title: Can non-invasive measurements aid clinical assessment of volume in patients with cirrhosis?
abstract: OBJECTIVE
  To evaluate the non-invasive assessments of volume status in patients with cirrhosis.
  
  
  METHODS
  Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable and 25 acutely decompensated patients with cirrhosis.
  
  
  RESULTS
  Both groups had similar clinical assessments, cortisol response and total body water (TBW), however the ratio of extracellular water (ECW)/TBW was significantly greater in the trunk (0.420 ± 0.004 vs 0.404 ± 0.005), and limbs (R leg 0.41 ± 0.003 vs 0.398 ± 0.003, P < 0.05, and L leg 0.412 ± 0.003 vs 0.399 ± 0.003) with decompensated cirrhosis compared to stable cirrhotics, P < 0.05). Echocardiogram derived right atrial and ventricular filling and end diastolic pressures and presence of increased left ventricular end diastolic volume and diastolic dysfunction were similar in both groups. The decompensated group had lower systemic blood pressure, mean systolic 101.8 ± 4.3 vs 122.4 ± 5.3 and diastolic 58.4 ± 4.1 mmHg vs 68.8 ± 3.1 mmHg respectively, P < 0.01, and serum albumin 30 (27-33) vs 32 (31-40.5) g/L, P < 0.01.
  
  
  CONCLUSIONS
  Decompensated cirrhotics had greater leg and truncal ECW expansion with lower serum albumin levels consistent with intravascular volume depletion and increased vascular permeability.
authors.affiliation: Andrew Davenport, UCL Center for Nephrology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.forename: Banwari
authors.initials: B
authors.lastname: Argawal
authors.forename: Gavin
authors.initials: G
authors.lastname: Wright
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mantzoukis
authors.forename: Rumyana
authors.initials: R
authors.lastname: Dimitrova
authors.forename: Joseph
authors.initials: J
authors.lastname: Davar
authors.forename: Panayota
authors.initials: P
authors.lastname: Vasianopoulou
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
keywords: Ascites; Bioimpedance; Cirrhosis; Cortisol; Echocardiography; Extracellular water
references.citation: Heart. 2002 Jan;87(1):9-15
references.pmid: 11751653
references.citation: Hepatology. 1994 Nov;20(5):1356-8
references.pmid: 7927272
references.citation: Clin J Am Soc Nephrol. 2009 Jul;4(7):1207-12
references.pmid: 19556380
references.citation: Am J Gastroenterol. 2009 Oct;104(10):2458-66
references.pmid: 19532126
references.citation: Liver Int. 2011 Apr;31(4):534-40
references.pmid: 21382164
references.citation: Nephron Extra. 2012 Jan;2(1):48-54
references.pmid: 22619667
references.citation: Crit Care. 2012 Feb 09;16(1):R23
references.pmid: 22322077
references.citation: Int J Artif Organs. 2009 Nov;32(11):779-86
references.pmid: 20020409
references.citation: Clin J Am Soc Nephrol. 2010 Jun;5(6):1036-40
references.pmid: 20507952
references.citation: Gut. 2011 May;60(5):702-9
references.pmid: 21325171
references.citation: Am J Kidney Dis. 2011 Jan;57(1):123-9
references.pmid: 20692749
references.citation: Arch Surg. 1992 Jul;127(7):817-21; discussion 821-2
references.pmid: 1524482
references.citation: Eur J Clin Nutr. 2013 Feb;67(2):223-5
references.pmid: 23249878
references.citation: Int J Artif Organs. 2013 Mar;36(3):203-7
references.pmid: 23404642
references.citation: Crit Care Med. 2008 Jun;36(6):1937-49
references.pmid: 18496365
references.citation: J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67
references.pmid: 2698218
references.citation: Nephrol Dial Transplant. 2012 Jan;27(1):34-41
references.pmid: 22287700
references.citation: Nephron Clin Pract. 2012;122(1-2):33-7
references.pmid: 23548328
references.citation: Ann Pharmacother. 1994 May;28(5):565-9
references.pmid: 8068989
references.citation: Eur J Appl Physiol. 2002 Apr;86(6):509-16
references.pmid: 11944099
references.citation: Anesthesiol Res Pract. 2011;2011:231493
references.pmid: 21785588
references.citation: Chest. 2008 Jul;134(1):172-8
references.pmid: 18628220
references.citation: Am J Nephrol. 2012;36(4):371-6
references.pmid: 23051933
references.citation: Zhonghua Gan Zang Bing Za Zhi. 2010 Oct;18(10):758-62
references.pmid: 21059293
references.citation: Circulation. 1981 Nov;64(5):1018-25
references.pmid: 7285290
references.citation: Am J Nephrol. 2011;33(2):150-6
references.pmid: 21293116
references.citation: J Cardiothorac Vasc Anesth. 2007 Oct;21(5):650-4
references.pmid: 17905268