Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 11/2015

01-11-2015 | Review

Cirrhotic Multiorgan Syndrome

Authors: Søren Møller, Flemming Bendtsen

Published in: Digestive Diseases and Sciences | Issue 11/2015

Login to get access

Abstract

Patients with cirrhosis and portal hypertension are at an increased risk of the development of circulatory dysfunction that may potentially result in multiple organ failure. Apart from the liver, this may involve the heart, lungs, kidneys, the immune system, the adrenal glands, and other organ systems. As the disease progresses, the circulation becomes hyperdynamic, and signs of cardiac, pulmonary, and renal dysfunction are observed, in addition to reduced survival. Infections and an altered cardiac function known as cirrhotic cardiomyopathy may be precipitators for the development of other complications such as hepatorenal syndrome. In patients with chronic organ dysfunction, various precipitating events may induce an acute-on-chronic renal failure and acute-on-chronic liver failure that negatively affect the prognosis. Future research on the pathophysiologic mechanisms of the complications and the precipitating factors is essential to understand the basics of the treatment of these challenging conditions. The aim of the present review is to focus on the development and precipitating factors of various organ failures in patients with decompensated cirrhosis.
Literature
1.
D’amico G, Pasta L, Morabito A, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther. 2014;39:1180–1193.PubMedCrossRef
2.
Zipprich A, Garcia-Tsao G, Rogowski S, Fleig WE, Seufferlein T, Dollinger MM. Prognostic indicators of survival in patients with compensated and decompensated cirrhosis. Liver Int. 2012;32:1407–1414.PubMedCentralPubMedCrossRef
3.
Bajaj JS, O’Leary JG, Reddy KR, et al. Survival in infection-related acute-on-chronic liver failure is defined by extra-hepatic organ failures. Hepatology. 2014;60:250–256.PubMedCentralPubMedCrossRef
4.
5.
Buck M, Garcia-Tsao G, Groszmann RJ, et al. Novel inflammatory biomarkers of portal pressure in compensated cirrhosis patients. Hepatology. 2014;59:1052–1059.PubMedCrossRef
6.
Rockey DC. The cell and molecular biology of hepatic fibrogenesis. Clinical and therapeutic implications. Clin Liver Dis. 2000;4:319–355.PubMedCrossRef
7.
Matuchansky C. Bacterial translocation in liver cirrhosis: site and role in fibrogenesis. J Hepatol. 2014;3:709–710.CrossRef
8.
Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008;28:26–42.PubMedCrossRef
9.
Gines P, Fernandez J, Durand F, Saliba F. Management of critically-ill cirrhotic patients. J Hepatol. 2012;56:S13–S24.PubMedCrossRef
10.
Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144:1426–1437.PubMedCrossRef
11.
Moreau R, Arroyo V. Acute on chronic liver failure: a new clinical entity. Clin Gastroenterol Hepatol 2015;13:836–841.PubMedCrossRef
12.
Marra F, Parola M. Cells in the liver—functions in health and disease. In: Gines P, Kamath PS, Arroyo V, eds. Chronic liver failure. Mechanisms and management. New York: Springer; 2011:3–32.CrossRef
13.
Matsumura H, Shimizu Y, Ohsawa Y, Kawahara A, Uchiyama Y, Nagata S. Necrotic death pathway in Fas receptor signaling. J Cell Biol. 2000;151:1247–1256.PubMedCentralPubMedCrossRef
14.
15.
Henriksen JH. Degradation of bioactive substances: physiology and pathophysiology. Boca Raton: CRC Press; 1991.
16.
Gerbes AL, Witthaut R, Gulberg V, Thibault G, Bilzer M, Jungst D. Role of the liver in splanchnic extraction of atrial natriuretic factor in the rat. Hepatology. 1992;16:790–793.PubMedCrossRef
17.
18.
19.
Rockey DC. Hepatic fibrosis, stellate cells, and portal hypertension. Clin Liver Dis. 2006;10:459–479.PubMedCrossRef
20.
Bosch J, Garcia-Pagan JC. Complications of cirrhosis. I. Portal hypertension. J Hepatol. 2000;32:141–156.PubMedCrossRef
21.
Albillos A, Banares R, Gonzalez M, et al. The extent of the collateral circulation influences the postprandial increase in portal pressure in cirrhotic patient. Gut. 2006;56:259–264.PubMedCentralPubMedCrossRef
