scholarly journals Sofosbuvir/ledipasvir in treatment of HCV infected Egyptian patients with decompensated liver cirrhosis Child Pugh class (B)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Abbass ◽  
A Ghalwash ◽  
M S Abdelhamid ◽  
H S Hamdy
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
International Normalized Ratio ◽  
Viral Clearance ◽  
Decompensated Cirrhosis ◽  
Decompensated Liver Cirrhosis ◽  
Decompensated Liver Disease ◽  
Number Of Patients ◽  
Egyptian Patients ◽  
Class B

Abstract Background The main goal of anti-HCV therapy in patients with decompensated (Child-Pugh B) cirrhosis not on a transplant waiting list is to achieve improvement in liver function and survival. Several studies have demonstrated acceptably high SVR rates, equivalent in Child-Pugh B patients, in individuals with decompensated cirrhosis, together with an effect of therapeutic viral clearance on liver function, with significant improvements in bilirubin, albumin and international normalized ratio values and, as a result, in MELD and Child-Pugh scores in one-third to half of patients. Similar results were reported in real-world studies. Patients with Child-Pugh B cirrhosis benefited more from viral clearance in terms of adverse event-free survival at 15 months than those with Child-Pugh C cirrhosis. Aim of the Work Assessment of the safety & efficacy of sofosbuvir/ ledipasvir in infected naïve and experienced HCV Egyptian patients with decompensated liver disease. Patients and Method This study was conducted on 100 patients with HCV related decompensated liver disease who presented to the hepatology outpatient clinic in El Agouza Police hospital and were evaluated according to the inclusion and exclusion criteria. Conclusion Ledipasvir/sofosbuvir is effective and safe in the treatment of HCV decompensated patients Child Pugh B. MELD and Child scores significantly improved with HCV treatment in decompensated patients Recommendations Longer follow up with assessment of the need for liver transplantation or HCC development is important. Larger number of patients is required.

Sofosbuvir plus Daclatasvir without Ribavirin for the Treatment of Chronic Hepatitis C in Patients with Decompensated Liver Disease

2020 ◽  
Vol 14 (1) ◽  
pp. 41-44
Author(s):  
Mahmood Ahmad ◽  
Muhammad Ayub ◽  
Fawad Iqbal Janjua ◽  
Abdul Moiz Bhatti ◽  
Nooman Gilani
Keyword(s):  
Chronic Hepatitis ◽  
Liver Disease ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Treatment Success ◽  
Virologic Response ◽  
Decompensated Cirrhosis ◽  
Hepatitis C Infection ◽  
Hepatic Decompensation ◽  
Decompensated Liver Disease

ABSTRACT Background: In chronic hepatitis C infection, hepatic decompensation remained a contraindication to treatment for many years. The direct acting antiviral drugs have shown high treatment success even in decompensated liver disease. This study aims to assess the response and safety profile of Sofosbuvir and Daclatasvir in patients of decompensated cirrhosis with chronic hepatitis C. Patients and Methods: It was a prospective observational study conducted at Gastroenterology Department of Gujranwala Medical College/ DHQ teaching Hospital, Gujranwala from February 2016 to December 2017.Consecutive patients of hepatitis C with decompensated cirrhosis were enrolled in the study. Sofosbuvir 400mg and Daclatasvir 60mg was given to all patients without ribavirin for a period of 24 weeks. Sustained virologic was taken as primary end point. Results: A total of 140 patients were included in our study, 122 patients (87%) completed the study, 08 patients (5.7%) were lost to follow up, treatment discontinuation was seen in 06 patients (4.2%) & 04 patients (2.8%) died during the study. 110 patients (90.2%) achieved end treatment response (ETR), 12 patients (9.8%) remained treatment non-responder, 100 patients (82%) achieved sustained virological response (SVR12) and 10 patients (8%) had a relapse of HCV infection. Conclusion: Once daily oral Sofosbuvir plus Daclatasvir without Ribavirin achieved overall high rates of sustained virologic response in patients with chronic HCV having decompensated liver disease.

scholarly journals Optimization of long-term prognosis of patients with alcoholic liver disease

2020 ◽  
pp. 176-181
Author(s):  
V. D. Lunkov ◽  
M. V. Maevskaya ◽  
V. T. Ivashkin
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Alcoholic Liver Disease ◽  
Psychological Assessment ◽  
Decompensated Cirrhosis ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival

Aim: to prove the effectiveness of combined physical and psychological assessment in improving the long-term outcome of patients with alcoholic liver disease (ALD).Materials and methods: the active outpatient follow-up (AOF) group included 29 patients with ALD consisted of active liver function and motivation assessment, motivational interviewing, liver panel lab tests with the rate once at 3 months. The AOF program consisted of dynamic monitoring of liver function at least 1 time in 3 months and psychological support provided by the hepatologist using brief interventional approach. The control of abstinence was provided by using self-reports and indirect biomarkers of alcohol consumption. The control group included 36 patients with ALD and history of two-years follow-up after first alcoholinduced liver injury who received comprehensive therapy and a simple advice to avoid alcohol.Results: the adherence to abstinence were significantly higher in AOF group compared with control group. The proportion of patients with decompensated cirrhosis was significantly lower in AOF group compared with control group at 12 and 24 months after enrollment. The long-term survival in AOF-group was significantly higher than in control group. The only parameter independently associated with long-term survival was the presence of AOF program.Conclusion: the combined physical and psychological assessment of patients with ALD, provided by internists improves adherence to abstinence, reduces the risk of decompensation of liver function, severity of ALD and improves patients survival in the long term period.

scholarly journals To Study the Correlation of Serum Cholinesterase Level With Different Scoring Systems in Cirrhosis of the Liver

2021 ◽  
Vol 6 (02) ◽  
pp. 162-166
Author(s):  
Jagadeesh B S ◽  
Ravi K ◽  
Avinash H R ◽  
Nitish Ashok Gurav
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Prothrombin Time ◽  
Liver Dysfunction ◽  
Scoring Systems ◽  
Meld Score ◽  
Cirrhosis Of The Liver ◽  
Decompensated Cirrhosis ◽  
Serum Cholinesterase ◽  
Cirrhosis Of Liver

Background: Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis1. The serum cholinesterase is mainly synthesized in the liver and it is released into the blood, which is reduced in liver dysfunction due to reduced synthesis, marked reduction of cholinesterase in liver dysfunction and restoration of synthesis with hepatocyte recovery suggest serum cholinesterase activity might be a more specific marker of liver dysfunction than traditional liver function tests. Objectives: To estimate the level of serum cholinesterase in patients with cirrhosis of the liver. To correlate the level of serum cholinesterase with different scoring systems of cirrhosis of the liver and assess the utility of serum cholinesterase levels in prognostification. Materials and Methods: A cross-sectional, hospital-based, time-bound study conducted on 200 patients with cirrhosis of liver attending medicine OPD and getting admitted in hospitals attached to BMCRI from November 1st2016 to August 30th2018. All cirrhosis of liver patients were included and patients with Pregnancy, Acute infection, Chronic infection like tuberculosis and Oral contraceptive use were excluded. Serum cholinesterase, ultrasound abdomen, prothrombin Time, International Normalized Ratio, liver function test, Child-Pugh score, MELD score were measured. Results: In the study, the majority of the study subjects belonged to the age group 41 – 50 years (38.5%), followed by 31-40 years (21.5%), 51 – 60 years (18.5%). Sex distribution male 70% and female 30%. Serum Cholinesterase was positively correlated with Albumin and Prothrombin time and negatively correlated with MELD, Creatinine and Child-Pugh Score. The mean S. cholinesterase values found in study subjects belonged to Child-Pugh Score A, B and C were 4235.17 + 341.260, 3226.26 + 707.206 and 1764.09 + 808.797. The ANOVA results showed that there was a significant association found between child-pugh scores and S. cholinesterase (p – 0.001). Conclusion: The Study has demonstrated that the level of cholinesterase is correlated with the severity of the liver disease. Serum cholinesterase shows a good correlation with serum albumin, PT INR, Child-pugh score, MELD score. Compared to the above parameters serum cholinesterase is less complex and not easily affected by treatments for decompensated cirrhosis.

