P-O14 The predictive role of pre-operative liver function tests in outcomes following emergency appendicectomy

Abstract Background Acute appendicitis remains one of the most common diagnoses in emergency general surgery, with recent evidence from the COMMA trial confirming that appendicectomy is the cornerstone of definitive management in most patients. With a wide range of severity and of patient physiology, complications are a burden to patients and the health service. We hypothesised that liver function tests have predictive value for complications following emergency appendicectomy. Methods A multicentre retrospective observational study was carried out across 4 hospitals (2 teaching centres and 2 district general hospitals) for adult patients who underwent emergency appendectomy between August 2018 and November 2020. Patients were identified through pathology records and data was extracted from electronic case records for patient demographics, pre-operative routine laboratory results, operative details, and clinical outcomes. Peak perioperative liver function parameters were analysed using unpaired two-way T-tests, Pearson’s correlation coefficient, ANOVA and multivariate regression to determine their relationship with conversion to open surgery, superficial and deep surgical site infection (SSI), length of stay (LOS) and 30-day re-admission rates. Results Of 1131 patients included, 57.4% were male, 80.5% were laparoscopic, with 7.3% converted to open, 10.8% performed open, and 1.5% by laparotomy. Mean LOS was 3.81 (SD4.0) days, 6.3% readmission rate, with 2.3% superficial SSI and 5.0% deep SSI. ALP was higher in patients with superficial SSI (p < 0.001). Lower ALT was associated with wound dehiscence (p < 0.001). Bilirubin, AST and ALT were lower in patients with chest infections (p < 0.001). ALP correlated with increased LOS (p < 0.001). On multivariable regression, ALP was associated with superficial SSI (p < 0.001), and LOS (p < 0.001). ROC curve analysis demonstrated AUC of 0.655 for ALP and superficial SSI. Conclusions Emergency appendicectomy is completed laparoscopically in more than 80% of patients and complication rates are acceptable. Routine liver function tests were associated with important clinical outcomes including superficial SSI, wound dehiscence, chest infection, LOS and readmission rate. Patients who had superficial SSI, wound dehiscence, chest infection and readmission with 30 days had lower transaminase levels compared with those with uncomplicated recovery.

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Faculty Opinions recommendation of Quantitative liver function tests improve the prediction of clinical outcomes in chronic hepatitis C: results from the Hepatitis C Antiviral Long-term Treatment Against Cirrhosis Trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14256977.15768111 ◽

2012 ◽

Author(s):

Antonio Craxi ◽

Vincenza Calvaruso

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Function ◽

Clinical Outcomes ◽

Chronic Hepatitis C ◽

Liver Function Tests ◽

Term Treatment ◽

Function Tests ◽

Long Term Treatment

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Quantitative liver function tests improve the prediction of clinical outcomes in chronic hepatitis C: Results from the hepatitis C antiviral long-term treatment against cirrhosis trial

Hepatology ◽

10.1002/hep.24752 ◽

2012 ◽

Vol 55 (4) ◽

pp. 1019-1029 ◽

Cited By ~ 39

Author(s):

Gregory T. Everson ◽

Mitchell L. Shiffman ◽

John C. Hoefs ◽

Timothy R. Morgan ◽

Richard K. Sterling ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Function ◽

Clinical Outcomes ◽

Chronic Hepatitis C ◽

Liver Function Tests ◽

Term Treatment ◽

Function Tests ◽

Long Term Treatment

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A unique type of fully covered metal stent for the management of post liver transplant biliary anastomotic strictures

10.21203/rs.3.rs-17342/v2 ◽

2020 ◽

Author(s):

Ben Warner ◽

Phillip Harrison ◽

Muhammad Farman ◽

John Devlin ◽

David Reffitt ◽

...

Keyword(s):

Liver Function ◽

Liver Transplant ◽

Biliary Obstruction ◽

Liver Function Tests ◽

Stent Insertion ◽

Complication Rates ◽

Metal Stent ◽

Unique Type ◽

Function Tests ◽

Anastomotic Strictures

Abstract Background: We report our experience of treating anastomotic strictures using a novel type of fully covered metal stent (FCSEMS). This stent, known as the Kaffes Stent, is short-length with an antimigration waist and easily removable due to long retrieval wires deployed within the duodenum. Methods: 62 patients underwent ERCP and Kaffes stent insertion for post-transplant anastomotic strictures following confirmation of a stricture and biliary obstruction on MRCP. These patients were retrospectively analysed for immediate and longterm stricture resolution, improvement in symptoms and liver function tests (LFTs), stricture recurrence and complication rates. Results: 96% had immediate stricture resolution and 81% of patients continued to have long-term resolution (mean follow-up period was 548 days). Of the 16 patients with symptoms of biliary obstruction, 13 had resolution of their symptoms. A further 46 patients were asymptomatic, although 18 of these had cholestatic liver function tests. Overall, there was a significant improvement in LFTs. Complication rates were 15% with only one patient requiring biliary reconstruction. Conclusions: The Kaffes stent is effective and safe at resolving post liver transplant biliary anastomotic strictures.

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Abnormal Liver Function Tests Were Associated Adverse Clinical Outcomes: An Observational Cohort Study of 2912 Patients with COVID-19

SSRN Electronic Journal ◽

10.2139/ssrn.3723310 ◽

2020 ◽

Author(s):

Yong Lv ◽

Xiaodi Zhao ◽

Yan Wang ◽

Jingpu Zhu ◽

Chengfei Ma ◽

...

Keyword(s):

Cohort Study ◽

Liver Function ◽

Clinical Outcomes ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Observational Cohort Study ◽

Function Tests ◽

Observational Cohort

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Clinical outcomes of non-variceal upper gastrointestinal bleeding and its relation to aspirin and anticoagulants.

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3222 ◽

2020 ◽

Vol 8 (B) ◽

pp. 11-19

Author(s):

Hend Radwan ◽

Ehab Elsayed ◽

Hesham Alshabrawi

Keyword(s):

Blood Transfusion ◽

Liver Function ◽

Gastrointestinal Bleeding ◽

Clinical Outcomes ◽

Upper Gastrointestinal Bleeding ◽

Liver Function Tests ◽

Gi Bleeding ◽

Function Tests ◽

History Of ◽

Upper Gastrointestinal

BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a life-threatening emergency that requires an urgent management. Antiplatelet (e.g., aspirin) and anticoagulant drugs are widely chronically used in various cardiac and coronary artery diseases. These drugs increase the risk of NVUGIB as they may cause ulceration of the upper gastrointestinal (GI) mucosa directly or may cause bleeding or rebleeding. The management of NVUGIB is complicated as the risk between GI bleeding episodes and cardiovascular attacks needs to be well managed. AIM: The aim of this study is to determine the impact of antiplatelets (aspirin) and anticoagulants use on the morbidity, mortality, and clinical outcomes in patients presented with non-variceal GI bleeding. PATIENTS AND METHODS: A total of 105 patients presented with melena and/or hematemesis and diagnosed by upper GI endoscopy were enrolled in a prospective cohort study. Patients were sub-grouped according to their use of antiplatelets, anticoagulants, or none (controls). Patients were excluded if they had portal hypertension or nonsteroidal anti-inflammatory drugs (NSAIDs) use and divided into five groups: Group I – patients who had not taken anticoagulants and antiplatelet; Group II – patients on heparin, warfarin, and LMWH only; Group III – patients on aspirin only; Group IV – patients on clopidogrel and ticlopidine with or without aspirin; and Group V – patients on combined anticoagulants and antiplatelet. All patients were subjected to clinical, laboratory (complete blood count, liver function tests, renal function tests, prothrombin time, and partial thromboplastin time), and endoscopic investigations. Clinical details were reported including admission, blood transfusion, rebleeding, and mortality. RESULTS: Full medical history revealed that 43 patients were diabetic, 45 patients were cardiac, and 67 patients were hypertensive. Regarding the history of analgesic drug intake, 38 patients used NSAIDs and 29 of them used non-selective NSAIDs and 8 patients used selective NSAIDs. There were non-significant differences among the studied groups with NVUGIB regarding sex, hematemesis only presentation, melena only presentation, liver function tests, and endoscopic findings. On the other hand, there were statistically significant differences between the studied groups with NVGIB regarding increasing age, NSAIDs use whatever selective or non-selective, decrease level of HB, WBCs, serum albumin, bleeding profile, kidney function tests, clinical presentation in the form of hematemesis and melena, need for blood transfusion, history of associated diseases, especially being cardiac patients, rebleeding after 6 and 12 months, and mortality. CONCLUSION: Aspirin intake may be associated with less favorable clinical outcomes in patients with NVUGIB, while combined anticoagulants and antiplatelets seem to be associated with the worse outcomes.

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An Unusual Occurrence of Hepatic Granulomas and Secondary Sitosterolemia in Turner Syndrome

Case Reports in Medicine ◽

10.1155/2015/186718 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

JayaKrishna Chintanaboina ◽

Pragnesh R. Shah ◽

Thomas R. Riley

Keyword(s):

Liver Transplantation ◽

Liver Function ◽

Turner Syndrome ◽

Cholesterol Metabolism ◽

Liver Function Tests ◽

Decompensated Liver Cirrhosis ◽

Function Tests ◽

Lipid Panel ◽

Wide Range ◽

Hepatic Granulomas

Although abnormal liver function tests occur in 50–80% of cases with Turner syndrome, there are no previous reports of overt hepatic disease or hepatic granulomas associated with Turner’s syndrome. We report three cases of Turner syndrome associated with hepatic granulomas with a wide range of liver dysfunction. Of the three patients, first patient underwent liver transplantation; second patient remained stable on immunosuppressants; and third patient died from complications of decompensated liver cirrhosis as she declined liver transplantation due to multiple comorbidities. One patient had sitosterolemia, a rare inherited autosomal recessive disorder of cholesterol metabolism, after she ingestedβ-sitosterol supplement and had worsening liver function tests and lipid panel. She had remarkably abnormal lipid panel that responded to ezetimibe and by stopping theβ-sitosterol supplement.

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