22.
Berzigotti A, De Gottardi A, Vukotic R, et al. Effect of meal ingestion on liver stiffness in patients with cirrhosis and portal hypertension. PLoS ONE. 2013;8:e58742.PubMedCentralPubMedCrossRef
23.
Bendtsen F, Krag A, Møller S. Treatment of acute variceal bleeding. Dig Liver Dis. 2008;40:328–336.PubMedCrossRef
24.
Bendtsen F, Simonsen L, Henriksen JH. Effect on hemodynamics of a liquid meal alone and in combination with propranolol in cirrhosis. Gastroenterology. 1992;102:1017–1023.PubMed
25.
Møller S, Henriksen JH. The systemic circulation in cirrhosis. In: Gines P, Arroyo V, Rodes J, Schrier RW, eds. Ascites and renal dysfunction in liver disease. Malden: Blackwell; 2005:139–155.
26.
Møller S, Bendtsen F, Henriksen JH. Vasoactive substances in the circulatory dysfunction of cirrhosis. Scand J Clin Lab Invest. 2001;61:421–429.PubMedCrossRef
27.
Møller S, Hobolth L, Winkler C, Bendtsen F, Christensen E. Determinants of the hyperdynamic circulation and central hypovolaemia in cirrhosis. Gut. 2011;60:1254–1259.PubMedCrossRef
28.
Shawcross DL, Austin MJ, Abeles RD, et al. The impact of organ dysfunction in cirrhosis: survival at a cost? J Hepatol. 2012;56:1054–1062.PubMedCrossRef
29.
Angeli P, Sanyal A, Møller S, et al. Current limits and future challenges in the management of renal dysfunction in patients with cirrhosis: report from the International Club of Ascites. Liver Int. 2013;33:16–23.PubMedCrossRef
30.
Arroyo V, Colmenero J. Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis of therapy and current management. J Hepatol. 2003;38:S69–S89.PubMedCrossRef
31.
32.
Langer DA, Shah VH. Nitric oxide and portal hypertension: interface of vasoreactivity and angiogenesis. J Hepatol. 2006;44:209–216.PubMedCrossRef
33.
Iwakiri Y, Shah V, Rockey DC. Vascular pathobiology in chronic liver disease and cirrhosis—current status and future directions. J Hepatol. 2014;61:912–924.PubMedCentralPubMedCrossRef
34.
Wiest R, Groszmann RJ. The paradox of nitric oxide in cirrhosis and portal hypertension: too much, not enough. Hepatology. 2002;35:478–491.PubMedCrossRef
35.
Møller S, Bendtsen F, Schifter S, Henriksen JH. Relation of calcitonin gene-related peptide to systemic vasodilatation and central hypovolaemia in cirrhosis. Scand J Gastroenterol. 1996;31:928–933.PubMedCrossRef
36.
Hori N, Okanoue T, Sawa Y, Kashima K. Role of calcitonin gene-related peptide in the vascular system on the development of the hyperdynamic circulation in conscious cirrhotic rats. J Hepatol. 1997;26:1111–1119.PubMedCrossRef
37.
Guevara M, Gines P, Jimenez W, et al. Increased adrenomedullin levels in cirrhosis: relationship with hemodynamic abnormalities and vasoconstrictor systems. Gastroenterology. 1998;114:336–343.PubMedCrossRef
38.
Batkai S, Jarai Z, Wagner JA, et al. Endocannabinoids acting at vascular CB1 receptors mediate the vasodilated state in advanced liver cirrhosis. Nat Med. 2001;7:827–832.PubMedCrossRef
39.
Moezi L, Gaskari SA, Lee SS. Endocannabinoids and liver disease. v. Endocannabinoids as mediators of vascular and cardiac abnormalities in cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2008;295:G649–G653.PubMedCrossRef
40.
Ros J, Claria J, To-Figueras J, et al. Endogenous cannabinoids: a new system involved in the homeostasis of arterial pressure in experimental cirrhosis in the rat. Gastroenterology. 2002;122:85–93.PubMedCrossRef
41.
Fernandez M, Mejias M, Angermayr B, Garcia-Pagan JC, Rodes J, Bosch J. Inhibition of VEGF receptor-2 decreases the development of hyperdynamic splanchnic circulation and portal-systemic collateral vessels in portal hypertensive rats. J Hepatol. 2005;43:98–103.PubMedCrossRef
42.
43.
Baldassarre M, Giannone FA, Napoli L, et al. The endocannabinoid system in advanced liver cirrhosis: pathophysiological implication and future perspectives. Liver Int. 2013;33:1298–1308.PubMedCrossRef
44.
Wiese S, Mortensen C, Gotze JP, et al. Cardiac and proinflammatory markers predict prognosis in cirrhosis. Liver Int. 2014;34:e19–e30.PubMedCrossRef
