Abstract:
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Background: bioelectrical impedance analysis is a technique
for the determination of the hydropic component. The
hydropic component, determined by blood volume, could
be a reflection of the hemodynamic situation. This study
aimed to evaluate the usefulness of peripheral bioelectrical
impedance analysis (BIA) for the prediction of hemodynamic
changes in large-volume paracentesis and prognosis.
Methods: this was a proof-of-concept prospective study of
14 patients with liver cirrhosis and refractory ascites. Peripheral
bioimpedance was measured three times using a
portable device, IVOL®, before and after large-volume paracentesis,
at different frequencies (5, 10, 20, 50, 100 and 200
kHz). Consequently, resistance, reactance and phase angle
were obtained, both pre- and post-paracentesis (the difference
between them was defined as ¿).
Results: the mean age of patients was 62.2 ± 9.6 years, the
Child-Pugh was 8.4 ± 1.3 and the MELD score was 15.2 ± 3.9.
A direct correlation between the extraction of ascitic fluid
and ¿resistance (10 kHz [r = 0.722; n = 12; p = 0.008], 20 kHz
[r = 0.658; n = 12; p = 0.020] and 50 kHz [r = 0.519; n = 14; p
= 0.057]) was observed. The presence of edema was related
to lower values of both pre-paracentesis resistance (10 Hz
[23.9 ± 8 vs 32.2 ± 4; p = 0.043]) and phase angle (5 kHz [-1.9
± 2.8 vs 5.9 ± 7.3; p = 0.032]). Pre-paracentesis phase angle
was directly correlated with the decline in blood pressure
after paracentesis at lower frequencies (5 kHz [r = 0.694; n
= 13; p = 0.008] and 10 kHz [r = 0.661; n = 13; p = 0.014]).
Lower frequencies of ¿phase-angle impacted on patient
prognosis (5 kHz [-8.6 ± 5 vs -2.5 ± 2.7; p = 0.021]), patients
with ¿phase-angle 5 kHz > -4 had a higher rate of mortality
(83.3% [5/6] vs 0% [0/6]; logRank 7.306, p = 0.007). ¿resistance
values were associated with overt HE at six months
(10 kHz [4.9 ± 2.5 vs -0.4 ± 4.7; p = 0.046]).
Conclusions: in conclusion, a significant correlation between
peripheral impedance and hemodynamic changes
was found. Impedance was also significantly related to
prognosis and overt hepatic encephalopathy. |