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Validity of Mini-Fluid Challenge for Predicting Fluid Responsiveness Following Liver Transplantation

صلاحية تحدي السوائل المصغرة للتنبؤ باستجابة السوائل بعد زراعة الكبد
Authors: Ahmed Mukhtar; Maha Awad; Mohamed Elayashy; A. Hussein; Gihan Obayah; Akram El Adawy; Mansoor Ahmed; +6 Authors

Validity of Mini-Fluid Challenge for Predicting Fluid Responsiveness Following Liver Transplantation

Abstract

Abstract Background Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. However, mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant. Methods Fifty patients receiving living donor liver transplant were included in the analysis. Mini-fluid challenge composed of 150 ml of albumin 5% administered over 1 min in three consecutive 50-ml fluid boluses. An additional 350 ml was then infused at a constant rate over 15 min (for a total of 500 ml). Stroke volume (SV) was measured as the product of the subaortic velocity time integral (VTI) and left ventricular outflow tract (LVOT) area. Fluid responsiveness was defined as an increase in SV by ≥15% after the infusion. Results Fifty patients were enrolled in the study. Fourteen patients were classified with Child A, 15 patients with Child B, and 21 patients with Child C cirrhosis. Thirty four patients were fluid responders and 16 patients were fluid non-responders. After 150 ml of albumin 5%, the SV increased significantly in our cohort. The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5–0.8, P = 0.005). In subgroup analysis, the SV increased significantly after mini fluid challenge in the Child A group (P = 0.017) but not Child B or C groups (P = 0.3 and 0.29, respectively). The AUROC for mini-fluid challenge in the Child A group was 0.86 (95% confidence interval [CI] 0.6–0.9, P = 0.0004), while mini-fluid challenge failed to discriminate between responders and non-responders in Child B and C groups. Conclusion A mini-fluid challenge of 150 ml albumin 5% can predict fluid responsiveness in liver transplant patients with fair sensitivity and specifiicty. Subgroup analyis revealed that minifluid challenge can predict fluid responsiveness in patients with Child A cirrhosis but not patients with Child B or C cirrhosis Trial Registration Number NCT03396159. (Prospective registered). Initial registration date was 10/01/2018

Keywords

Adult, Male, Ejection fraction, Liver Cirrhosis and Associated Complications, Fluid responsiveness, Serum Albumin, Human, Receiver operating characteristic, Heart failure, End Stage Liver Disease, Predictive Value of Tests, Anesthesiology, Health Sciences, Humans, RD78.3-87.3, Anesthesia, Prospective Studies, Internal medicine, Area under the curve, Transplantation, Intraoperative Fluid Management, Liver transplantation, Optimization of Perioperative Fluid Therapy, Hepatology, Fluid Responsiveness, Stroke Volume Variation, Albumin, Confidence interval, Hemodynamics, Gastroenterology, Middle Aged, Minifluid challenge, Liver Transplantation, Stroke volume, Cirrhosis, Nephrology, Fluid Therapy, Medicine, Female, Surgery, Metabolic Acidosis in Chronic Kidney Disease, Research Article

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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
8
Top 10%
Average
Top 10%
Green
gold