scholarly journals Acute Brucellosis and Cirrhosis: The Triggering Event of Fatal Liver Decompensation

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Maria Kosmidou ◽  
Eleftherios Klouras ◽  
Iro Rapti ◽  
Sebastien Filippas-Ntekouan ◽  
Haralampos Milionis
Keyword(s):  
Alcoholic Cirrhosis ◽  
Reticuloendothelial System ◽  
Infectious Complications ◽  
Hepatic Decompensation ◽  
Fatal Liver ◽  
Worldwide Distribution ◽  
Hepatic Involvement ◽  
Liver Decompensation ◽  
Triggering Factor ◽  
Cirrhotic Patients

Cirrhotic patients are known to be particularly susceptible to infectious complications that may vary according to regional endemic patterns. Brucellosis, a common zoonosis with worldwide distribution, exhibits a predilection for the reticuloendothelial system and thus resulting in hepatic involvement. We describe three cirrhotic patients in whom acute brucellosis and/or its treatment served as the triggering factor of hepatic decompensation, with deleterious effects. The patients suffered from alcoholic cirrhosis and culture-proven brucellosis. All patients came from an area endemic to brucellosis. The first patient exhibited a relapsing brucellosis course with progressive deterioration of his fragile liver function. The second patient progressed rapidly to jaundice, possibly partly attributed to antibiotic pharmacotoxicity, and died during liver transplantation. The third patient eventually succumbed to diffuse intravascular coagulation. Brucellosis can be a triggering event of fatal liver decompensation in cirrhotic patients. Enhancing health literacy of the patients, particularly in endemic areas, is of paramount importance for prevention of exposure to similar pathogens.

scholarly journals Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Ahmed Abdelrahman Mohamed Baz ◽  
Rana Magdy Mohamed ◽  
Khaled Helmy El-kaffas
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Meld Score ◽  
Hepatic Decompensation ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Us Findings ◽  
End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

scholarly journals RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenzhen Zhang ◽  
Guomin Xie ◽  
Li Liang ◽  
Hui Liu ◽  
Jing Pan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Poor Prognosis ◽  
Alcoholic Cirrhosis ◽  
Normal Liver ◽  
Neutrophil Infiltration ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

scholarly journals Diurnal Corrected QT Interval and QT Dispersion Variation in Non-Alcoholic Cirrhotic Patients and Healthy Control: A Case-Control Study, Iran

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Taghi Amiriani ◽  
Vahid Khori ◽  
Ali Davarian ◽  
Niloofar Rajabli ◽  
Mahsa Niknam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diurnal Variation ◽  
Healthy Subjects ◽  
Alcoholic Cirrhosis ◽  
Qt Dispersion ◽  
Qtc Interval ◽  
Healthy Controls ◽  
Cirrhotic Patients ◽  
The Mean

Background: Cirrhosis could lead to a long corrected QT (QTc) interval in a subgroup of patients, but there are spare data on its diurnal variation. Objectives: The present study aimed to determine the diurnal variation of QTc interval and its relationship to heart rate and blood pressure variation during 24-hour Holter-monitoring in non-alcoholic cirrhosis in comparison with the healthy controls. Methods: The study population comprised 15 patients with non-alcoholic cirrhosis and 15 healthy subjects, undergoing 24-hour electrocardiogram (ECG), heart rate, and blood pressure monitoring. The mean QT interval, mean QTc, maximum and minimum QT, QT dispersion (QT disp), heart rate, and mean arterial blood pressure were measured for each person for 24 hours. Liver stiffness measurement (LSM) was performed by FibroScan® 502 machine (EchoSense, Paris, France, 5 MHz). The results were demonstrated as percentages and mean ± SD. P value ≤ 0.05 was considered significant. Results: Mean QTc was significantly higher in cirrhosis (438 ms) than healthy controls (401.7 ms) (P = 0.03). The mean heart rate was significantly different in cirrhotic patients (79.6 ± 2.9/bpm) compared to healthy controls (72.47 ± 2.0/bpm) (P = 0.05). Conclusions: In this study, QTc was prolonged and increased with the severity of cirrhosis, and its diurnal variation in cirrhosis was different from healthy subjects.

