the development of ascites or refractory ascites in patients with cirrhosis.
abstract: OBJECTIVE
  In patients with cirrhosis, the relationships between haemodynamic alterations and the development of ascites or the occurrence of refractory ascites are unknown. The aim of the present study was to compare haemodynamic measurements obtained in patients with non-refractory ascites to haemodynamic measurements obtained in patients without ascites and in patients with refractory ascites.
  
  
  METHODS
  A cohort of 121 patients was prospectively studied, of whom 29 patients did not have ascites, 45 had non-refractory ascites and 47 had refractory ascites. Splanchnic, renal and systemic haemodynamics were measured in all patients.
  
  
  RESULTS
  The hepatic venous pressure gradient was significantly higher in patients with non-refractory ascites than in patients without ascites (18.5 +/- 0.8 mmHg versus 15.8 +/- 0.7 mmHg). Renal and systemic haemodynamics did not significantly differ between patients with non-refractory ascites and patients without ascites. The glomerular filtration rate and renal blood flow were significantly lower in patients with refractory ascites than in patients with non-refractory ascites (77 +/- 4 versus 107 +/- 5 ml/min and 867 +/- 62 versus 1,008 +/- 68 ml/min, respectively). Splanchnic and systemic haemodynamics did not significantly differ between patients with refractory ascites and patients with non-refractory ascites.
  
  
  CONCLUSIONS
  In patients with cirrhosis, an increase in portal hypertension was the sole haemodynamic alteration related to the development of ascites. Renal vasoconstriction (and subsequent renal hypoperfusion and hypofiltration) was the only haemodynamic alteration related to the occurrence of refractory ascites. The development of ascites or refractory ascites was not associated with any alteration in systemic haemodynamics.
authors: Laboratoire d'Hémodynamique Splanchnique et de Biologie Vasculaire, INSERM U-481, Service d'Hépatologie, Clichy, France.
authors: I
authors: I
authors: Colle
authors: R
authors: R
authors: Moreau
authors: F
authors: F
authors: Pessione
authors: E
authors: E
authors: Rassiat
authors: J
authors: J
authors: Heller
authors: C
authors: C
authors: Chagneau
authors: D
authors: D
authors: Pateron
authors: E
authors: E
authors: Barrière
authors: B
authors: B
authors: Condat
authors: P
authors: P
authors: Sogni
authors: D
authors: D
authors: Valla
authors: D
authors: D
authors: Lebrec
mesh_terms: D000450:Aldosterone / Q000097:blood; D001201:Ascites / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000098:blood supply; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012083:Renin / Q000097:blood
chemical_list: D000450:Aldosterone; D012083:Renin