Ascites, bakteriel peritonitis, hepatorenalt syndrom og hyponatriæmi ved levercirrose: diagnostik og behandling

Interessekonflikter

Henning Grønbæk: Forskningsstøtte fra NOVO Nordis Foundation, Intercept, Abbvie, Ipsen; Investigator for Ipsen, Intecept; Foredragsholder for Sanofi, Ipsen; Advisory board: Ipsen, Novartis

Flemming Bendtsen: Medical Advisor for Ferring

Søren Møller: Forskningsstøtte fra NOVO Nordic Foundation; Foredragsholder for Ferring

Referencer

(1) Guevara M, Cardenas A, Ginés P. Prognosis of patients with cirrhosis and ascites. In: Ginés P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and renal dysfunction in liver disease.  ed. Malden: Blackwell; 2005. p. 260-270.

(2) Gines P, Cardenas A. The management of ascites and hyponatremia in cirrhosis. Semin Liver Dis 2008;28(1):43-58.

(3) Møller S, Henriksen JH. The systemic circulation in cirrhosis. In: Gines P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and renal dysfunction in liver disease. 2nd ed. Malden: Blackwell; 2005. p. 139-155.

(4) Ripoll C, Groszmann R, Garcia-Tsao G, Grace N, Burroughs A, Planas R et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 2007;133(2):481-488.

(5) Gines P, Guevara M. Hyponatremia in cirrhosis: pathogenesis, clinical significance, and management. Hepatology 2008;48(3):1002-1010.

(6) Møller S, Henriksen JH, Bendtsen F. Ascites: Pathogenesis and therapeutic principles. Scand J Gastroenterol 2009:902-911.

(7) Angeli P, Merkel C. Pathogenesis and management of hepatorenal syndrome in patients with cirrhosis. J Hepatol 2008;48(Suppl.1):S93-S103.

(8) Wong F, Bernardi M, Balk R, Christman B, Moreau R, Garcia-Tsao G et al. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut 2005;54(5):718-725.

(9) Khan J, Pikkarainen P, Karvonen AL, Makela T, Peraaho M, Pehkonen E et al. Ascites: Aetiology, mortality and the prevalence of spontaneous bacterial peritonitis. Scand J Gastroenterol 2009;1-5.

(10) Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F et al. The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club. Hepatology 2003;38(1):258-266.

(11) Schrier RW. Decreased effective blood volume in edematous disorders: what does this mean? J Am Soc Nephrol 2007;18(7):2028-2031.

(12) Bernardi M, Domenicali M. The renin-angiotensin-aldosterone system in cirrhosis. In: Ginés P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and renal dysfunction in liver disease. 2nd ed. Malden: Blackwell Pullishing Ltd; 2005. p. 43-54.

(13) Dudley FJ, Esler M. The sympathetic nervous system in cirrhosis. In: Ginés P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and renal dysfunction in liver disease. 2nd ed. Malden: Blackwell Publishing Ltd; 2005. p. 54-72.

(14) Henriksen JH, Møller S. Alterations of hepatic and splanchnic microvascular exchange in cirrhosis: Local factors in the formation of ascites. In: Gines P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and renal dysfunction in liver disease. 2nd ed. Malden: Blackwell; 2005. p. 174-185.

(15) Runyon BA. Management of adult patients with ascites due to cirrhosis: An update. Hepatology 2009;49(6):2087-2107.

(16) Gatta A, Angeli P, Caregaro L, Menon F, Sacerdoti D, Merkel C. A pathophysiological interpretation of unresponsiveness to spironolactone in a stepped-care approach to the diuretic treatment of ascites in nonazotemic cirrhotic patients. Hepatology 1991;14(2):231-236.

(17) Bernardi M, Laffi G, Salvagnini M, Azzena G, Bonato S, Marra F et al. Efficacy and safety of the stepped care medical treatment of ascites in liver cirrhosis: a randomized controlled clinical trial comparing two diets with different sodium content. Liver 1993;13(3):156-162.

(18) Angeli P, Gatta A, Caregaro L, Menon F, Sacerdoti D, Merkel C et al. Tubular site of renal sodium retention in ascitic liver cirrhosis evaluated by lithium clearance. Eur J Clin Invest 1990;20(1):111-117.

(19) Angeli P, De Bei E, Dalla PM, Caregaro L, Ceolotto G, Albino G et al. Effects of amiloride on renal lithium handling in nonazotemic ascitic cirrhotic patients with avid sodium retention. Hepatology 1992;15(4):651-654.

