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

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 √(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 controls and cirrhotic patients stratified by Child-Pugh class (A/B/C), and to determine whether a platelet threshold lower than the conventional 140 × 10³ /µL more accurately identifies the hyperdynamic circulatory phenotype.

Materials and Methods

Cross-sectional study (2023-2025) of 12 controls and 40 β-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 /µL) 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 /µL 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 /µL 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 (SVR) (dyn·s·cm^-5)	892 ± 207	1 677 ± 801	1 024 ± 608	1 147 ± 421	0.002
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