Prophylaxis for venous thromboembolism in liver disease: a narrative literature review

2021 ◽  
Vol 19 (Sup10) ◽  
pp. S24-S31
Author(s):  
Alex Hadall
Keyword(s):  
Liver Disease ◽  
Venous Thromboembolism ◽  
Bleeding Risk ◽  
Assessment Tools ◽  
Decompensated Liver Disease ◽  
Vte Prophylaxis ◽  
Risk Of Bleeding ◽  
Number Of Patients ◽  
Increased Risk ◽  
Narrative Literature Review

Background: Patients with liver disease have traditionally been regarded as auto-anticoagulated against developing blood clots due to haemorrhage being regarded as the most significant haemostatic complication. More recently, there has been increasing recognition that hypercoagulability is a prominent aspect of cirrhosis, with an increasing number of patients developing thromboembolisms. When prescribing prophylactic low molecular weight heparin for prevention, clinicians are often concerned about the risk of bleeding, including gastrointestinal bleeding, specifically in those with decompensated liver disease and cirrhosis, due to the altered coagulopathy associated with these patients. Aim: The aim of this review was to assess if the use of prophylaxis in patients with liver disease is effective in the prevention of venous thromboembolism (VTE) and whether its use is related to an increase in bleeding episodes. Methods: A review of the literature was conducted to identify the incidence of VTE and bleeding in liver patients when given prophylactic VTE treatment. Results: The majority of evidence was inconclusive; however, the main emerging theme was that administering prophylaxis to patients with decompensated liver disease results in an increased risk of bleeding, while having little effect on reducing the risk of VTE development. Conclusion: The bleeding risk associated with VTE prophylaxis treatment and liver disease remains uncertain. Thus the ideal methods of medical prophylactic VTE prevention and monitoring in this patient population have not yet been determined. It is suggested that additional consideration should be given to serum albumin, platelet count and international normalised ratio, as well as renal function, in conjunction with risk assessment tools, when deciding whether to prescribe VTE prophylaxis or not.

scholarly journals Treatment of Hepatitis B in Decompensated Liver Cirrhosis

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Richard Guan ◽  
Hock Foong Lui
Keyword(s):  
Chronic Hepatitis ◽  
Liver Disease ◽  
Hepatitis B ◽  
Antiviral Agents ◽  
Antiviral Agent ◽  
Decompensated Cirrhosis ◽  
Decompensated Liver Cirrhosis ◽  
Chronic Hepatitis B Infection ◽  
Advanced Cirrhosis ◽  
Hepatitis B Treatment

Chronic hepatitis B infection progresses from an asymptomatic persistently infected state to chronic hepatitis, cirrhosis, decompensated liver disease, and/or hepatocellular carcinoma. About 3% of patients with chronic hepatitis develop cirrhosis yearly, and about 5% of individuals with hepatitis B cirrhosis become decompensated annually. The outcome for patients with decompensated cirrhosis is bleak. Lamivudine, the first oral antiviral agent available for hepatitis B treatment is safe and effective and can improve or stabilize liver disease in patients with advanced cirrhosis and viraemia. Viral resistance restricts its prolonged use. Entecavir and tenofovir are newer agents with excellent resistance profile to date. These and some other antiviral agents are being investigated for optimal use in this rather challenging patient group.

Acute on Chronic Liver Failure and Immune Dysfunction: A Mimic of Sepsis

2018 ◽  
Vol 39 (05) ◽  
pp. 588-597 ◽  
Author(s):  
Matthew Hensley ◽  
Jane Deng
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Immune Cell ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Low Grade ◽  
Chronic Liver Failure ◽  
Decompensated Liver Disease ◽  
Susceptibility To Infection ◽  
Inflammatory State

AbstractBoth the adaptive and innate arms of immunity are altered in patients with cirrhosis, which have both prognostic and clinical implications. Acute on chronic liver failure (ACLF), defined as decompensated cirrhosis with associated organ failure, carries a high risk of 28-day mortality and is marked by a significant inflammatory response. Patients with decompensated chronic liver disease display a shift from a chronic low-grade inflammatory state to one of intense inflammation, followed by the development of immunoparalysis. Considerable heterogeneity exists depending on the nature of the inciting cause and duration of ACLF. In this review, we will highlight the changes that immune cell populations in the liver undergo during decompensated liver disease, underscoring the immunological paradox between inflammation and increased susceptibility to infection that occurs during ACLF and progressive cirrhosis, as well as provide future perspectives regarding potentially useful biomarkers and possible avenues for treatment.