45.
46.
47.
Møller S, Iversen JS, Krag A, Bie P, Kjaer A, Bendtsen F. Reduced baroreflex sensitivity and pulmonary dysfunction in alcoholic cirrhosis: effect of hyperoxia. Am J Physiol Gastrointest Liver Physiol. 2010;299:G784–G790.PubMedCrossRef
48.
Bolognesi M, Di Pascoli M, Verardo A, Gatta A. Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis. World J Gastroenterol. 2014;20:2555–2563.PubMedCentralPubMedCrossRef
49.
Tage-Jensen U, Henriksen JH, Christensen E, Widding A, Ring-Larsen H, Christensen NJ. Plasma catecholamine level and portal venous pressure as guides to prognosis in patients with cirrhosis. J Hepatol. 1988;6:350–358.PubMedCrossRef
50.
Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology. 2006;43:S121–S131.PubMedCrossRef
51.
Kiszka-Kanowitz M, Henriksen JH, Møller S, Bendtsen F. Blood volume distribution in patients with cirrhosis: aspects of the dual-head gamma-camera technique. J Hepatol. 2001;35:605–612.PubMedCrossRef
52.
Henriksen JH, Bendtsen F, Gerbes AL, Christensen NJ, Ring-Larsen H, Sørensen TIA. Estimated central blood volume in cirrhosis—relationship to sympathetic nervous activity, beta-adrenergic blockade and atrial natriuretic factor. Hepatology. 1992;16:1163–1170.PubMedCrossRef
53.
Brinch K, Møller S, Bendtsen F, Becker U, Henriksen JH. Plasma volume expansion by albumin in cirrhosis. Relation to blood volume distribution, arterial compliance and severity of disease. J Hepatol. 2003;39:24–31.PubMedCrossRef
54.
Schrier RW. Water and sodium retention in edematous disorders: role of vasopressin and aldosterone. Am J Med. 2006;119:S47–S53.PubMedCrossRef
55.
Møller S, Henriksen JH, Bendtsen F. Central- and non-central blood volumes in cirrhosis. Relation to anthropometrics and gender. Am J Physiol Gastrointest Liver Physiol. 2003;284:G970–G979.PubMedCrossRef
56.
Ruiz-Del-Arbol L, Monescillo A, Arocena C, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology. 2005;42:439–447.PubMedCrossRef
57.
Krag A, Bendtsen F, Henriksen JH, Møller S. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut. 2010;59:105–110.PubMedCrossRef
58.
Braillon A, Cales P, Valla D, Gaudy D, Geoffroy P, Lebrec D. Influence of the degree of liver failure on systemic and splanchnic haemodynamics and on response to propranolol in patients with cirrhosis. Gut. 1986;27:1204–1209.PubMedCentralPubMedCrossRef
59.
Bendtsen F, Henriksen JH, Sørensen TIA. Long-term effects of oral propranolol on splanchnic and systemic haemodynamics in patients with cirrhosis and oesophageal varices. Scand J Gastroenterol. 1991;26:933–939.PubMedCrossRef
60.
Krag A, Møller S, Burroughs AK, Bendtsen F. Betablockers induce cardiac chronotropic incompetence. J Hepatol. 2012;56:298–299.PubMedCrossRef
61.
Ge PS, Runyon BA. The changing role of beta-blocker therapy in patients with cirrhosis. J Hepatol. 2013;60:643–653.PubMedCrossRef
62.
Tripathi D, Hayes P. Beta blockers in portal hypertension: new developments and controversies. Liver Int. 2013;34:655–667.PubMedCrossRef
63.
Llach J, Ginés P, Arroyo V, et al. Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites. Gastroenterology. 1988;94:482–487.PubMed
64.
Vilar GE, Torres GA, Calzadilla BL, Yasells GA, Sanchez RY, Perez YM. Arterial blood pressure is closely related to ascites development in compensated HCV-related cirrhosis. PLoS ONE. 2014;9:e95736.CrossRef
65.
Fasolato S, Angeli P, Dallagnese L, et al. Renal failure and bacterial infections in patients with cirrhosis: Epidemiology and clinical features. Hepatology. 2007;45:223–229.PubMedCrossRef
66.
Bajaj JS, O’Leary JG, Wong F, Reddy KR, Kamath PS. Bacterial infections in end-stage liver disease: current challenges and future directions. Gut. 2012;61:1219–1225.PubMedCentralPubMedCrossRef
67.
Fernandez J, Gustot T. Management of bacterial infections in cirrhosis. J Hepatol. 2012;56:S1–12.PubMedCrossRef
68.
Reiberger T, Ferlitsch A, Payer BA, et al. Non-selective betablocker therapy decreases intestinal permeability and serum levels of LBP and IL-6 in patients with cirrhosis. J Hepatol. 2013;58:911–921.PubMedCrossRef
69.
Wiest R, Lawson M, Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014;60:197–209.PubMedCrossRef
70.
Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut. 2012;61:297–310.PubMedCrossRef
71.
72.
Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R. Severe sepsis in cirrhosis. Hepatology. 2009;50:2022–2033.PubMedCrossRef
73.
Mehta G, Gustot T, Mookerjee RP, et al. Inflammation and portal hypertension - The undiscovered country. J Hepatol. 2014;61:155–163.PubMedCrossRef
74.
Leithead JA, Ferguson JW, Bates CM, et al. The systemic inflammatory response syndrome is predictive of renal dysfunction in patients with non-paracetamol-induced acute liver failure. Gut. 2009;58:443–449.PubMedCrossRef
75.
Follo A, Llovet JM, Navasa M, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology. 1994;20:1495–1501.PubMedCrossRef
76.
Fagundes C, Gines P. Hepatorenal syndrome: a severe, but treatable, cause of kidney failure in cirrhosis. Am J Kidney Dis. 2012;59:874–885.PubMedCrossRef
77.
Mehta G, Mookerjee RP, Sharma V, Jalan R. Systemic inflammation is associated with increased intrahepatic resistance and mortality in alcohol-related acute-on-chronic liver failure. Liver Int. 2015;35:724–734.PubMedCrossRef
78.
Møller S, Hove JD, Dixen U, Bendtsen F. New insights into cirrhotic cardiomyopathy. Int J Cardiol. 2013;167:1101–1108.PubMedCrossRef
79.
Zambruni A, Trevisani F, Caraceni P, Bernardi M. Cardiac electrophysiological abnormalities in patients with cirrhosis. J Hepatol. 2006;2006:994–1002.CrossRef
80.
81.
Rabie RN, Cazzaniga M, Salerno F, Wong F. The use of E/A ratio as a predictor of outcome in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt. Am J Gastroenterol. 2009;104:2458–2466.PubMedCrossRef
82.
Saner FH, Neumann T, Canbay A, et al. High brain-natriuretic peptide level predicts cirrhotic cardiomyopathy in liver transplant patients. Transpl Int. 2011;24:425–432.PubMedCrossRef
83.
84.
Krag A, Bendtsen F, Mortensen C, Henriksen JH, Møller S. Effects of a single terlipressin administration on cardiac function and perfusion in cirrhosis. Eur J Gastroenterol Hepatol. 2010;22:1085–1092.PubMedCrossRef
85.
Kazankov K, Holland-Fischer P, Andersen NH, et al. Resting myocardial dysfunction in cirrhosis quantified by tissue Doppler imaging. Liver Int. 2011;31:534–540.PubMedCrossRef
86.
Sampaio F, Pimenta J, Bettencourt N, et al. Systolic and diastolic dysfunction in cirrhosis: a tissue-Doppler and speckle tracking echocardiography study. Liver Int. 2013;33:1158–1165.PubMedCrossRef
87.
Pozzi M, Redaelli E, Ratti L, et al. Time-course of diastolic dysfunction in different stages of chronic HCV related liver diseases. Minerva Gastroenterol Dietol. 2005;51:179–186.PubMed
88.
Gaskari SA, Honar H, Lee SS. Therapy insight: cirrhotic cardiomyopathy. Nat Clin Pract Gastroenterol Hepatol. 2006;3:329–337.PubMedCrossRef
89.
Møller S, Henriksen JH. Cardiovascular dysfunction in cirrhosis. Pathophysiological evidence of a cirrhotic cardiomyopathy. Scand J Gastroenterol. 2001;36:785–794.PubMedCrossRef
90.
Torregrosa M, Aguade S, Dos L, et al. Cardiac alterations in cirrhosis: reversibility after liver transplantation. J Hepatol. 2005;42:68–74.PubMedCrossRef
91.
Henriksen JH, Bendtsen F, Hansen EF, Møller S. Acute non-selective beta-adrenergic blockade reduces prolonged frequency-adjusted Q-T interval (QTc) in patients with cirrhosis. J Hepatol. 2004;40:239–246.PubMedCrossRef
92.
Henriksen JH, Gøetze JP, Fuglsang S, Christensen E, Bendtsen F, Møller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut. 2003;52:1511–1517.PubMedCentralPubMedCrossRef
93.
Genovesi S, Prata Pizzala DM, Pozzi M, et al. QT interval prolongation and decreased heart rate variability in cirrhotic patients: relevance of hepatic venous pressure gradient and serum calcium. Clin Sci (Lond). 2009;116:851–859.CrossRef
94.
Bernardi M, Maggioli C, Dibra V, Zaccherini G. QT interval prolongation in liver cirrhosis: innocent bystander or serious threat? Expert Rev Gastroenterol Hepatol. 2012;6:57–66.PubMedCrossRef
