Validity of mini-fluid challenge for predicting fluid responsiveness following liver transplantation.

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:NCT03396159 . (Prospective registered). Initial registration date was 10/01/2018.

SUBMITTER: Mukhtar A 

PROVIDER: S-EPMC6463636 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature