The usefulness in cirrhotic patients of hemodynamic measurements by Doppler ultrasonography (US) is still not defined. We investigated the relationships between Doppler measurements and the severity of ascites. Portal blood flow velocity and volume, and hepatic and renal arterial resistance indexes (RI) were measured in 57 cirrhotic patients (19 without ascites, 28 with responsive ascites, and 10 with refractory ascites) and 15 healthy controls. The renal arterial RI were obtained for the main renal artery, interlobar vessels, and cortical vessels. Cirrhotic patients had decreased portal blood flow and an increased congestion index (CI). Only the CI was correlated to the severity of ascites, showing that it is also a reliable measure of the severity of portal hypertension in patients with ascites. The hepatic and renal artery RI were increased in cirrhotic patients, and the two values were correlated (r ‫؍‬ .68; P ‫؍‬ .00001). The RI of renal interlobar and cortical vessels were higher in patients with refractory ascites than in patients without ascites (P F .02 and P F .009), and correlated with sodium excretion rate (r ‫؍‬ Ϫ.45; P F .003), the reninaldosterone system, and creatinine clearance (r ‫؍‬ Ϫ.62; P F .0002). The RI decreased from the hilum of the kidney to the outer parenchyma in healthy subjects and patients with responsive ascites, but this difference disappeared in patients with refractory ascites. This indicates that the degree of renal vasoconstriction varies in different areas according to the severity of the ascites. Cortical vessels are involved mainly in patients with refractory ascites, suggesting that the intrarenal blood flow distribution in cirrhosis tends to preserve the cortical area and that severe cortical ischemia is a feature of refractory ascites. (HEPATOLOGY 1998; 28:1235-1240.) Doppler ultrasonography (US) is a noninvasive tool for the assessment of vascular patency. It has been used to measure the hepatic arterial and venous flows of patients with portal hypertension [1][2][3][4] and to document the increases in renal resistances that occur in some cirrhotic patients. [5][6][7][8] That some of these measures have prognostic value has been demonstrated. 4,7-9 Although a diagnostic gray-scale US is widely employed in the evaluation of cirrhotic patients, Doppler is rarely used. One pending problem is to establish which Doppler measurements correlate best with the different complications of portal hypertension. This could also help to determine whether or not the Doppler is useful in monitoring the effects of pharmacological therapies.The aim of the present study was to correlate the Doppler measurements of portal blood flow and of hepatic and renal arterial resistances with the presence and severity of ascites and renal failure in cirrhotic patients. PATIENTS AND METHODSFifty-seven cirrhotic patients, 35 men and 22 women, admitted consecutively to our hospital were enrolled in the present study. Their mean age was 57 Ϯ 9 years (range, 37-73 years), and their mean body weight was 6...

Fifty-four cirrhotic patients with refractory ascites were treated with one-session large-volume paracentesis and randomly assigned to two groups. The first group was infused with human albumin, and the second group was infused with hemaccel at doses with comparable oncotic power. The two groups were compared for incidence of complications, recurrence of massive ascites after hospital dismissal and survival rate. The incidence of complications traditionally related to paracentesis, the probability of requiring readmission to the hospital for ascites (p = 0.48) and the probability of survival after entry into the study (p = 0.85) were the same for the two groups. A multivariate analysis of 16 parameters, including treatment modality, identified absolute unresponsiveness to diuretics as the only independent predictor of mortality. These results indicate that hemaccel infusion may safely replace albumin infusion after total paracentesis for cirrhotic patients with refractory ascites.

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