Relationships between Splenorenal Shunt/Portal Vein Diameter Ratio and Systemic Hemodynamics in Patients with Liver Cirrhosis

Objectives: The purpose of this study was to investigate the relationships between the splenorenal shunt (SRS)/portal vein (PV) diameter ratio (SRS/PV ratio) and systemic hemodynamics in patients with liver cirrhosis. Patients and Methods: Thirty-seven patients with SRS due to liver cirrhosis were included in this study. SRS was evaluated in the retropancreatic space on contrast-enhanced CT and the diameter was measured at the maximum point. Systemic hemodynamics was studied using a thermodilution catheter. Results: The SRS/PV ratio showed a significant correlation with the cardiac index (p < 0.01), and showed an inverse correlation with the systemic vascular resistance index and the arteriovenous oxygen content difference [C(a-v)O-2] (p < 0.01). The Child-Pugh score showed a correlation with the SRS/PV ratio (p < 0.01). The SRS/PV ratio was 0.89 +/- 0.52, 1.02 +/- 0.51, and 1.74 +/- 0.50 in the Child-Pugh A, B, and C classes, respectively. The SRS/PV ratio in the Child-Pugh C class was significantly higher than those in classes A and B (p < 0.01). The plasma ammonia level was 75.3 +/- 23.2 in the group with an SRS/PV ratio <1.0 (n = 19) versus 102.6 +/- 34.8 in the group with an SRS/PV ratio >= 1.0 (n = 18), and the ratio of encephalopathy was 5% (1/19) in the group with an SRS/PV ratio <1.0 (n = 19) versus 50% (9/18) in the group with an SRS/PV ratio >= 1.0 (n = 18), respectively. The differences between the two groups were statistically significant (p < 0.01). Conclusions: We conclude that the increase in the SRS/PV ratio is accompanied by deteriorated liver function, hyperdynamic status, and narrowed C(a-v)O-2. (C) 2014 S. Karger AG, Basel