Cirrhotic Multiorgan Syndrome

Abstract

Patients with cirrhosis and portal hypertension are at an increased risk of the development of circulatory dysfunction that may potentially result in multiple organ failure. Apart from the liver, this may involve the heart, lungs, kidneys, the immune system, the adrenal glands, and other organ systems. As the disease progresses, the circulation becomes hyperdynamic, and signs of cardiac, pulmonary, and renal dysfunction are observed, in addition to reduced survival. Infections and an altered cardiac function known as cirrhotic cardiomyopathy may be precipitators for the development of other complications such as hepatorenal syndrome. In patients with chronic organ dysfunction, various precipitating events may induce an acute-on-chronic renal failure and acute-on-chronic liver failure that negatively affect the prognosis. Future research on the pathophysiologic mechanisms of the complications and the precipitating factors is essential to understand the basics of the treatment of these challenging conditions. The aim of the present review is to focus on the development and precipitating factors of various organ failures in patients with decompensated cirrhosis.

Cirrhotic cardiomyopathy: we already know. What comes next?

“…Common findings observed in the cardiac doppler echocardiography indicate myocardial relaxation impaired in cirrhotic patients: decrease of E/A ratio (<1), and prolonged E wave deceleration time (DT) and isovolumetric relaxation time (IVRT) > 80ms [27][28][29][30]. The more severe is the diastolic dysfunction, shorter is the IVRT and mitral DT, and higher is the E/A velocity ratio, characterizing advanced diastolic dysfunction, increased LA pressure, and worse functional class.…”

Molecular Mechanisms Leading to Splanchnic Vasodilation in Liver Cirrhosis

“…1). Portal hypertension plays a fundamental role in the development of ascites, hepatic encephalopathy, gastric and esophageal varices, and hepatorenal syndrome, which are among the most serious clinical complications in these patients [1,2,3]. Therefore, understanding the mechanisms responsible for splanchnic vasodilation is crucial for planning strategies to prevent and treat the complications that occur in cirrhosis.…”

Cirrhotic Cardiomyopathy: Another Case of a Successful Approach to Treatment of Hepatorenal Syndrome

“…Extensive hepatic fibrosis leads to an increase in portal pressure and to portosystemic shunt, associating with peripheral vasodilatation and hyperdynamic circulation. Some systemic repercussions may be consequent of these impairments, with multiple organ dysfunction, such as cirrhotic cardiomyopathy (CCM) and hepatorenal syndrome (HRS) [2, 4, 5]. …”

“…These clinical conditions might be related to each other and, since most of the patients remain asymptomatic for a long time – due to reduced vascular peripheral resistance and compensative increase in cardiac output – it may only present clinically in a stressing scenario [5, 9]. On the other hand, CCM is characterized by a decrease in ventricular response to stress even though the patient presents normal or increased basal cardiac output.…”