95.
Cavasi A, Cavasi E, Grigorescu M, Sitar-Taut A. Relationship between NT-proBNP and cardio-renal dysfunction in patients with advanced liver cirrhosis. J Gastrointestin Liver Dis. 2014;23:51–56.PubMed
96.
Mohamed R, Forsey PR, Davies MK, Neuberger JM. Effect of liver transplantation on QT interval prolongation and autonomic dysfunction in end-stage liver disease. Hepatology. 1996;23:1128–1134.PubMedCrossRef
97.
98.
Pellicori P, Torromeo C, Calicchia A, et al. Does cirrhotic cardiomyopathy exist? 50 years of uncertainty. Clin Res Cardiol. 2013;102:859–864.PubMedCrossRef
99.
Dumcke CW, Møller S. Autonomic dysfunction in cirrhosis and portal hypertension. Scand J Clin Lab Invest. 2008;68:437–447.PubMedCrossRef
100.
Dahl EK, Møller S, Kjaer A, Petersen CL, Bendtsen F, Krag A. Diastolic and autonomic dysfunction in early cirrhosis: a dobutamine stress study. Scand J Gastroenterol. 2014;49:362–372.PubMedCrossRef
101.
Ates F, Topal E, Kosar F, et al. The relationship of heart rate variability with severity and prognosis of cirrhosis. Dig Dis Sci. 2006;51:1614–1618.PubMedCrossRef
102.
Wiese S, Hove JD, Bendtsen F, Møller S. Cirrhotic cardiomyopathy: pathogenesis and clinical relevance. Nat Rev Gastroenterol Hepatol. 2014;11:177–186.PubMedCrossRef
103.
Møller S, Iversen JS, Henriksen JH, Bendtsen F. Reduced baroreflex sensitivity in alcoholic cirrhosis:relations to hemodynamics and humoral systems. Am J Physiol Heart Circ Physiol. 2007;292:H2966–H2972.PubMedCrossRef
104.
Song JG, Kim YK, Shin WJ, Hwang GS. Changes in cardiovagal baroreflex sensitivity are related to increased ventricular mass in patients with liver cirrhosis. Circ J. 2012;76:2807–2813.PubMedCrossRef
105.
Møller S, Mortensen C, Bendtsen F, Jensen LT, Gotze JP, Madsen JL. Cardiac sympathetic imaging with mIBG in cirrhosis and portal hypertension: Relation to autonomic and cardiac function. Am J Physiol Gastrointest Liver Physiol. 2012;303:G1228–G1235.PubMedCrossRef
106.
Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis. A position statement based on the EASL special conference 2013. J Hepatol. 2014;60:1310–1324.PubMedCrossRef
107.
Grace JA, Angus PW. Hepatopulmonary syndrome: update on recent advances in pathophysiology, investigation and treatment. J Gastroenterol Hepatol. 2013;28:313–319.CrossRef
108.
109.
110.
Scarlata S, Conte ME, Cesari M, et al. Gas exchanges and pulmonary vascular abnormalities at different stages of chronic liver disease. Liver Int. 2011;31:525–533.PubMedCrossRef
111.
112.
Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB. Pulmonary-hepatic vascular disorders (PHD). Eur Respir J. 2004;24:861–880.PubMedCrossRef
113.
Deibert P, Allgaier HP, Stefanie L, et al. Hepatopulmonary syndrome in patients with chronic liver disease: role of pulse oximetry. BMC Gastroenterol. 2006;6:15.PubMedCentralPubMedCrossRef
114.
Møller S, Krag A, Madsen JL, Henriksen JH, Bendtsen F. Pulmonary dysfunction and hepatopulmonary syndrome in cirrhosis and portal hypertension. Liver Int. 2009;29:1528–1537.PubMedCrossRef
115.
116.
Horvatits T, Fuhrmann V. Therapeutic options in pulmonary hepatic vascular diseases. Expert Rev Clin Pharmacol. 2014;7:31–42.PubMedCrossRef
117.
Zhang J, Fallon MB. Hepatopulmonary syndrome: update on pathogenesis and clinical features. Nat Rev Gastroenterol Hepatol. 2012;130:1136–1144.
118.
Machicao VI, Balakrishnan M, Fallon MB. Pulmonary complications in chronic liver disease. Hepatology. 2014;59:1627–1637.PubMedCrossRef
119.
Grace JA, Angus PW. Hepatopulmonary syndrome: update on recent advances in pathophysiology, investigation, and treatment. J Gastroenterol Hepatol. 2013;28:213–219.PubMedCrossRef
120.
Krishnamurthy GT, Krishnamurthy S. Nuclear hepatology. A textbook of hepatobiliary diseases. Berlin: Springer; 2000.
121.
Schwartz JM, Beymer C, Althaus SJ, et al. Cardiopulmonary consequences of transjugular intrahepatic portosystemic shunts: Role of increased pulmonary artery pressure. J Clin Gastroenterol. 2004;38:590–594.PubMedCrossRef