(20) Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut 2006;55 Suppl 6:vi1-vi12.

(21) Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C et al. Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology 2001;120(1):170-178.

(22) Angeli P, Albino G, Carraro P, Dalla PM, Merkel C, Caregaro L et al. Cirrhosis and muscle cramps: evidence of a causal relationship. Hepatology 1996;23(2):264-273.

(23) Fernandez-Esparrach G, Guevara M, Sort P, Pardo A, Jimenez W, Gines P et al. Diuretic requirements after therapeutic paracentesis in non-azotemic patients with cirrhosis. A randomized double-blind trial of spironolactone versus placebo. J Hepatol 1997;26(3):614-620.

(24) Sola R, Andreu M, Coll S, Vila MC, Oliver MI, Arroyo V. Spontaneous bacterial peritonitis in cirrhotic patients treated using paracentesis or diuretics: results of a randomized study. Hepatology 1995;21(2):340-344.

(25) Lin CH, Shih FY, Ma MH, Chiang WC, Yang CW, Ko PC. Should bleeding tendency deter abdominal paracentesis? Dig Liver Dis 2005;37(12):946-951.

(26) Webster ST, Brown KL, Lucey MR, Nostrant TT. Hemorrhagic complications of large volume abdominal paracentesis. Am J Gastroenterol 1996;91(2):366-368.

(27) Gines A, Fernandez-Esparrach G, Monescillo A, Vila C, Domenech E, Abecasis R et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002-1010.

(28) Pozzi M, Osculati G, Boari G, Serboli P, Colombo P, Lambrughi C et al. Time course of circulatory and humoral effects of rapid total paracentesis in cirrhotic patients with tense, refractory ascites. Gastroenterology 1994;106(3):709-719.

(29) Vila MC, Sola R, Molina L, Andreu M, Coll S, Gana J et al. Hemodynamic changes in patients developing effective hypovolemia after total paracentesis. J Hepatol 1998;28:639-645.

(30) Moreau R, Asselah T, Condat B, de Kerguenec C, Pessione F, Bernard B et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study. Gut 2002;50(1):90-94.

(31) Moreau R, Valla DC, Durand-Zaleski I, Bronowicki JP, Durand F, Chaput JC et al. Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail. Liver Int 2006;26(1):46-54.

(32) Cardenas A, Arroyo V. Refractory ascites. Dig Dis 2005;23(1):30-38.

(33) Guardiola J, Baliellas C, Xiol X, Fernandez EG, Gines P, Ventura P et al. External validation of a prognostic model for predicting survival of cirrhotic patients with refractory ascites. Am J Gastroenterol 2002;97(9):2374-2378.

(34) Moreau R, Delegue P, Pessione F, Hillaire S, Durand F, Lebrec D et al. Clinical characteristics and outcome of patients with cirrhosis and refractory ascites. Liver Int 2004;24(5):457-464.

(35) Serste T, Melot C, Francoz C, Durand F, Rautou PE, Valla D et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010;52:1017-1022.

(36) Serste T, Francoz C, Durand F, Rautou PE, Melot C, Valla D et al. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: A cross-over study. J Hepatol 2011;55:794-799.

(37) Bang UC, Benfield T, Hyldstrup L, Jensen JE, Bendtsen F. Effect of propranolol on survival in patients with decompensated cirrhosis: a nationwide study based Danish patient registers. Liver Int 2016;36(9):1304-1312.

(38) Reiberger T, Mandorfer M. Beta adrenergic blockade and decompensated cirrhosis. J Hepatol 2017;66(4):849-859.

(39) Sanyal AJ, Genning C, Reddy KR, Wong F, Kowdley KV, Benner K et al. The North American Study for the treatment of refractory ascites. Gastroenterology 2003;124(3):634-641.

(40) Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology 2004;40(3):629-635.

(41) Gines P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, del Arbol LR et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology 2002;123(6):1839-1847.

(42) Saab S, Nieto JM, Lewis SK, Runyon BA. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev 2006;(4):CD004889.

(43) Salerno F, Camma C, Enea M, Rossle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007;133(3):825-834.

(44) Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A et al. Transjugular Intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology 2017;152(1)(157):163.

(45) D'amico G, Luca A, Morabito A, Miraglia R, D'Amico M. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Gastroenterology 2005;129(4):1282-1293.

(46) Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology 2005;41(3):422-433.

(47) Guarner C, Soriano G. Bacterial translocation and its consequences in patients with cirrhosis. Eur J Gastroenterol Hepatol 2005;17(1):27-31.

(48) Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis 2001;33(1):41-48.

(49) Felisart J, Rimola A, Arroyo V, Perez-Ayuso RM, Quintero E, Gines P et al. Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections. Hepatology 1985;5(3):457-462.

(50) Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruizdelarbol L et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341(6):403-409.

(51) Andreu M, Sola R, Sitges-Serra A, Alia C, Gallen M, Vila MC et al. Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Gastroenterology 1993;104(4):1133-1138.

(52) Terg R, Fassio E, Guevara M, Cartier M, Longo C, Lucero R et al. Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: a randomized, placebo-controlled study. J Hepatol 2008;48(5):774-779.

(53) Gines P, Rimola A, Planas R, Vargas V, Marco F, Almela M et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology 1990;12(4 Pt 1):716-724.

(54) Arroyo V, Fernandez J. Management of hepatorenal syndrome in patients with cirrhosis. Nat Rev Nephrol 2011;7(9):517-526.

(55) Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11(2):R31.

(56) Cruz DN, Bagshaw SM, Maisel A, Lewington A, Thadhani R, Chakravarthi R et al. Use of biomarkers to assess prognosis and guide management of patients with acute kidney injury. Contrib Nephrol 2013;182:45-64. doi: 10.1159/000349965. Epub;%2013 May 13.:45-64.

(57) Fagundes C, Barreto R, Guevara M, Garcia E, Sola E, Rodriguez E et al. A Modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepatol 2013;(3):474-481.

(58) Piano S, Rosi S, Maresio G, Fasolato S, Cavallin M, Romano A et al. Evaluation of the acute kidney injury network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol 2013;(3):482-489.

(59) Wong F, Angeli P. New diagnostic criteria and management of acute kidney injury. J Hepatol 2017;66(4):860-861.

(60) Terra C, Guevara M, Torre A, Gilabert R, Fernandez J, Martin-Llahi M et al. Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis: Value of MELD score. Gastroenterology 2005;129(6):1944-1953.

(61) Angeli P, Tonon M, Pilutti C, Morando F, Piano S. Sepsis-induced acute kidney injury in patients with cirrhosis. Hepatol Int 2016;10(1):115-123.

(62) Thabut D, Massard J, Gangloff A, Carbonell N, Francoz C, Nguyen-Khac E et al. Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure. Hepatology 2007;46(6):1872-1882.

(63) Schmidt LE, Ring-Larsen H. Vasoconstrictor therapy for hepatorenal syndrome in liver cirrhosis. Curr Pharm Des 2006;12(35):4637-4647.

(64) Gluud LL, Christensen K, Christensen E, Krag A. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010;51(2):576-584.

(65) Gines P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009;361(13):1279-1290.

(66) Nazar A, Pereira GH, Guevara M, Martin-Llahi M, Pepin MN, Marinelli M et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2010;51(1):219-226.

(67) Salerno F, Monti V. HRS type 1 and bacterial infection. A catastrophic association in patients with cirrhosis. Hepatology 2014;():1239-1241.

(68) Barreto R, Fagundes C, Guevara M, Sola E, Pereira G, Rodriguez E et al. Type-1 hepatorenal syndrome associated with infections in cirrhosis. Natural history, outcome of kidney function and survival. Hepatology 2013;59(4):1505-1513.

(69) Guevara M, Baccaro ME, Torre A, Gomez-Anson B, Rios J, Torres F et al. Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: A prospective study with time-dependent analysis. Am J Gastroenterol 2009;104:1382-1389.

(70) Londono MC, Guevara M, Rimola A, Navasa M, Taura P, Mas A et al. Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation. Gastroenterology 2006 Apr 2006;1135-1143.

(71) Shchekochikhin D, Tkachenko O, Schrier RW. Hyponatremia: an update on current pharmacotherapy. Expert Opin Pharmacother 2013;14(6):747-755.

(72) Angeli P, Wong F, Watson H, Gines P. Hyponatremia in cirrhosis: Results of a patient population survey. Hepatology 2006;44(6):1535-1542.

Forkortelser

AKI: Acute kidney injury

HA: Human albumin

HRS: Hepatorenalt syndrome

PICD: Post-paracentese-induceret cirkulatorisk dysfunktion

SAAG: Serum-ascites-albumin gradient

SBP: Spontan bakteriel peritonitis

TIPS: Transjugulær-intrahepatisk portosystemisk shunt

Figur 1. Flow-chart til behandling af ukompliceret ascites