Hemodynamic Response to a Rapid Fluid Challenge in End-Stage Liver Disease

Abstract

Background: Patients with end-stage liver disease have a hyperdynamic circulatory state complicated by a high right ventricular end-diastolic volume index (RVEDVI) and a low ventricular performance. These changes often make if difficult to evaluate volume status and preload. In this study, we analyzed hemodynamic profiles after a rapid fluid challenge in the recipients of a liver transplant.Methods: Hemodynamic responses were evaluated before and after 200 ml of a 5% albumin challenge in forty patients, recipients of a liver transplant with a Swan-Ganz right-heart ejection fraction oximetry thermodilution cathether. Patients were divided into two groups, group A (responders, n = 12, ≥10% increase in stroke volume index (SVI) after fluid challenge) and group B (non-responders, n = 28, decrease or ＜ 10% increase in SVI after fluid challenge). We analyzed hemodynamic data obtained from the two groups before and after the fluid challenge.Results: Group B had a lower baseline right ventricular ejection fraction (REF) (49.9 ± 5.9% vs 42.8 ± 5.7%), a higher RVEDVI (120.8 ± 19.4 ml/m 2 vs 143.6 ± 26.3 ml/m 2 ), and a higher right ventricular end-systolic volume index (RVESVI) (60.8 ± 14.0 ml/m 2 vs 82.8 ± 20.5 ml/m 2 ) than group A. In group B, the cardic index (CI) and right ventricular stroke work index (RVSWI) were not increased after the fluid challenge. There was a mild decrease in the mean arterial pressure (MAP) in group B after the fluid challenge. There was a moderate negative correlation between the fluid-induced change in SVI and the baseline RVEDVI in all patients (r = -0.40, P ＜ 0.05).Conclusions: Our study suggests that there is no improvement of hemodynamic profiles after a rapid fluid challenge in many patients with end-stage liver disease, especially those with a high RVEDVI.