122.
Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology. 2005;41:386–400.PubMedCrossRef
123.
Iyer VN, Swanson KL, Cartin-Ceba R, et al. Hepatopulmonary syndrome: Favorable outcomes in the MELD exception era. Hepatology. 2013;57:2427–2435.PubMedCrossRef
124.
Pascasio JM, Grilo I, Lopez-Pardo FJ, et al. Prevalence and severity of hepatopulmonary syndrome and Its Influence on survival in cirrhotic patients evaluated for liver transplantation. Am J Transplant. 2014;14:1391–1399.PubMedCrossRef
125.
Katsuta Y, Zhang XJ, Kato Y, et al. Hemodynamic features and impaired arterial oxygenation in patients with portopulmonary hypertension. Hepatol Res. 2005;32:79–88.PubMedCrossRef
126.
Kawut SM, Taichman DB, Ahya VN, et al. Hemodynamics and survival of patients with portopulmonary hypertension. Liver Transpl. 2005;11:1107–1111.PubMedCrossRef
127.
Luo B, Liu L, Tang L, et al. Increased pulmonary vascular endothelin B receptor expression and responsiveness to endothelin-1 in cirrhotic and portal hypertensive rats: a potential mechanism in experimental hepatopulmonary syndrome. J Hepatol. 2003;38:556–563.PubMedCrossRef
128.
Giusca S, Jinga M, Jurcut C, Jurcut R, Serban M, Ginghina C. Portopulmonary hypertension: from diagnosis to treatment. Eur J Intern Med. 2011;22:441–447.PubMedCrossRef
129.
Koch DG, Bogatkevich G, Ramshesh V, Lemasters JJ, Uflacker R, Reuben A. Elevated levels of endothelin-1 in hepatic venous blood are associated with intrapulmonary vasodilatation in humans. Dig Dis Sci. 2012;57:516–523.PubMedCentralPubMedCrossRef
130.
131.
Krowka MJ. Portopulmonary hypertension and the issue of survival. Liver Transpl. 2005;11:1026–1027.PubMedCrossRef
132.
Kuo PC, Plotkin JS, Johnson LB, et al. Distinctive clinical features of portopulmonary hypertension. Chest. 1997;112:980–986.PubMedCrossRef
133.
Swanson KL, Krowka MJ. Screen for portopulmonary hypertension, especially in liver transplant candidates. Cleve Clin J Med. 2008;75:121–133.PubMedCrossRef
134.
Hoeper MM, Seyfarth HJ, Hoeffken G, et al. Experience with inhaled iloprost and bosentan in portopulmonary hypertension. Eur Respir J. 2007;30:1096–1102.PubMedCrossRef
135.
Grander W, Eller P, Fuschelberger R, Tilg H. Bosentan treatment of portopulmonary hypertension related to liver cirrhosis owing to hepatitis C. Eur J Clin Invest. 2006;36:67–70.PubMedCrossRef
136.
Hollatz TJ, Musat A, Westphal S, et al. Treatment with sildenafil and treprostinil allows successful liver transplantation of patients with moderate to severe portopulmonary hypertension. Liver Transpl. 2012;18:686–695.PubMedCrossRef
137.
Krowka MJ. Hepatopulmonary syndrome and portopulmonary hypertension: implications for liver transplantation. Clin Chest Med. 2005;26:587–597.PubMedCrossRef
138.
Murray KF, Carithers RL Jr. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology. 2006;41:1407–1432.CrossRef
139.
Safdar Z, Bartolome S, Sussman N. Portopulmonary hypertension: an update. Liver Transpl. 2012;18:881–891.PubMedCrossRef
140.
Koh C, Zhao X, Samala N, Sakiani S, Liang TJ, Talwalkar JA. AASLD clinical practice guidelines: a critical review of scientific evidence and evolving recommendations. Hepatology. 2013;58:2142–2152.PubMedCentralPubMedCrossRef
141.
142.
Mindikoglu AL, Dowling TC, Weir MR, Seliger SL, Christenson RH, Magder LS. Performance of chronic kidney disease epidemiology collaboration creatinine-cystatin C equation for estimating kidney function in cirrhosis. Hepatology. 2014;59:1532–1542.PubMedCentralPubMedCrossRef
143.
Krag A, Bendtsen F, Burroughs AK, Møller S. The cardiorenal link in advanced cirrhosis. Med Hypotheses. 2012;79:53–55.PubMedCrossRef
144.
Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48:2064–2077.PubMedCrossRef
145.
Piano S, Rosi S, Maresio G, et al. Evaluation of the acute kidney injury network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol. 2013;59:482–489.PubMedCrossRef
146.
Belcher JM, Parikh CR, Garcia-Tsao G. Acute kidney injury in patients with cirrhosis: perils and promise. Clin Gastroenterol Hepatol. 2013;11:1550–1558.PubMedCrossRef
