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Cirrhotic liver failure

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https://www.readbyqxmd.com/read/29135574/interferon-free-therapy-for-treating-hcv-in-difficult-to-treat-hiv-coinfected-patients-as-implemented-in-routine-medical-practice
#1
Carlos Mínguez, Miguel García-Deltoro, Juan Flores, Maria-José Galindo, Marta Montero, Sergio Reus, Jorge Carmena, Mar Masiá, Concepción Amador, Enrique Ortega
BACKGROUND/AIMS: Data regarding the use of all-oral direct-acting antivirals (DAA) in HIV/HCV-coinfected patients with advanced liver fibrosis are required, because they are generally under-represented in clinical trials. This study sought to evaluate the use of these drugs in a cohort of coinfected patients, mostly with factors that have previously been recognised as predictors of treatment failure. METHODS: COINFECOVA-2 is an observational, multicenter study conducted in Eastern Spain...
November 10, 2017: AIDS
https://www.readbyqxmd.com/read/29105936/circulating-cxcl10-in-cirrhotic-portal-hypertension-might-reflect-systemic-inflammation-and-predict-aclf-and-mortality
#2
Jennifer M Lehmann, Karina Claus, Christian Jansen, Alessandra Pohlmann, Robert Schierwagen, Carsten Meyer, Daniel Thomas, Steffen Manekeller, Joan Claria, Christian P Strassburg, Christian Trautwein, Hermann E Wasmuth, Marie-Luise Berres, Jonel Trebicka
BACKGROUND & AIMS: CXCR% ligands play an important role in hepatic injury, inflammation and fibrosis. While CXCL9 and CXCL11 are associated with survival in patients receiving transjugular intrahepatic portosystemic shunt (TIPS), the role of CXCL10 in severe portal hypertension remains unknown. METHODS: A total of 89 cirrhotic patients were analysed. CXCL10 protein levels were measured in portal and hepatic blood at TIPS insertion and 2 weeks later in 24 patients...
November 6, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29100896/liver-disease-and-heart-failure-back-and-forth
#3
REVIEW
Michele Correale, Nicola Tarantino, Rossella Petrucci, Lucia Tricarico, Irma Laonigro, Matteo Di Biase, Natale Daniele Brunetti
In their clinical practice, physicians can face heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both heart and liver. Therefore, it is crucial in clinical practice to identify complex interactions between heart and liver, in order to provide the best treatment for both. In this review, we sought to summarize principal evidence explaining the mechanisms and supporting the existence of this complicate cross-talk between heart and liver...
October 31, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29091196/efficacy-and-safety-of-direct-antiviral-agents-in-a-cohort-of-cirrhotic-hcv-hiv-coinfected-patients
#4
Jordi Navarro, Montserrat Laguno, Helem Haydee Vilchez, Jose M Guardiola, Jose A Carrion, Luis Force, Mireia Cairó, Carmen Cifuentes, Josep Vilaró, Josep Cucurull, Andrés Marco, Mercè Roget, Eva Erice, Manuel Crespo
Background: New direct-acting antiviral agents (DAAs) have shown great efficacy and tolerability in clinical trials and real-life cohorts. However, data are scarce regarding efficacy and safety in cirrhotic HCV/HIV-coinfected patients. Methods: A multicentre prospective analysis was performed in 13 Spanish hospitals, including all cirrhotic HCV/HIV-coinfected patients starting DAA combinations from January to December 2015. Sustained virological response 12 weeks after treatment (SVR12) was analysed...
October 1, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29077657/does-portopulmonary-hypertension-impede-liver-transplantation-in-cirrhotic-patients-a-french-multicentric-retrospective-study
#5
Maud Reymond, Louise Barbier, Ephrem Salame, Camille Besh, Jerome Dumortier, Georges-Philippe Pageaux, Christophe Bureau, Sébastien Dharancy, Claire Vanlemmens, Armand Abergel, Marie-Lorraine Woehl Jaegle, Pascal Magro, Frederic Patat, Emeline Laurent, Jean-Marc Perarnau
BACKGROUND: Portopulmonary hypertension is defined by the presence of pulmonary arterial hypertension associated with portal hypertension. Its presence is a major stake for cirrhotic patients requiring liver transplantation, with increased postoperative mortality and unpredictable evolution after transplantation. The aim was to study outcomes after liver transplantation in patients with portopulmonary hypertension and to identify factors associated with normalization of pulmonary hypertension...
October 26, 2017: Transplantation
https://www.readbyqxmd.com/read/29064853/red-blood-cell-distribution-width-independently-predicts-1-month-mortality-in-acute-decompensation-of-cirrhotic-patients-admitted-to-emergency-department
#6
Gianni Turcato, Tommaso Campagnaro, Antonio Bonora, Nicola Vignola, Gian Luca Salvagno, Gianfranco Cervellin, Giorgio Ricci, Antonio Maccagnani, Giuseppe Lippi
AIM: The aim of this study was to explore whether red blood cell distribution width (RDW) can help predict the risk of short-term mortality in patients with acute decompensation of cirrhosis. PATIENTS AND METHODS: We carried out a retrospective analysis of all patients consecutively admitted to the emergency department (ED) of the University Hospital of Verona (Italy) for acute decompensation of liver cirrhosis, between 1 June 2013 and 31 December 2016. The RDW value was measured at ED admission, along with collection of clinical features and other laboratory data, and was then correlated with severity of disease (Chronic Liver Failure Consortium Acute Decompensation score; CLIF-C AD score) and 1-month mortality...
October 23, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29059469/fat-free-muscle-mass-in-magnetic-resonance-imaging-predicts-acute-on-chronic-liver-failure-and-survival-in-decompensated-cirrhosis
#7
Michael Praktiknjo, Marius Book, Julian Luetkens, Alessandra Pohlmann, Carsten Meyer, Daniel Thomas, Christian Jansen, Andreas Feist, Johannes Chang, Jochen Grimm, Jennifer Lehmann, Christian P Strassburg, Juan Gonzalez Abraldes, Guido Kukuk, Jonel Trebicka
BACKGROUND: Muscle mass seems to be a prognostic marker in patients with liver cirrhosis. However, reported methods to quantify muscle mass are heterogeneous, consented cut-off values are missing and most studies used computed tomography (CT). This study evaluated fat-free muscle area as a marker of sarcopenia using magnetic resonance imaging (MRI) in decompensated cirrhotic patients with transjugular intrahepatic portosystemic shunt (TIPS). METHODS: The total erector spinae muscle area and the intramuscular fat tissue area were measured and subtracted to calculate the fat-free muscle area (FFMA) in 116 cirrhotic patients with TIPS and MRI...
October 23, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29049129/transjugular-intrahepatic-portosystemic-shunt-placement-before-abdominal-intervention-in-cirrhotic-patients-with-portal-hypertension-lessons-from-a-pilot-study
#8
Nadim Fares, Marie-Angèle Robic, Jean-Marie Péron, Fabrice Muscari, Philippe Otal, Bertrand Suc, Jean-Pierre Vinel, Christophe Bureau
BACKGROUND: Abdominal interventions are usually contraindicated in patients with cirrhosis and portal hypertension because of increased morbidity and mortality. Decreasing portal pressure with transjugular intrahepatic portosystemic shunt (TIPS) may improve patient outcomes. We report our experience with patients treated by neoadjuvant TIPS to identify those who would most benefit from this two-step procedure. PATIENTS AND METHODS: All patients treated by dedicated neoadjuvant TIPS between 2005 and March 2013 in two tertiary referral hospitals were included...
October 18, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29043403/hepatic-morphology-abnormalities-beyond-cirrhosis
#9
REVIEW
Giuseppe Mamone, Kelvin Cortis, Aquilina Sarah, Settimo Caruso, Roberto Miraglia
The diagnosis of cirrhosis can be reached on the basis of established hepatic morphological changes. However, some other conditions can mimic cirrhosis. The aim of this pictorial essay is to review the CT and MRI appearances of hepatic morphology abnormalities in the cirrhotic liver and other diseases, describing pathologic conditions that can mimic cirrhosis, with useful tips for the differential diagnosis. Mimickers of cirrhosis include congenital hepatic fibrosis, Caroli disease, Budd-Chiari Syndrome, hepatoportal sclerosis, cavernous transformation of the portal vein, pseudocirrhosis from metastatic disease, acute liver failure, post-therapeutic morphologic changes in the liver, and infective conditions including schistosomiasis and oriental cholangiohepatitis...
October 17, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29023872/cell-death-markers-in-cirrhotic-patients-with-acute-decompensation
#10
Stewart Macdonald, Fausto Andreola, Patrik Bachtiger, Alex Amoros, Marco Pavesi, Rajeshwar Mookerjee, Yu Bao Zheng, Henning Grønbaek, Alexander L Gerbes, Elsa Sola, Paolo Caraceni, Richard Moreau, Pere Gines, Vicente Arroyo, Rajiv Jalan
The aims of this study were to determine the role of cell death in cirrhotic patients with acute decompensation (AD) and acute on chronic liver failure (ACLF) using plasma-based biomarkers. The patients studied were part of the CANONIC study (N=337; AD: 258; ACLF: 79); additional cohorts included healthy volunteers, stable cirrhotic patients and a group of 16 AD patients for histological studies. Caspase-cleaved keratin 18 (cK18) and keratin 18 (K18), which reflect apoptotic and total cell death respectively and cK18:K18 ratio (apoptotic index) were measured in the plasma by ELISA...
October 10, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28983839/aki-persistence-at-48%C3%A2-h-predicts-mortality-in-patients-with-acute-on-chronic-liver-failure
#11
Rakhi Maiwall, Guresh Kumar, Ankit Bharadwaj, Kapil Jamwal, Ajeet Singh Bhadoria, Priyanka Jain, Shiv Kumar Sarin
BACKGROUND AND AIM: Management of acute kidney injury (AKI) in cirrhotics has undergone a paradigm change. We evaluated the impact of AKI persistence at 48 h on outcome in patients with acute on chronic liver failure (ACLF). METHODS: Consecutive patients with ACLF (n = 373) were prospectively followed. AKI was defined as increase in serum creatinine of 0.3 mg/dl or 1.5- to 2-fold from baseline. Persistent AKI was defined as nonresponsive AKI at 48 h with respect to admission serum creatinine...
October 5, 2017: Hepatology International
https://www.readbyqxmd.com/read/28979154/risks-of-peg-tube-placement-in-patients-with-cirrhosis-associated-ascites
#12
Yasir Al-Abboodi, Ali Ridha, Matthew Fasullo, Tarek H Naguib
This study examined the safety of placing percutaneous endoscopic gastrostomy (PEG) tube in people with liver cirrhosis. The target population was further subdivided into people with ascites (case group) and people without ascites (control). We compare the morbidity and the mortality difference of PEG placement in cirrhotic patients with ascites vs cirrhotic patients without ascites. We then examined multiple factors including sex, race, chronic illness including hypertension, congestive heart failure, and others and their influence on the inpatient mortality of all cirrhotic patients who had PEG placement...
2017: Clinical and Experimental Gastroenterology
https://www.readbyqxmd.com/read/28959427/raised-serum-lactate-in-a-cirrhotic-patient-presenting-after-a-trivial-fall
#13
Olusegun M Ayeko, Jonathan Barrow, Michael O Ayeko
We present the case of a pelvic fracture in a 69-year-old man with Child-Pugh class C cirrhosis who presented to the Accident and Emergency department after a slip on wet grass. After initially being systemically well, he became haemodynamically unstable in the Emergency department requiring resuscitation via the massive transfusion pathway. He was admitted to intensive care unit for resuscitation following a CT angiogram which showed no arterial bleed, but significant retroperitoneal haematoma. He received a prophylactic embolization of the internal iliac artery 2 days later and his acetabular fracture was managed with skeletal traction...
September 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28948051/persistent-unexplained-dyspnea-a-case-of-hepatopulmonary-syndrome
#14
Alfonso Campanile, Alessandro Colombo, Maurizio Del Pinto, Claudio Cavallini
Regarding a patient with dyspnea, the history and physical examination often lead to the correct diagnosis. In some circumstances, when more than one underlying disease is present, the diagnostic process can be more challenging. We describe an unusual case of dyspnea and persistent hypoxemia related to a hepatopulmonary syndrome in a 53-year-old patient with known heart failure and chronic liver disease. Initially managed with intravenous diuretic therapy, due to signs of lung and peripheral congestion, our patient did not improve as expected; therefore we performed more advanced studies with a chest-abdomen CT scan and a right heart catheterization...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28935188/liver-transplantation-for-nash-cirrhosis-is-not-performed-at-the-expense-of-major-post-operative-morbidity
#15
Eline H van den Berg, Rianne M Douwes, Vincent E de Meijer, Tim C M A Schreuder, Hans Blokzijl
BACKGROUND: Non-alcoholic steatohepatitis (NASH) is an emerging indication for liver transplantation (LT) and coexists with multiple comorbidities. Obese and cirrhotic patients experience more perioperative complications. Limited data exist about short-term complications after LT for NASH cirrhosis. AIM: Investigate short-term complications in patients transplanted for NASH cirrhosis. METHODS: Single center retrospective cohort study including patients >18years who underwent LT between 2009-2015...
August 12, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28930918/neutrophil-to-lymphocyte-ratio-predicts-death-in-acute-on-chronic-liver-failure-patients-admitted-to-the-intensive-care-unit-a-retrospective-cohort-study
#16
Nicolas Moreau, Xavier Wittebole, Yvan Fleury, Patrice Forget, Pierre-François Laterre, Castanares-Zapatero Diego
The neutrophil-to-lymphocyte ratio (NLR) is an inflammation score recognized as associated with outcome. While inflammation has been shown to correlate with the development of acute-on-chronic liver failure (ACLF), we sought to investigate the role of NLR in predicting 90-day mortality in cirrhotic patients experiencing ACLF.We performed a retrospective cohort study involving a total of 108 consecutive cirrhotic patients admitted in the intensive care unit (ICU). NLR, clinical and biological data were recorded...
September 19, 2017: Shock
https://www.readbyqxmd.com/read/28928275/development-of-diagnostic-criteria-and-a-prognostic-score-for-hepatitis-b-virus-related-acute-on-chronic-liver-failure
#17
Tianzhou Wu, Jiang Li, Li Shao, Jiaojiao Xin, Longyan Jiang, Qian Zhou, Dongyan Shi, Jing Jiang, Suwan Sun, Linfeng Jin, Ping Ye, Lingling Yang, Yinyun Lu, Tan Li, Jianrong Huang, Xiaowei Xu, Jiajia Chen, Shaorui Hao, Yuemei Chen, Shaojie Xin, Zhiliang Gao, Zhongping Duan, Tao Han, Yuming Wang, Jianhe Gan, Tingting Feng, Chen Pan, Yongping Chen, Hai Li, Yan Huang, Qing Xie, Shumei Lin, Lanjuan Li, Jun Li
OBJECTIVE: The definition of acute-on-chronic liver failure (ACLF) based on cirrhosis, irrespective of aetiology, remains controversial. This study aimed to clarify the clinicopathological characteristics of patients with hepatitis B virus-related ACLF (HBV-ACLF) in a prospective study and develop new diagnostic criteria and a prognostic score for such patients. DESIGN: The clinical data from 1322 hospitalised patients with acute decompensation of cirrhosis or severe liver injury due to chronic hepatitis B (CHB) at 13 liver centres in China were used to develop new diagnostic and prognostic criteria...
September 19, 2017: Gut
https://www.readbyqxmd.com/read/28921803/the-pathophysiology-of-arterial-vasodilatation-and-hyperdynamic-circulation-in-cirrhosis
#18
Søren Møller, Flemming Bendtsen
Patients with cirrhosis and portal hypertension often develop complications from a variety of organ systems leading to a multiple organ failure. The combination of liver failure and portal hypertension result in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral arterial vasodilatation. Increases in circulatory vasodilators are believed to be due to portosystemic shunting and bacterial translocation leading to redistribution of the blood volume with central hypovolemia. Portal hypertension per se and increased splanchnic blood flow are mainly responsible for the development and perpetuation of the hyperdynamic circulation and the associated changes in cardiovascular function with development of cirrhotic cardiomyopathy, autonomic dysfunction, and renal dysfunction as part of a cardiorenal syndrome...
September 16, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28901345/-acute-alcoholic-hepatitis
#19
Gianni Testino, Emanuele Scafato, Valentino Patussi
Chronic alcohol related liver disease is characterized by a cascade of events defined as follows: steatosis, steatohepatitis/steatofibrosi, cirrhosis and hepatocellular carcinoma. On one of these histologic patterns may overlap acute alcoholic hepatitis (AAE) (mild, moderate, severe). Severe AAE can cause a severe clinical picture: jaundice with a duration of less than three months, jaundice in the first decompensation event, serum bilirubin higher than 5 mg/dL, ratio AST/ALT >2:1, AST less than 500 IU/L ALT <300 IU/L, neutrophil leukocytosis and increased GGT...
September 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28900784/liver-involvement-in-urea-cycle-disorders-a-review-of-the-literature
#20
REVIEW
Adrien Bigot, Michel C Tchan, Benjamin Thoreau, Hélène Blasco, François Maillot
Urea cycle disorders (UCDs) are inborn errors of metabolism of the nitrogen detoxification pathway and encompass six principal enzymatic deficiencies. The aging of UCD patients leads to a better knowledge of the long-term natural history of the condition and to the reporting of previously unnoticed manifestations. Despite historical evidence of liver involvement in UCDs, little attention has been paid to this organ until recently. Hence, we reviewed the available scientific evidence on acute and chronic liver dysfunction and liver carcinogenesis in UCDs and discuss their pathophysiology...
November 2017: Journal of Inherited Metabolic Disease
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