Prevalence and risk factors of lymphatic dysfunction in cirrhosis patients with refractory ascites:An often unconsidered mechanism

作     者：Rahul Arya Ramesh Kumar Tarun Kumar Sudhir Kumar Utpal Anand Rajeev Nayan Priyadarshi Tanmoy Maji 

作者机构：Department of GastroenterologyAll India Institute of Medical SciencesPatna 801507BiharIndia Department of PathologyAll India Institute of Medical SciencesPatna 801507BiharIndia Department of Surgical GastroenterologyAll India Institute of Medical SciencesPatna 801507BiharIndia Department of RadiodiagnosisAll India Institute of Medical SciencesPatna 801507BiharIndia 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志(英文版)(电子版))

年 卷 期：2023年第15卷第10期

页      面：1140-1152页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Cirrhosis Lymphedema Lymphangicetasia Refractory ascites Chylous ascites Lymphocytopenia 

摘      要：BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis ***,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid *** To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with *** This observational study included 155 consecutive cirrhosis patients with *** presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic *** A total of 69(44.5%)patients out of 155 had evidence of lymphatic *** lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)*** to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein5 g/dL)and lymphocytopenia(15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without *** multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrho