SEQUENTIAL EVALUATION OF PORTAL VENOUS HEMODYNAMICS BY DOPPLER ULTRASOUND IN PATIENTS WITH SEVERE ACUTE HEPATITIS

Objectives: Portal hypertension may develop in patients with severe ac ute hepatitis. Sequential changes of portal venous hemodynamics in acu te hepatitis is not well understood. This study evaluated portal hemod ynamic changes and prognostic values in patients with severe, acute he patitis. Methods: Doppler studies, liver function tests, and virology studies were done in the inclusion, the 3rd month, and the 6th month f or patients with severe, acute hepatitis. An indocyanine green clearan ce was done in the inclusion. Doppler portal hemodynamic studies were done in the hilar area by an average of two measurements. Results: A t otal of 88 consecutive patients was included. Nine of them died. On in itial study, fatalities were generally older patients with more delaye d indocyanine green clearance, lower portal vein velocity, lower album in values, higher bilirubin values, longer prothrombin time, and ascit es. Using stepwise logistic regression, portal blood flow and prothrom bin time were the two independence prognostic factors. By multiple lin ear regression, portal blood flow was associated with ascites, and ave rage portal blood velocity was associated with bilirubin. During the h ospital days, transient, depressed portal blood velocities followed by a hyperdynamic stage were found in survivors. The portal vein velocit y changes for fatalities either were kept at a lower level or had a de clining pattern. Conclusions: Doppler ultrasound detects portal hemody namic changes for patients with severe, acute hepatitis. Sequential po rtal hemodynamic studies will be helpful for evaluating patients with severe, acute hepatitis.