Contrast-enhanced ultrasound evaluation of the renal microcirculation response to terlipressin in hepato-renal syndrome: a preliminary report

Figures & data

Figure 1. CEUS-derived parameters. Panel (a): RBV indicates contrast agent intensity—increases with higher perfusion. Panel (b): mTT (mean Transit Time) indicates time taken for contrast agent to travel through tissue—increases with lower perfusion. Panel (c): perfusion index: ratio of RBV/mTT.

Table 1. Patients characteristics and outcomes.

	Patient 1	Patient 2	Patient 3	Patient 4
Patients characteristics
Age and sex	51-year-old male	48-year-old male	60-year-old male	45-year-old male
CLD etiology	Alcoholic liver disease	Chronic HCV infection	Alcoholic liver disease	Chronic HCV infection
Body weight (kg)	96	105	88.5	83
Hospital and ICU stay
Hospital LOS	24	36	9	14
ICU admission (LOS)	Yes (7 d)	Yes (6 d)	No	No
APACHE III score	89	68	–	–
Documented infection	N	N	N	Y (E. asbunriae SBP)
Noradrenaline (duration)	Yes (84 h)	No	No	No
Dose max	17 µg/min
Terlipressin
Total number of doses	8	4	25	15
Initiated on hospital day	16	2	2	3
Acute kidney injury
Baseline creatinine (µmol/L)	84	41	120	91
Peak creatinine (µmol/L)	389	183	653	262
RIFLE class	F	F	F	F
Day of peak creatinine	D14	D1	D1	D1
Nadir creatinine (µmol/L)	146 (3 d off RRT)	44	238	85
Clinical response to terlipressin?	Yes	Yes	No	Yes
Liver function tests
Baseline INR	2.1	1.4	1.6	1.2
Peak INR during hospital stay	3.5	1.9	1.9	1.7
Baseline bilirubin (mmol/L)	102	29	34	15
Peak bilirubin during hospital stay (mmol/L)	225	101	50	124
Outcomes
RRT (duration)	Yes (46 h)	No	No	No
Vital status day 30	Alive	Alive	Alive	Alive
Location at day 30	Home	Ward	Ward	Ward
Vital status at day 90	Alive	Alive	Alive	Alive
Location at day 90	Home	Ward	Home	Home
Discharge destination	Home	Rehabilitation	Home	Home
Liver transplantation within 90 d	Yes	Yes	No	No

Notes: CLD, chronic liver disease; HCV, hepatitis C virus; LOS, length of stay; ICU, intensive care unit; SBP, spontaneous bacterial peritonitis; RIFLE, risk, injury, failure, loss and end-stage-renal failure; RRT, renal replacement therapy.

Figure 2. Screenshot of CEUS images. Left side of the panel: images obtained at baseline; right side of the panel images obtained 2 h after intravenous administration of 1 mg terlipressin. Each image is divided into two (left side: contrast-enhanced image and right side: conventional “B mode” ultrasound image for orientation).