Spleen Stiffness Measurements Predict the Risk of Hepatic Decompensation After Direct-Acting Antivirals in HCV Cirrhotic Patients

2020 ◽  
Author(s):  
Elton Dajti ◽  
Federico Ravaioli ◽  
Antonio Colecchia ◽  
Giovanni Marasco ◽  
Maria Letizia Bacchi Reggiani ◽  
...  
Keyword(s):  
Protective Factor ◽  
Control Group ◽  
Direct Acting Antivirals ◽  
Hepatic Decompensation ◽  
Weighting Method ◽  
Historical Cohort ◽  
Tertiary Center ◽  
Cirrhotic Patients ◽  
Direct Acting ◽  
Noninvasive Tests

Abstract Purpose Little evidence is available regarding the risk of hepatic decompensation (HD) after direct-acting antivirals (DAAs) in patients with advanced chronic liver disease. Our aim was to assess the risk of decompensation and the prognostic role of noninvasive tests, such as liver (LSM) and spleen (SSM) stiffness measurements, in the prediction of decompensation after sustained virologic response (SVR) by DAAs. Materials and Methods A cohort study involving 146 cirrhotic patients treated with DAAs in our tertiary center with LSM and SSM available both before and six months after treatment (SVR24). A historical cohort of 92 consecutive cirrhotic patients with active HCV was used as a control group. A propensity score inverse probability weighting method was used to account for differences between the groups. Time-dependent models for the prediction of decompensation were applied to account for changes in noninvasive tests after therapy. Results The decompensation incidence in the DAA cohort was 7.07 (4.56–10.96) per 100 person-years (PYs), which was significantly lower than in the active HCV cohort. The DAA therapy was an independent protective factor for HD development (SHR: 0.071, 95 %-CI: 0.015–0.332). SSM ≥ 54 kPa was independently associated with decompensation despite SVR achievement (SHR: 4.169, 95 %-CI: 1.050–16.559), alongside with a history of decompensation (SHR: 7.956, 95 %-CI: 2.556–24.762). SSM reduction < 10 % also predicted the risk of decompensation after SVR24. Conclusion The risk of decompensation was markedly reduced after DAA therapy, but it was not eliminated. Paired SSM values stratified the risk of decompensation after SVR better than other noninvasive tests.

scholarly journals COMPARATIVE STUDY OF LV MASS ABNORMALITY, EJECTION FRACTION ABNORMALITY AND ABNORMAL E/A RATIO BETWEEN ALCOHOLIC AND NON ALCOHOLIC CIRRHOTICS

2020 ◽  
pp. 1-2
Author(s):  
Bharathraj M. Y
Keyword(s):  
Heart Failure ◽  
Alcohol Consumption ◽  
Ejection Fraction ◽  
Severe Heart Failure ◽  
Alcoholic Cirrhosis ◽  
Medical Institute ◽  
2D Echocardiography ◽  
Lv Mass ◽  
Cirrhotic Patients ◽  
Cardiovascular Evaluation

Background : In case of ischemic hepatic disease, patients with severe heart failure usually remain asymptomatic, while for patients with congestive hepatopathy, signs of right-sided heart failure could mask hepatic injury. However, changes in hepatic function, that are proven by laboratory tests are significant¬ in predicting the survival of patients with severe heart failure. There is possible considerable changes in the involvement of cardiac morbidity among both alcoholics and non alcoholics. This study evaluates the cardiac profile of cirrhotic individuals with respect to their alcohol consumption. Materials and methods : It is a comparative cross sectional study carried out at Medical department of SSIMS and RC, a tertiary medical institute in central part of the Karnataka. Study randomly selected patients with cirrhosis which comprised of 50 alcoholics and 50 non alcoholics. A normal group of 50 individuals without history of alcohol consumption and cirrhosis were selected for secondary comparison. Non Probability Purposive Sampling Technique is used and data was analyzed using latest SPSS for windows. Results : ECHO revealed that all the patients with alcoholic and non alcoholic cirrhosis had abnormal LVIDd (>56mm). LV mass abnormality was found among 76% of patients with non alcoholic cirrhosis compared to 66% of patients with alcoholic cirrhosis. High Ejection fraction abnormality was found among only 4% of patients with non alcoholic cirrhosis. The abnormal E/A ratio was observed among 8% of patients with non alcoholic cirrhosis compared to 4% of alcoholic cirrhosis patients. Conclusion : 2D Echocardiography showed increase in LAD, LVIDd and LV mass among cirrhotic patients thereby suggesting definitive cardiac involvement. The cardiovascular abnormalities did not show much differences between the alcoholic and non alcoholic patients. all cirrhotic patients irrespective of their aetiology has to undergo a cardiovascular evaluation.

scholarly journals Natural History of Cholelithiasis in Patients with Alcoholic Cirrhosis (Cholelithiasis in Cirrhotic Patients)

1987 ◽  
Vol 205 (3) ◽  
pp. 226-229 ◽  
Author(s):  
G. DUNNINGTON ◽  
E. ALFREY ◽  
R. SAMPLINER ◽  
F. KOGAN ◽  
C. PUTNAM
Keyword(s):  
Natural History ◽  
Alcoholic Cirrhosis ◽  
History Of ◽  
Cirrhotic Patients

scholarly journals Single portal pressure measurement predicts survival in cirrhotic patients with recent bleeding

Gut ◽  
1999 ◽  
Vol 44 (2) ◽  
pp. 264-269 ◽  
Author(s):  
D Patch ◽  
A Armonis ◽  
C Sabin ◽  
K Christopoulou ◽  
L Greenslade ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Pressure Measurement ◽  
Predictive Value ◽  
Bleeding Episode ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Alcoholic Cirrhosis ◽  
Hepatic Venous Pressure Gradient ◽  
Cox Regression Analysis ◽  
Cirrhotic Patients

BackgroundHeight of portal pressure correlates with severity of alcoholic cirrhosis. Portal pressure indices are not however used routinely as predictors of survival.AimsTo examine the clinical value of a single portal pressure measurement in predicting outcome in cirrhotic patients who have bled.MethodsA series of 105 cirrhotic patients who consecutively underwent hepatic venous pressure measurement were investigated. The main cause of cirrhosis was alcoholic (64.8%) and prior to admission all patients had bled from varices.ResultsDuring the follow up period (median 566 days, range 10–2555), 33 patients died, and 54 developed variceal haemorrhage. Applying Cox regression analysis, hepatic venous pressure gradient, bilirubin, prothrombin time, ascites, and previous long term endoscopic treatment were the only statistically independent predictors of survival, irrespective of cirrhotic aetiology. The predictive value of the pressure gradient was much higher if the measurement was taken within the first or the second week from the bleeding and there was no association after 15 days. A hepatic venous pressure gradient of at least 16 mm Hg appeared to identify patients with a greatly increased risk of dying.ConclusionsIndirectly measured portal pressure is an independent predictor of survival in patients with both alcoholic and non-alcoholic cirrhosis. In patients with a previous variceal bleeding episode this predictive value seems to be better if the measurement is taken within the first two weeks from the bleeding episode. A greater use of this technique is recommended for the prognostic assessment and management of patients with chronic liver disease.

scholarly journals Risk Factors for Liver Decompensation and HCC in HCV-Cirrhotic Patients after DAAs: A Multicenter Prospective Study

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3810
Author(s):  
Filomena Morisco ◽  
Alessandro Federico ◽  
Massimo Marignani ◽  
Mariarita Cannavò ◽  
Giuseppina Pontillo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Independent Predictor ◽  
Liver Stiffness ◽  
Cox Regression Analysis ◽  
Liver Decompensation ◽  
Cirrhotic Patients ◽  
Multicenter Prospective Study

Background: Prospective studies on predictors of liver-related events in cirrhotic subjects achieving SVR after DAAs are lacking. Methods: We prospectively enrolled HCV cirrhotic patients in four Italian centers between November 2015 and October 2017. SVR and no-SVR cases were compared according to the presence or absence of liver-related events during a 24-month follow-up. Independent predictors of liver-related events were evaluated by Cox regression analysis. Results: A total of 706 subjects started DAAs therapy. SVR was confirmed in 687 (97.3%). A total of 61 subjects (8.9%) in the SVR group and 5 (26.3%) in the no-SVR group had liver-related events (p < 0.03). The incidence rate x 100 p/y was 1.6 for HCC, 1.7 for any liver decompensation, and 0.5 for hepatic death. Baseline liver stiffness (LSM) ≥ 20 kPa (HR 4.0; 95% CI 1.1–14.1) and genotype different from 1 (HR 7.5; 95% CI 2.1–27.3) were both independent predictors of liver decompensation. Baseline LSM > 20 KPa (HR 7.2; 95% CI 1.9–26.7) was the sole independent predictor of HCC. A decrease in liver stiffness (Delta LSM) by at least 20% at the end of follow-up was not associated with a decreased risk of liver-related events. Conclusion: Baseline LSM ≥ 20 kPa identifies HCV cirrhotic subjects at higher risk of liver-related events after SVR.

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