147.
Cholongitas E, Arsos G, Goulis J, et al. Glomerular filtration rate is an independent factor of mortality in patients with decompensated cirrhosis. Hepatol Res. 2014;44:145–155.CrossRef
148.
Fabrizi F, Aghemo A, Messa P. Hepatorenal syndrome and novel advances in its management. Kidney Blood Press Res. 2013;37:588–601.PubMedCrossRef
149.
Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.PubMedCentralPubMedCrossRef
150.
Belcher JM, Sanyal AJ, Peixoto AJ, et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology. 2014;60:622–632.PubMedCentralPubMedCrossRef
151.
Møller S, Krag A, Bendtsen F. Kidney injury in cirrhosis: Pathophysiological and therapeutic aspects of hepatorenal syndromes. Liver Int. 2014;34:1153–1163.PubMedCrossRef
152.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification: Am J Kidney Dis 2002;39:S1–S266.
153.
Trawale JM, Paradis V, Rautou PE, et al. The spectrum of renal lesions in patients with cirrhosis: a clinicopathological study. Liver Int. 2010;3:725–732.CrossRef
154.
Wong F, Nadim MK, Kellum JA, et al. Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut. 2011;60:702–709.PubMedCrossRef
155.
Wong F, Murray P. Kidney damage biomarkers: novel tools for the diagnostic assessment of acute kidney injury in cirrhosis. Hepatology. 2014;60:455–457.PubMedCrossRef
156.
157.
Fede G, D’amico G, Arvaniti V, et al. Renal failure and cirrhosis: a systematic review of mortality and prognosis. J Hepatol. 2012;56:810–818.PubMedCrossRef
158.
159.
Gines P, Angeli P, Lenz K, et al. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397–417.CrossRef
160.
Angeli P, Gines P. Hepatorenal syndrome, MELD score and liver transplantation: an evolving issue with relevant implications for clinical practice. J Hepatol. 2012;57:1135–1140.PubMedCrossRef
161.
Barreto R, Fagundes C, Guevara M, et al. Type-1 hepatorenal syndrome associated with infections in cirrhosis: natural history, outcome of kidney function, and survival. Hepatology. 2014;59:1505–1513.PubMedCrossRef
162.
Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of the hepatorenal syndrome in cirrhosis. A consensus workshop of the international ascites club. Gut. 2007;56:1310–1318.PubMedCentralPubMed
163.
Stadlbauer VP, Wright GA, Banaji M, et al. Relationship between activation of the sympathetic nervous system and renal blood flow autoregulation in cirrhosis. Gastroenterology. 2008;134:111–119.PubMedCrossRef
164.
Møller S, Krag A: Cardiorenal syndrome: A new entity? In Gerbes A, (ed) Hyponatremia and hepatorenal syndrome: progress in treatment. Front Gastrointest Res. Basel, Karger, 2011, pp 102–111.
165.
Schrier RW. Decreased effective blood volume in edematous disorders: what does this mean? J Am Soc Nephrol. 2007;18:2028–2031.PubMedCrossRef
166.
Acevedo J, Fernandez J, Prado V, et al. Relative adrenal insufficiency in decompensated cirrhosis. Relationship to short-term risk of severe sepsis, hepatorenal syndrome and death. Hepatology. 2013;58:1757–1765.PubMedCrossRef
167.
168.
Theocharidou E, Krag A, Bendtsen F, Moller S, Burroughs AK. Cardiac dysfunction in cirrhosis—does adrenal function play a role? A hypothesis. Liver Int. 2012;32:1327–1332.PubMedCrossRef
169.
Galbois A, Thabut D. Adrenal insufficiency: diagnosis in patients with liver cirrhosis is difficult. J Hepatol. 2011;54:590–591.CrossRef
170.
Galbois A, Rudler M, Massard J, et al. Assessment of adrenal function in cirrhotic patients: salivary cortisol should be preferred. J Hepatol. 2010;52:839–845.PubMedCrossRef
171.
Amarapurkar DN. Adrenal function in cirrhosis: the pendulum swings. J Gastroenterol Hepatol. 2012;27:1543–1544.PubMedCrossRef
172.
Almdal T, Schroeder T, Ranek L. Cerebral blood flow and liver function in patients with encephalopathy due to acute and chronic liver diseases. Scand J Gastroenterol. 1989;24:299–303.PubMedCrossRef
173.
Larsen FS, Olsen KS, Ejlersen E, Hansen BA, Paulson OB, Knudsen GM. Cerebral blood flow autoregulation and transcranial doppler sonography in patients with cirrhosis. Hepatology. 1995;22:730–736.PubMed
