Diabetes mellitus at the time of diagnosis ofcirrhosis is associated with higher incidence of spontaneous bacterial peritonitis, but not with increased mortality

2013 ◽  
Vol 125 (7) ◽  
pp. 341-348 ◽  
Author(s):  
Nick Wlazlo ◽  
Marleen M. van Greevenbroek ◽  
Joyce Curvers ◽  
Erik J. Schoon ◽  
Pieter Friederich ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Platelet Count ◽  
Spontaneous Bacterial Peritonitis ◽  
Laboratory Data ◽  
Meld Score ◽  
Prognostic Impact ◽  
Bacterial Peritonitis ◽  
Increased Risk ◽  
End Stage

DM (diabetes mellitus) is present in 20–40% of patients with liver cirrhosis, but its prognostic impact is unclear. Therefore, in the present study, we investigated whether the presence of DM in patients with cirrhosis was associated with increased mortality, and/or with increased incidence of SBP (spontaneous bacterial peritonitis). We reviewed medical and laboratory data of 230 patients with cirrhosis from the period 2001–2011, for whom data were complete in n=226. Follow-up for the outcomes mortality and SBP was performed until May 2012, with only 13 patients lost to follow-up. DM was present at baseline in 78 patients (35%). Median follow-up was 6.2 (interquartile range, 3.1–9.3) years, during which 118 patients died [47 out of 78 with DM (60%), and 71 out of 148 without DM (48%)]. The presence of DM at baseline was not associated with increased mortality after adjustment for age {HR (hazard ratio), 1.00 [95% CI (confidence interval), 0.67–1.50]}. Further adjustment for sex, aetiology of cirrhosis, platelet count and the Child–Pugh or MELD (model for end-stage liver disease) score did not change this finding. During follow-up, 37 patients developed incident SBP (19 with DM and 18 without DM). DM at baseline was associated with incident SBP, even after adjustment for age, sex, aetiology, platelet count and the Child–Pugh [HR, 2.39 (95% CI, 1.10–5.18)] or MELD score [HR, 2.50 (95% CI, 1.16–5.40)]. In conclusion, the presence of DM at baseline in patients with cirrhosis was associated with an increased risk of SBP, which may represent an increased susceptibility to infections. On the other hand, DM was not clearly associated with increased mortality in these patients.

Predictive and Prognostic Value of Ascitic Fluid Mannose‑binding lectin in Patients with Spontaneous Bacterial Peritonitis

2020 ◽  
Vol 19 ◽  
Author(s):  
Amal A. Mohamed ◽  
Mohamed Abdelhamid ◽  
Naglaa El-Toukhy ◽  
Ahmed Sabry ◽  
Rania Abdelmonem Khattab ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Significant Negative Correlation ◽  
Meld Score ◽  
Mannose Binding Lectin ◽  
Bacterial Peritonitis ◽  
Mannose Binding ◽  
End Stage ◽  
Binding Lectin

Background/Aim: Spontaneous bacterial peritonitis is a common bacterial infection of ascitic fluid mainly in ascites due to liver cirrhosis. Mannose-binding lectin (MBL) can activate phagocytosis and the complement system. Spontaneous bacterial peritonitis was detected to be higher in MBL deficiency. This study aimed to assess ascitic fluid MBL in liver cirrhosis and spontaneous bacterial peritonitis. Methods: Ninety patients with cirrhotic ascites were included. Forty five of them had SBP. Child-Pugh score, Model for End Stage Liver Disease (MELD) and its update (uMELD) scores were used to assess severity of liver cirrhosis. Ascitic fluid samples were obtained for differentiation of leucocytic count, estimation of albumin, protein, glucose, and serumascitic albumin gradient. Ascitic fluid levels of MBL were measured for all patients. SBP was documented if polymorphonuclear leucocytic count ≥250/mm in ascitic fluid. Results: Ascitic fluid MBL level was significantly lower in patients with SBP. MBL had a significant negative correlation with ascitic total leukocytic count (TLC), also with serum creatinine, bilirubin, PT, INR and MELD score among SBP patients. However, it had a significant positive correlation with ascitic protein and with platelets. According to multivariate analysis; fever, TLC, platelets, creatinine, MBL, glucose and polymorphs were independent predictors for SBP development. Conclusion: Ascitic fluid MBL could be a good predictive and prognostic marker in patients with cirrhosis and spontaneous bacterial peritonitis.

Prognostic impact of right ventricular overload in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Sato ◽  
Y Ogihara ◽  
T Kurita ◽  
H Mizutani ◽  
A Takasaki ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Right Ventricular ◽  
Laboratory Data ◽  
Prognostic Impact ◽  
Entire Study ◽  
Poor Prognostic Factor ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Right ventricular (RV) overload is associated with adverse outcome in patients with chronic heart failure. However, its prognostic value in acute coronary syndrome (ACS) patients remains unknown. Purpose The purpose of this study was to investigate the prevalence and prognostic impact of right ventricular overload in ACS patients. Methods We studied 2797 ACS patients from Mie ACS registry, a prospective and multicenter registry in Japan. They were divided into 4 subgroups according to the severity of RV overload and the extent of Left Ventricle Ejection Fraction (LVEF) assessed by echocardiography before hospital discharge. High RV overload was defined as trans-tricuspid pressure gradient (TRPG) ≥40mmHg and preserved LVEF was defined as ≥50%. The primary outcome was defined as 2-year all-cause mortality. Median follow up duration was 730 days (1–2215 days). Results High RV overload was detected in 76 patients (2.7%). In basic patients characteristics, high RV overload patients were significantly older and higher killip classification than low RV overload patients (P<0.01, respectively). Laboratory data in high RV overload patients showed lower hemoglobin level and higher serum creatinine level than those in low RV overload patients (P<0.01, respectively). Echocardiographic findings in high RV overload represented lower LVEF, higher rate of moderate or severe mitral regurgitation and left atrial enlargement than those in low RV overload patients (P<0.01, respectively). During the follow-up periods (median 730 days), 260 (9.3%) patients experienced all-cause death. Multivariate cox hazard regression analysis for all-cause mortality demonstrated that high RV overload was an independent poor prognostic factor in the entire study population. Among patients with preserved LVEF, high RV overload resulted in an increased risk of all-cause mortality compared to low RV overload (P<0.0001). Conclusion In ACS patients, high RV overload strongly contributes to worsening of prognosis regardless of the extent of LVEF. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

scholarly journals Dosing of ceftriaxone and outcomes after spontaneous bacterial peritonitis

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 57
Author(s):  
Laura Mazer ◽  
Elliot B. Tapper ◽  
Gail Piatkowski ◽  
Michelle Lai
Keyword(s):  
Intensive Care ◽  
Odds Ratio ◽  
Spontaneous Bacterial Peritonitis ◽  
Meld Score ◽  
Baseline Model ◽  
Bacterial Peritonitis ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
One Year ◽  
End Stage

Background: Spontaneous bacterial peritonitis (SBP) is a common, often fatal affliction for cirrhotic patients. Despite all clinical trials of ceftriaxone for SBP using 2g daily, it is often given at 1g daily.Aim: We evaluated outcomes of SBP as a function of ceftriaxone dosage.Methods:  A retrospective cohort of all patients who received ceftriaxone for SBP (greater than 250 neutrophils in the ascites).Results: As opposed to 1 gram, median survival is longer for patients receiving 2 grams (228 days vs. 102 days (p = 0.26) and one year survival is significantly higher (p = 0.0034).  After adjusting for baseline Model for End Stage Liver Disease (MELD) score, however, this difference was no longer significant.  Similarly, there was a significantly shorter length of intensive care for patients receiving 2 g (0.59 ± 1.78 days vs. 3.26 ± 6.9, p = 0.034), odds ratio 0.11 (95% CI 0.02 - 0.65). This difference, too, was no longer significant after controlling for the MELD score - odds ratio 0.21 (95% CI 0.04 - 1.07). Additionally, 70% of patients received at least one additional antibiotic; over 25 different medications were used in various combinations.Conclusions:  We recommend fastidious antibiotic stewardship for patients with cirrhosis and that efforts should be made to standardize the treatment of SBP. The complexity of antibiotic regimens to which cirrhotic patients are exposed must be studied further and rationalized.  Patients receiving 2 g of ceftriaxone may require fewer intensive care days and enjoy an improved 1 year survival compared to those receiving 1 g daily.

scholarly journals The need for antibiotic stewardship and treatment standardization in the care of cirrhotic patients with spontaneous bacterial peritonitis – a retrospective cohort study examining the effect of ceftriaxone dosing

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 57 ◽  
Author(s):  
Laura Mazer ◽  
Elliot B. Tapper ◽  
Gail Piatkowski ◽  
Michelle Lai
Keyword(s):  
Intensive Care ◽  
Antibiotic Stewardship ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Spontaneous Bacterial Peritonitis ◽  
Meld Score ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
One Year ◽  
End Stage

Background: Spontaneous bacterial peritonitis (SBP) is a common, often fatal affliction for cirrhotic patients. Despite all clinical trials of ceftriaxone for SBP using 2g daily, it is often given at 1g daily.Aim: We evaluated survival after SBP as a function of ceftriaxone dosage.Methods:  A retrospective cohort of all patients who received ceftriaxone for SBP (greater than 250 neutrophils in the ascites).Results: As opposed to 1 gram, median survival is longer for patients receiving 2 grams (228 days vs. 102 days (p = 0.26) and one year survival is significantly higher (p = 0.0034).  After adjusting for baseline Model for End Stage Liver Disease (MELD) score, however, this difference was no longer significant.  Similarly, there was a significantly shorter length of intensive care for patients receiving 2 g (0.59 ± 1.78 days vs. 3.26 ± 6.9, p = 0.034), odds ratio 0.11 (95% CI 0.02 - 0.65). This difference, too, was no longer significant after controlling for the MELD score - odds ratio 0.21 (95% CI 0.04 - 1.07). Additionally, 70% of patients received at least one additional antibiotic; over 25 different medications were used in various combinations.Conclusions:  Patients receiving 2 g of ceftriaxone may require fewer intensive care days and may enjoy an improved survival compared to those receiving 1 g daily. The complexity of antibiotic regimens to which cirrhotic patients are exposed must be studied further and rationalized.  We recommend fastidious antibiotic stewardship for patients with cirrhosis. Efforts should be made to craft local standards for the treatment of SBP that include appropriate antibiotic selection and dose.

scholarly journals Predictive Value of the Model of End-Stage Liver Disease in Cirrhotic Patients with and without Spontaneous Bacterial Peritonitis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Bledar Kraja ◽  
Marsela Sina ◽  
Iris Mone ◽  
Fatjona Pupuleku ◽  
Adriana Babameto ◽  
...  
Keyword(s):  
Liver Disease ◽  
Predictive Value ◽  
Spontaneous Bacterial Peritonitis ◽  
Fatal Outcome ◽  
Meld Score ◽  
University Hospital ◽  
Bacterial Peritonitis ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Objective. We aimed to assess the predictive value of the model of end-stage liver disease (MELD) in hospitalized cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) and fatal outcome.Methods. A cross-sectional study included 256 consecutive patients (199 men and 57 women) diagnosed with cirrhosis and ascites who were hospitalized at the University Hospital Center in Tirana from January 2008 to December 2009. SBP was defined as a neutrophil count of ≥250 cells/mm3in ascitic fluid. MELD score was based on laboratory parameters determined by UNOS Internet site MELD calculator.Results. In multivariable-adjusted logistic regression models controlling for age, sex, diabetes, and etiology, there was evidence of a positive association of SBP with MELD score: the odds ratio (OR) for SBP for one unit increment of MELD score was 1.06 (95% Cl = 1.02–1.09). MELD score was significantly higher in fatal cases than nonfatal patients (mean age-adjusted score was 32.7 versus 18.4 overall; 34.8 versus 18.0 in SBP patients, and 32.0 versus 18.5 in non-SBP patients; allP<0.001).Conclusions. In this Albanian sample of hospitalized cirrhotic patients, MELD score was confirmed as a significant predictor of both SBP and fatal outcome.

Prevalence and prognostic impact of somatic mutations in patients with heart failure and reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.J Vazquez Andres ◽  
A Hernandez Vicente ◽  
M Diez Diez ◽  
M Gomez Molina ◽  
A Quintas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Somatic Mutations ◽  
Myocardial Dysfunction ◽  
Study Endpoint ◽  
Prognostic Impact ◽  
Reduced Ejection Fraction ◽  
Increased Risk ◽  
Patients With Heart Failure

Abstract Introduction Somatic mutations in hematopoietic cells are associated with age and have been associated with higher mortality in apparently healthy adults, especially due to atherosclerotic disease. In animal models, somatic mutations are associated with atherosclerosis progression and myocardial dysfunction, especially when gene TET2 is affected. Preliminary clinical data, referred to ischemic heart failure (HF), have associate the presence of these acquired mutations with impaired prognosis. Purpose To study the prevalence of somatic mutations in patients with heart failure with reduced ejection fraction (HFrEF) and their impact on long-term prognosis. Methods We studied a cohort of elderly patients (more than 60 years old) hospitalized with HFrEF (LVEF&lt;45%). The presence of somatic mutations was assessed using next generation sequencing (Illumina HiSeq 2500), with a mutated allelic fraction of at least 2% and a panel of 55 genes related with clonal hematopoiesis. Patients were followed-up for a median of three years. The study endpoint was a composite of death or readmission for worsening HF. Kaplan-Meier analysis (log-rank test) and Cox proportional hazards regression models were performed adjusting for age, sex and LVEF. Results A total of 62 patients (46 males (74.2%), age 74±7.5 years) with HFrEF (LVEF 29.7±7.8%) were enrolled in the study. The ischemic etiology was present in 54% of patients. Somatic mutations in Dnmt3a or Tet2 were present in 11 patients (17.7%). No differences existed in baseline characteristics except for a higher prevalence of atrial fibrillation in patients with somatic mutations (70% vs. 40%, p=0.007). During the follow-up period, 40 patients (64.5%) died and 38 (61.3%) had HF re-admission. The KM survival analysis for the combined event is shown in Figure 1. Compared with patients without somatic mutations and after adjusting for covariates, there was an increased risk of adverse outcomes when the somatic mutations were present (HR 3.6, 95% CI [1.6, 7.8], p=0.0014). This results remains considering death as a competing risk (Gray's test p=0.0097) and adjusting for covariates (HR = 2.21 95% CI [0.98, 5], p=0.0556). Conclusions Somatic mutation are present in patients with HFrEF and determine a higher risk of adverse events in the follow-up. Further studies are needed to assess the clinical implications of these findings. Figure 1 Funding Acknowledgement Type of funding source: None

Mo1002 MELD Score Is a Risk for First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis

2014 ◽  
Vol 146 (5) ◽  
pp. S-983
Author(s):  
Rashid Khan ◽  
Whitney Jennings ◽  
Habeeb Salameh ◽  
Kirk Russ ◽  
Matthew J. Skinner ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Meld Score ◽  
First Episode ◽  
Bacterial Peritonitis

scholarly journals Clinical Outcomes of Patients With Primary Membranous Nephropathy and Subnephrotic Proteinuria

2021 ◽  
Vol 8 ◽  
Author(s):  
Peng He ◽  
Yang Zha ◽  
Jing Liu ◽  
Hanmin Wang ◽  
Lijie He
Keyword(s):  
Kidney Function ◽  
Membranous Nephropathy ◽  
Independent Predictor ◽  
Effective Management ◽  
Nephrotic Proteinuria ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Course Outcomes ◽  
End Stage

Objectives: To update the information about the prognosis of patients with primary membranous nephropathy (MN) and subnephrotic proteinuria and identify the relevant predictors.Methods: In total, 474 cases of biopsy-proven primary MN with at least 18 months of follow-up were reviewed to determine the outcomes of the subgroup of patients that presented with subnephrotic proteinuria. Clinical data included initial proteinuria and microhematuria, defined as the average proteinuria/microhematuria of the first 6 months during the course. Outcomes included partial remission (PR), complete remission (CR), nephrotic proteinuria progression, and kidney function progression, defined as ≥50% loss of kidney function or end-stage kidney disease.Results: In total, 205 patients with primary MN and subnephrotic proteinuria at biopsy were eligible. During a median follow-up of 43 months, 200 (97.56%), 167 (81.46%), and 53 (25.85%) patients attained PR, CR, and nephrotic proteinuria progression, respectively. Only one patient (0.49%) progressed to the kidney function progression. By multivariate Cox hazards regression analyses, the initial proteinuria was identified as the independent predictor for PR, CR, and nephrotic proteinuria progression with adjusted hazard ratios (aHRs) of 0.67 (95% confidence interval, 0.56–0.80), 0.50 (95% CI, 0.40–0.63), and 2.97 (95% CI, 2.23–3.97), respectively. A higher level of initial microhematuria was also associated with an increased risk of nephrotic proteinuria progression. The corresponding aHR was 1.11 (95% CI, 1.05–1.17).Conclusion: Among patients with primary MN and subnephrotic proteinuria, although the overall prognosis is excellent, dynamic detection and effective management of proteinuria remain important. In addition, initial microhematuria may be another predictor of nephrotic proteinuria progression.

scholarly journals Perioperative changes of response to antiplatelet medication in vascular surgery patients

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244330
Author(s):  
Thomas Hummel ◽  
Saskia Hannah Meves ◽  
Andreas Breuer-Kaiser ◽  
Jan-Ole Düsterwald ◽  
Dominic Mühlberger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Vascular Surgery ◽  
Reactive Protein ◽  
Antiplatelet Medication ◽  
Impedance Aggregometry ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Artery Disease

Introduction Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures. Methods Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response. Results A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence. Conclusion The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions.

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