AI Article Synopsis
- The study aimed to assess whether total bile acid (TBA) levels can help identify patients with decompensated cirrhosis who need echocardiography for diagnosing portopulmonary hypertension.
- Out of 135 patients evaluated, elevated TBA levels and main pulmonary artery diameter were linked to higher tricuspid regurgitation pressure gradient (TRPG), suggesting TBA can indicate TRPG elevation effectively.
- However, for patients taking ursodeoxycholic acid (UDCA), the effectiveness of TBA in diagnosing TRPG elevation was reduced, indicating the need for careful interpretation in such cases.
Article Abstract
Aim: Echocardiography is necessary for portopulmonary hypertension diagnosis, and identifying patients with cirrhosis who require it is challenging. In this study, we aimed to investigate the utility of the total bile acid (TBA) levels as a screening tool for identifying patients with decompensated cirrhosis who should undergo echocardiography for portopulmonary hypertension diagnosis.
Methods: We evaluated 135 patients with decompensated cirrhosis who underwent liver transplantation. Subsequently, factors contributing to tricuspid regurgitation pressure gradient (TRPG) elevation (≥30 mmHg) were analyzed using preoperative data, including the TBA levels.
Results: The median age of patients was 58 years (61 women), and 45 and 90 patients had Child-Turcotte-Pugh grades of B and C, respectively. The median TRPG level was 21 mmHg, and 17 patients (12.6%) showed TRPG elevation. Multiple logistic regression analysis revealed that elevated TBA (odds ratio 4.322; p = 0.013) and main pulmonary artery diameter ≥33 mm (odds ratio 4.333; p = 0.016) were significantly associated with TRPG elevation. The TBA cut-off value (167.7 μmol/L) showed a high diagnostic performance, with 70.6% sensitivity and 64.4% specificity. Ursodeoxycholic acid (UDCA) administration increased the TBA levels dose-dependently. Analysis stratified by UDCA use revealed that in patients not taking UDCA (n = 59), elevated TBA levels and younger age significantly contributed to TRPG elevation. However, in those taking UDCA (n = 76), this contribution disappeared, suggesting that UDCA consumption reduced TBA levels' efficiency in diagnosing TRPG elevation.
Conclusions: The TBA levels may be a potential screening tool for TRPG elevation; however, caution is warranted when interpreting cases treated with UDCA.
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| http://dx.doi.org/10.1111/hepr.14059 | DOI Listing |
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