174.
O’Carroll RE, Hayes PC, Ebmeier KP, et al. Regional cerebral blood flow and cognitive function in patients with chronic liver disease. Lancet. 1991;337:1250–1253.PubMedCrossRef
175.
Ede RJ, Gimson AES, Bihari D, Williams R. Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure. J Hepatol. 1986;2:43–51.PubMedCrossRef
176.
Larsen FS, Knudsen GM, Hansen BA. Pathophysiological changes in cerebral circulation, oxidative metabolism and blood-brain barrier in patients with acute liver failure. Tailored cerebral oxygen utilization. J Hepatol. 1997;27:231–238.PubMedCrossRef
177.
Frokjaer VG, Strauss GI, Mehlsen J, Knudsen GM, Rasmussen V, Larsen FS. Autonomic dysfunction and impaired cerebral autoregulation in cirrhosis. Clin Auton Res. 2006;16:208–216.PubMedCrossRef
178.
Lagi A, Lavilla G, Barletta G, et al. Cerebral autoregulation in patients with cirrhosis and ascites: a transcranial doppler study. J Hepatol. 1997;27:114–120.PubMedCrossRef
179.
Dam M, Burra P, Tedeschi U, et al. Regional cerebral blood flow changes in patients with cirrhosis assessed with Tc-99 m-HM-PAO single-photon emission computed tomography: effect of liver transplantation. J Hepatol. 1998;29:78–84.PubMedCrossRef
180.
Jalan R, Newby DE, Damink SW, Redhead DN, Hayes PC, Lee A. Acute changes in cerebral blood flow and metabolism during portasystemic shunting. Liver Transpl. 2001;7:274–278.PubMedCrossRef
181.
Zheng G, Zhang LJ, Zhong J, et al. Cerebral blood flow measured by arterial-spin labeling MRI: a useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis. Eur J Radiol. 2013;82:1981–1988.PubMedCrossRef
182.
Zheng G, Zhang LJ, Wang Z, et al. Changes in cerebral blood flow after transjugular intrahepatic portosystemic shunt can help predict the development of hepatic encephalopathy: an arterial spin labeling MR study. Eur J Radiol. 2012;81:3851–3856.PubMedCrossRef
183.
Zheng G, Zhang LJ, Cao Y, et al. Transjugular intrahepatic portosystemic shunt induced short- and long-term cerebral blood flow variations in cirrhotic patients: an arterial spin labeling MRI study. Metab Brain Dis. 2013;28:463–471.PubMedCrossRef
184.
185.
Kumar A, Das K, Sharma P, Mehta V, Sharma BC, Sarin SK. Hemodynamic studies in acute-on-chronic liver failure. Dig Dis Sci. 2009;54:869–878.PubMedCrossRef
186.
Liu H, Lee SS. Acute-on-chronic liver failure: the heart and systemic hemodynamics. Curr Opin Crit Care. 2011;17:190–194.PubMedCrossRef
187.
Jalan R, Saliba F, Pavesi M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol. 2014;61:1038–1047.PubMedCrossRef
188.
Silva PE, Fayad L, Lazzarotto C, Ronsoni MF, Bazzo ML, Colombo BS, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LL: Single-centre validation of the EASL-CLIF Consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis. Liver Int. 2014. doi: 10.​1111/​liv.​12597.
Metadata
Title
Cirrhotic Multiorgan Syndrome
Authors
Søren Møller
Flemming Bendtsen
Publication date
01-11-2015
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 11/2015
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-015-3752-3

Other articles of this Issue 11/2015

Digestive Diseases and Sciences 11/2015 Go to the issue

Original Article

Seasonal Variation in Flares of Intestinal Behçet’s Disease

Original Article

The Toxin-Producing Pathobiont Klebsiella oxytoca Is Not Associated with Flares of Inflammatory Bowel Diseases

Original Article

Psoriasiform Skin Lesions Are Caused by Anti-TNF Agents Used for the Treatment of Inflammatory Bowel Disease

Original Article

Multicenter Study Assessing Physician Recommendations Regarding the Continuation of Aspirin and/or NSAIDs Prior to Gastrointestinal Endoscopy

Original Article

Nod2–Rip2 Signaling Contributes to Intestinal Injury Induced by Muramyl Dipeptide Via Oligopeptide Transporter in Rats

Original Article

Role of Environmental Factors in the Development of Pediatric Eosinophilic Esophagitis
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits