NON-INVASIVE HEMODYNAMIC ASSESSMENT IN CIRRHOSIS - CHILD-PUGH STRATIFICATION AND A PLATELET THRESHOLD TO DEFINE THE HYPERDYNAMIC STATE

Q: What index was developed to integrate haemodynamic variables in cirrhosis?

The study developed the Cardiac Haemodynamic Status (CHS) index, combining standardized cardiac output, systemic vascular resistance, and arterial compliance.

Q: How were patients grouped for comparison of haemodynamic profiles?

Participants were stratified by Child-Pugh class (A/B/C) alongside healthy controls.

Q: What platelet threshold best identifies the hyperdynamic circulatory phenotype?

A platelet count below 93×10^3/mL optimally discriminated hyperdynamism, with CHS and related haemodynamic parameters shifting accordingly.

Sep 27, 2026

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Non-invasive impedance cardiography is used to characterize cirrhosis-related circulatory changes, from an early hyperdynamic profile with elevated cardiac output and reduced systemic vascular resistance to potential later low-output failure. A unitless Cardiac Haemodynamic Status (CHS) index integrates standardized cardiac output, systemic vascular resistance, and arterial compliance. In 12 controls and 40 beta-blocker-free cirrhotics stratified by Child-Pugh class, distinct haemodynamic phenotypes emerge. A platelet threshold below 93×10^3/mL best discriminates hyperdynamism and serves as a surrogate marker.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Introduction and Objectives

Materials and Methods

Results

Conclusions

Figure 2. Educational Outcomes 􀀕 HCC Clinical Excellence Program [https://doi.org/10.1016/j.aohep.2025.102010](https://doi.org/10.1016/j.aohep.2025.102010) [\#60](#60) NON-INVASIVE HEMODYNAMIC ASSESSMENT IN CIRRHOSIS: CHILD-PUGH STRATIFICATION AND A PLATELET THRESHOLD TO DEFINE THE HYPERDYNAMIC STATE Martín Elizondo1, Eugenia Ipar2, Romina Rey1, Leandro Cymberknop2, Marcelo Valverde1, Solange Gerona1, Ricardo Armentano2 1 Unidad Bi-Institucional de Enfermedades Hepticas Complejas (Hospital Militar. Hospital de Clínicas). Programa de Trasplante Heptico. Montevideo. Uruguay. 2 Universidad Tecnolgica Nacional. Facultad Regional Buenos Aires. Grupo de Investigaciny Desarrollo en Bioingeniería (GIBIO). Buenos Aires. Argentina. Introduction and Objectives: Cirrhosis initially presents a hyperdynamic proﬁle—elevated cardiac output (CO), reduced systemic vascular resistance (SVR) and arterial pressure—which may later evolve into low-output cardiocirculatory failure. Impedance cardiography (IC) enables non-invasive quantiﬁcation of these changes. To integrate them, we developed the unitless Cardiac Haemodynamic Status (CHS) index, deﬁned as x(CO2 + SVR2 + arterial compliance [AC]2), with all parameters standardised prior to calculation. This study aimed to compare CO, SVR, AC and CHS across healthy controlsand cirrhotic patients stratiﬁed by Child-Pugh class (A/B/C), and to determine whether a platelet threshold lower than the conventional 140 £ 103 /mL more accurately identiﬁes the hyperdynamic circulatory phenotype. Materials and Methods: Cross-sectional study (2023-2025) of 12 controls and 40 b-blocker􀀕free cirrhotics (A 20, B 12, C 8). Each subject underwent IC. Normality was checked (Shapiro􀀕Wilk); groups were compared with Kruskal􀀕Wallis and Holm-adjusted Mann 􀀕Whitney tests. All observed platelet counts (40􀀕190 £ 103 /mL) were screened; the cut-off with the lowest p and highest Youden index for CHS was validated by bootstrap ROC. Results: CO, SVR, AC and CHS differed among the four groups (p􀀃0.006) (Table). Versus controls, C-P A showed higher SVR/CHS but lower CO/AC; C-P B displayed an isolated CO rise; C-P C had higher SVR/CHS (all p<0.04). A platelet threshold of 93 £ 103 /mL optimally discriminated hyperdynamism (p=0.006; Cohen d 0.86; AUC 0.82). Patients below this level had higher CO, AC and CHS and lower SVR. Conclusions: IC identiﬁes three distinct haemodynamic phenotypes across Child-Pugh classes. The CHS index captures these proﬁles, while a platelet count below 93 £ 103 /mL appears to be a useful surrogate of hyperdynamic circulation. Conﬂict of interest: None | Variable | Controls | Child A | Child B | Child C | p | | --- | --- | --- | --- | --- | --- | | Cardiac output (CO) (L¢min) | 6.78 § 1.41 | 4.76 § 1.48 | 8.27 § 4.10 | 6.20 § 3.25 | 0.006 | | Systemic vascular resistance | 892 § 207 | 1 677 § 801 | 1 024 § 608 | 1 147 § 421 | 0.002 | | (SVR) (dyn¢s¢cm-5) | | | | | | | Arterial compliance (AC) (mL¢mmHg-1) | 2.69 § 0.75 | 1.47 § 0.52 | 2.41 § 0.98 | 1.97 § 0.93 | 0.001 | | CHS index | 0.93 § 0.21 | 1.74 § 0.81 | 1.12 § 0.61 | 1.21 § 0.42 | 0.002 | [https://doi.org/10.1016/j.aohep.2025.102011](https://doi.org/10.1016/j.aohep.2025.102011) [\#63](#63) IRON METABOLISM DISTURBANCES ARE ASSOCIATED WITH LIVER FIBROSIS SEVERITY IN MASLD: A CROSS-SECTIONAL STUDY USING NONINVASIVE TOOLS Romina Rey Laguarda1, Martín Elizondo Barcel1, Lain Lin Liu2, Emilia Moreira Milanesi3, Solange Gerona Sangiovanni1 1 Hospital Militar, Uruguay. 2 Hospital Maciel, Uruguay. 3 Hospital de Clínicas, Uruguay. Introduction and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. Disturbances in iron metabolism—particularly hyperferritinemia—may play a role in ﬁbrosis progression through mechanisms involving oxidative stress and chronic inﬂammation. To describe iron metabolism parameters in patients with MASLD and an

FAQs

What index was developed to integrate haemodynamic variables in cirrhosis?

The study developed the Cardiac Haemodynamic Status (CHS) index, combining standardized cardiac output, systemic vascular resistance, and arterial compliance.

How were patients grouped for comparison of haemodynamic profiles?

Participants were stratified by Child-Pugh class (A/B/C) alongside healthy controls.

What platelet threshold best identifies the hyperdynamic circulatory phenotype?

A platelet count below 93×10^3/mL optimally discriminated hyperdynamism, with CHS and related haemodynamic parameters shifting accordingly.

Sep 27, 2026

Uploaded by นรินทร์