Parallel Reduction of Plasma Levels of High and Low Molecular Weight Kininogen in Patients with Cirrhosis

1999 ◽  
Vol 82 (11) ◽  
pp. 1428-1432 ◽  
Author(s):  
Cheryl Scott ◽  
Francesco Salerno ◽  
Elettra Lorenzano ◽  
Werner Müller-Esterl ◽  
Angelo Agostoni ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Liver Disease ◽  
Liver Function ◽  
Plasma Levels ◽  
Plasma Concentrations ◽  
Normal Subjects ◽  
Low Molecular Weight ◽  
Major Band ◽  
Sds Page ◽  
Normal Controls

SummaryLittle is known about the regulation of high-molecular-weight-kininogen (HK) and low-molecular-weight-kininogen (LK) or the relationship of each to the degree of liver function impairment in patients with cirrhosis. In this study, we evaluated HK and LK quantitatively by a recently described particle concentration fluorescence immunoassay (PCFIA) and qualitatively by SDS PAGE and immunoblotting analyses in plasma from 33 patients with cirrhosis presenting various degrees of impairment of liver function. Thirty-three healthy subjects served as normal controls. Patients with cirrhosis had significantly lower plasma levels of HK (median 49 μg/ml [range 22-99 μg/ml]) and LK (58 μg/ml [15-100 μg/ml]) than normal subjects (HK 83 μg/ml [65-115 μg/ml]; LK 80 μg/ml [45-120 μg/ml]) (p < 0.0001). The plasma concentrations of HK and LK were directly related to plasma levels of cholinesterase (P < 0.0001) and albumin (P < 0.0001 and P < 0.001) and inversely to the Child-Pugh score (P < 0.0001) and to prothrombin time ratio (P < 0.0001) (reflecting the clinical and laboratory abnormalities in liver disease). Similar to normal individuals, in patients with cirrhosis, plasma HK and LK levels paralleled one another, suggesting that a coordinate regulation of those proteins persists in liver disease. SDS PAGE and immunoblotting analyses of kininogens in cirrhotic plasma showed a pattern similar to that observed in normal controls for LK (a single band at 66 kDa) with some lower molecular weight forms noted in cirrhotic plasma. A slight increase of cleavage of HK (a major band at 130 kDa and a faint but increased band at 107 kDa) was evident. The increased cleavage of HK was confirmed by the lower cleaved kininogen index (CKI), as compared to normal controls. These data suggest a defect in hepatic synthesis as well as increased destructive cleavage of both kininogens in plasma from patients with cirrhosis. The decrease of important regulatory proteins like kininogens may contribute to the imbalance in coagulation and fibrinolytic systems, which frequently occurs in cirrhotic patients.

Urokinase Antigen in Plasma of Patients with Liver Cirrhosis and Hepatoma

1985 ◽  
Vol 54 (03) ◽  
pp. 617-618 ◽  
Author(s):  
J C Kirchheimer ◽  
K Huber ◽  
P Polterauer ◽  
B R Binder
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Liver Function ◽  
Matched Control ◽  
Malignant Growth ◽  
Control Groups ◽  
Impaired Liver Function ◽  
Impaired Liver ◽  
Specific Medication ◽  
History Of

SummaryPlasma urokinase antigen levels were studied in 78 patients suffering from liver diseases. Blood was drawn before any specific medication was initiated. Impairment of liver function was comparable in all patients. In both groups of cirrhotic liver disease (alcoholic and non-alcoholic), normal levels of plasma urokinase antigen were found as compared to age-matched control groups. In both groups of patients with hepatomas (with or without a history of liver cirrhosis), however, significantly increased plasma urokinase antigen levels could be determined. These data indicate that an increase in plasma urokinase antigen might rather relate to malignant growth in liver disease than to impaired liver function.

Mechanisms of liver damage in COVID-19

2020 ◽  
Vol 1 (19) ◽  
pp. 39-46
Author(s):  
T. V. Pinchuk ◽  
N. V. Orlova ◽  
T. G. Suranova ◽  
T. I. Bonkalo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Risk Factor ◽  
Liver Disease ◽  
Liver Function ◽  
Liver Damage ◽  
The World ◽  
Coronavirus Infection ◽  
The Impact ◽  
Analyze Data

At the end of 2019, a new coronavirus (SARS-CoV-2) was discovered in China, causing the coronavirus infection COVID-19. The ongoing COVID-19 pandemic poses a major challenge to health systems around the world. There is still little information on how infection affects liver function and the significance of pre-existing liver disease as a risk factor for infection and severe COVID-19. In addition, some drugs used to treat the new coronavirus infection are hepatotoxic. In this article, we analyze data on the impact of COVID-19 on liver function, as well as on the course and outcome of COVID-19 in patients with liver disease, including hepatocellular carcinoma, or those on immunosuppressive therapy after liver transplantation.

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