Point-of-Care Echocardiography to Assess Impact of Dynamic Cardiac Function, Renal and Cardiac Biomarkers in Cirrhosis With Refractory Ascites

Point-of-care echocardiography (POC-Echo) is used to determine left ventricular systolic and diastolic dysfunction (LVDD), inferior vena cava (IVC) dynamics and volume status in cirrhosis and Acute-on-chronic liver failure ACLF accurately.We will assess IVC dynamics, LV systolic function [LV ejection fraction (EF) & cardiac output (CO)], and diastolic dysfunction (E/e', e' and E/A ratio) and urinary biomarkers (cystatin C and NGAL) in patients with cirrhosis and Refractory Ascites.

Inclusion Criteria:Cirrhosis of any EtiologyPatient with Refractory AscitesExclusion Criteria:Hepatocellular carcinomaPatients with active variceal bleedingHIV or severe immunocompromised stateChronic kidney disease (CKD) on renal replacement therapy (RRT),Previous transjugular intra hepatic portosystemic shunt (TIPS)Porto-pulmonary hypertension,Coronary artery diseaseCongenital or valvular heart diseaseProsthetic cardiac valves