Rifaximin has the potential to prevent complications of cirrhosis

Background: Cirrhosis-related complications are associated with poor prognosis. With our analyses, we examined the potential benefit of rifaximin in reducing the risk of developing cirrhosis-related complications. Methods: Adults with cirrhosis and hepatic encephalopathy (HE) in remission were randomly assigned to receive rifaximin 550 mg twice daily or placebo for 6 months with concomitant lactulose permitted. Post hoc analyses examined time to cirrhosis-related complications (HE, spontaneous bacterial peritonitis (SBP), variceal bleeding, acute kidney injury/hepatorenal syndrome). Subgroup analyses evaluated efficacy for select baseline disease characteristics. Results: Of patients receiving rifaximin ( n = 140) and placebo ( n = 159), 53.6% and 49.1%, respectively, had baseline Model for End-Stage Liver Disease (MELD) score ⩾ 12 and international normalized ratio (INR) ⩾ 1.2. Baseline ascites was observed in 36.4% (rifaximin) and 34.6% (placebo) of patients. In patients with MELD score ⩾ 12 and INR ⩾ 1.2, rifaximin reduced the relative risk (RR) of any first complication experienced during trial by 59% [hazard ratio (HR) = 0.41, 95% confidence interval (CI): 0.25–0.67; p < 0.001] versus placebo. For patients with baseline ascites, rifaximin reduced the RR of any first complication experienced during trial by 42% versus placebo (HR = 0.58, 95% CI: 0.34–1.0; p = 0.045). For some subgroups, there was a decrease in RR of complications of SBP, variceal bleeding, and acute kidney injury/hepatorenal syndrome with rifaximin versus placebo, although there were few events reported in the study. Conclusion: Rifaximin may reduce the incidence of cirrhosis-related complications and the recurrence of overt HE. [ ClinicalTrials.gov identifier: NCT00298038.]

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Profile of Acute Kidney Injury in Patients with Decompensated Cirrhosis at a Tertiary-Care Center in Uttarakhand, India

Digestive Diseases ◽

10.1159/000504836 ◽

2019 ◽

Vol 38 (4) ◽

pp. 335-343

Author(s):

Manjot S. Arora ◽

Reshma Kaushik ◽

Shahbaj Ahmad ◽

Rajeev Mohan Kaushik

Keyword(s):

Acute Kidney Injury ◽

Care Center ◽

Tertiary Care ◽

Kidney Injury ◽

International Normalized Ratio ◽

Meld Score ◽

Decompensated Cirrhosis ◽

Total Leucocyte Count ◽

Bacterial Peritonitis ◽

Ctp Score

Objectives: To study the clinical profile and predictors of acute kidney injury (AKI) in patients with decompensated cirrhosis. Materials and Methods: This observational study was conducted at Himalayan Institute of Medical Sciences, Dehradun, India, on 175 consecutive patients with decompensated cirrhosis. Patients were studied for AKI as per International Club of Ascites-AKI criteria. Results: The prevalence of AKI was 40.6%, with prerenal AKI 67.6%, hepatorenal syndrome (HRS) 23.8%, intrinsic renal AKI 7%, and postrenal AKI 1.4%. Mean arterial pressure (MAP), platelet count, and serum albumin were significantly lower and total leucocyte count (TLC), blood urea nitrogen, serum creatinine (SCr), total bilirubin, aspartate aminotransferase, international normalized ratio, Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score higher in cirrhosis patients with AKI than without AKI (p < 0.05 each). MAP, hemoglobin, TLC, and SCr were significantly different in various types of AKI (p < 0.05 each). AKI had a significant association with CTP score, alcohol, spontaneous bacterial peritonitis (SBP), sepsis, and shock (p < 0.05 each). Type of AKI had significant association with SBP, sepsis, and shock (p < 0.05 each). Mortality occurred in 33.8% patients with AKI with 64.7% mortality in patients with HRS. Outcome had significant association with AKI, stage and type of AKI (p < 0.05 each). Multivariate analysis showed SBP, sepsis, and shock as independent predictors of AKI (p < 0.05 each). Conclusions: AKI occurred commonly in patients with decompensated cirrhosis. Prerenal AKI and HRS were the most common types of AKI. SBP, sepsis, and shock were important predictors of AKI.

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Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm10235621 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5621

Author(s):

Roula Sasso ◽

Ahmad Abou Yassine ◽

Liliane Deeb

Keyword(s):

Acute Kidney Injury ◽

Spontaneous Bacterial Peritonitis ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Alcoholic Cirrhosis ◽

Clinical Feature ◽

Decompensated Liver Cirrhosis ◽

Bacterial Peritonitis ◽

Cirrhotic Patients ◽

End Stage

Hepatorenal syndrome (HRS) is a type of acute kidney injury (AKI), occurring in patients with decompensated liver cirrhosis and is associated with high mortality. We aim to describe the predictors associated with the development of HRS in cirrhotic patients with AKI. We retrospectively analyzed 529 cirrhotic patient encounters with AKI across all Northwell Health institutions between 1 January 2015 and 31 December 2018. We performed multivariate analyses to determine independent predictors of development of HRS. Alcoholic cirrhosis was the most common identified etiology of cirrhosis. The mean Model for End-Stage Liver Disease Scorewas18 (±7). Ascites was the most commonly identified clinical feature of portal hypertension. Infection was identified in 38.4% of patients with urinary tract infection/pyelonephritis being the most common. Spontaneous bacterial peritonitis occurred in 5.9% of patients. The most common cause of AKI was pre-renal. Hepatorenal syndrome was identified in 9.8% of patient encounters. Predictors of HRS were history of ascites, serum creatinine >2.5 mg/dL, albumin <3 g/dL, bilirubin >2 mg/dL and spontaneous bacterial peritonitis. We demonstrate strong predictors for the development of HRS which can aid clinicians to attain an early diagnosis of HRS, leading to prompt and targeted management and improving outcomes.

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Albumin: Indications in chronic liver disease

United European Gastroenterology Journal ◽

10.1177/2050640620910339 ◽

2020 ◽

Vol 8 (5) ◽

pp. 528-535 ◽

Cited By ~ 1

Author(s):

Manuel Tufoni ◽

Giacomo Zaccherini ◽

Paolo Caraceni ◽

Mauro Bernardi

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Cost Effective ◽

Decompensated Cirrhosis ◽

Plasma Expander ◽

Bacterial Peritonitis ◽

Good Safety Profile ◽

Complications Of Cirrhosis

Albumin is currently employed as a plasma expander to prevent and treat specific complications of cirrhosis with ascites, such as the prevention of paracentesis-induced circulatory dysfunction and renal dysfunction induced by spontaneous bacterial peritonitis, as well as the diagnosis and treatment of acute kidney injury and hepatorenal syndrome. Recently, evidence has shown that long-term albumin administration in patients with decompensated cirrhosis reduces mortality and incidence of complications, eases the management of ascites, is cost effective, and has a good safety profile.

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Terlipressin-induced ischaemic skin necrosis

BMJ Case Reports ◽

10.1136/bcr-2019-233089 ◽

2020 ◽

Vol 13 (1) ◽

pp. e233089 ◽

Cited By ~ 1

Author(s):

Anand V Kulkarni ◽

Pramod Kumar ◽

Nagaraj P Rao ◽

Nageshwar Reddy

Keyword(s):

Continuous Infusion ◽

Skin Necrosis ◽

Multiorgan Failure ◽

Kidney Injury ◽

Meld Score ◽

Medical Emergency ◽

Variceal Bleed ◽

Male Patients ◽

Complications Of Cirrhosis ◽

End Stage

Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

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PROGNOSTIC VALUE OF MELD SCORE IN CHILD PUGH C CIRRHOTIC PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.3.9 ◽

2019 ◽

pp. 67-73

Author(s):

Thi Minh Duc Vo ◽

Stackhouse Frank A. ◽

Van Huy Tran

Keyword(s):

Variceal Bleeding ◽

Prognostic Value ◽

Spontaneous Bacterial Peritonitis ◽

Hepatorenal Syndrome ◽

Prognostic Score ◽

Meld Score ◽

Decompensated Cirrhosis ◽

Bacterial Peritonitis ◽

Acute Variceal Bleeding ◽

Cirrhotic Patients

Background and aims: The Model for End Stage Liver Disease (MELD) is a scoring system used for the prioritization of patients waiting for liver transplantation. Patients with decompensated cirrhosis often have serious complications. The aims of this study were to evaluate the prognostic value of MELD score in relation to mortality complications and to acute variceal bleeding, spontaneous bacterial peritonitis, hepatoencephalopathy, hepatorenal syndrome of Child Pugh C Vietnamese cirrhotic patients in a period of six months after hospitalization. Methods: This prospective study includes 102 consecutive Child Pugh C cirrhotic patients who were admitted to the Gastrointestinal Department of Hue Central Hospital and the General Internal Medicine Department of Hue University of Medicine and Pharmacy Hospital, Vietnam, from April 2016 to February 2017. The MELD score of each patient was calculated at admission. All patients were then observed for 6 months to assess the following: acute variceal bleeding, spontaneous bacterial peritonitis, hepatoencephalopathy, hepatorenal syndrome and mortality. Results: The mean MELD score of all patients was 19.5 ± 7.1; of male patients was 19.7 ± 7.4; of female patients was 18.43 ± 4.4; of alcoholic patients was 19.5 ±7.5; and of non – alcoholic patients was 19.6 ± 5.9. The MELD score correlated with mortality during 6 months after hospitalization (with cut – off = 20; AUC = 0,69; sensitivity and specificity were 56.0% and 76.6%) and with hepatorenal syndrome (with cut – off = 25; AUC = 0.90; sensitivity = 83.3% and specificity = 85.4%). In this study, the MELD score did not correlated acute variceal bleeding, spontaneous bacterial peritonitis, hepatoencephalopathy during 6 months after hospitalization. Conclusion: MELD is a valuable prognostic score for mortality and hepatorenal syndrome in Child Pugh C cirrhotic patients in 6 months after hospitalization. Key words: MELD score, Child Pugh C cirrhotic patients

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A study of factors determining outcome of acute kidney injury patients requiring hemodialysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183389 ◽

2018 ◽

Vol 6 (9) ◽

pp. 2974

Author(s):

Vasanth G. ◽

Surendrakumar P. ◽

Catherine P. ◽

Venu G.

Keyword(s):

Acute Kidney Injury ◽

High Mortality ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Demographic Variables ◽

Acute Glomerulonephritis ◽

Severe Renal Failure ◽

One Year ◽

Stage Renal Disease ◽

End Stage

Background: High mortality rate in acute kidney injury (AKI) has interested many authors to conduct studies about factors predicting its outcome. The need for both dialysis and ICU care defines a group of critically ill patients who may have poor prognosis and consume vast amounts of resources. In this study we determine the variables predicting the outcome of patients with severe acute kidney failure requiring haemodialysis and to ascertain the aetiology of acute kidney injury in this group.Methods: We prospectively analysed 114 patients admitted with severe renal failure requiring renal replacement therapy over a period of one year. The influence of various factors such as demographic variables, pre morbidities, details of admission, clinical presentation and extent of organ dysfunction on the clinical outcome such as mortality and progression to end stage kidney disease were statistically analyzed using SPSS version 12 (SPSS Inc., Chicago, Ill).Results: Univariate and multivariate analysis showed that parameters such as chronic liver disease, preexisting heart disease, mechanical ventilation and vasopressor requirement, oliguria, sepsis, hepatorenal syndrome, cardiogenic shock and admission in ICU were associated with high mortality (p<0.05). Of the 114 patients, 49 died (42.98%), 61 (53.5%) were dialysis independent and 4 patients (3.5%) progressed to end stage renal disease (ESRD).Conclusions: AKI patients requiring hemodialysis were associated with high hospital mortality. Patients who were diagnosed to have acute glomerulonephritis especially rapidly progressing glomerulonephritis as the cause of AKI were more prone to ESRD. Most survivors were dialysis independent at the time of discharge.

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Endogenous Heparinoids Detected by anti-Xa Activity are Present in Blood during Acute Variceal Bleeding in Cirrhosis. A Prospective Study

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.cht1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 187-194 ◽

Cited By ~ 4

Author(s):

Christos Triantos ◽

Emmanuel Louvros ◽

Maria Kalafateli ◽

Anne Riddell ◽

Ulrich Thalheimer ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Variceal Bleeding ◽

Blood Cells ◽

Venous Pressure ◽

White Blood Cells ◽

International Normalized Ratio ◽

Ulcer Bleeding ◽

Factor X ◽

Packed Red Blood Cells ◽

Bacterial Peritonitis

Background & Aims: Endogenous heparinoids have been detected by thromboelastography and quantified by clotting based anti-Xa activity assays in patients with cirrhosis, but their presence in variceal bleeding has not been established yet.Methods: Clotting based anti-Xa activity was measured in A) 30 cirrhotics with variceal bleeding, B) 15 noncirrhotics with peptic ulcer bleeding, C) 10 cirrhotics without infection or bleeding, and D) 10 cirrhotics with hepatocellular carcinoma (HCC).Results: Anti-Xa activity was not detected in ulcer bleeders or in cirrhotics without infection or bleedingbut was present in seven (23%) variceal bleeders (median levels: 0.03 u/mL (0.01-0.07)) and was quantifiable for 3 days in six of seven patients. Four of seven variceal bleeders with anti-Xa activity present had HCC (p=0.023). Age, creatinine, platelet count and total infections the second day from admission were significantly correlated with the presence of measureable anti-Xa levels (p=0.014, 0.032, 0.004 and 0.019, respectively). In the HCC group, anti-Xa activity was present in three patients (30%) [median levels: 0.05 u/mL (0.01-0.06)].Conclusions: In this study, variceal bleeders and 30% of the patients with HCC had endogenous heparinoids that were detected by a clotting based anti-Xa activity assay, whereas there was no anti Xa activity present in patients with cirrhosis without infection, or bleeding or HCC, nor in those with ulcer bleeding. Thus, the anti-Xa activity is likely to be a response to bacterial infection and/or presence of HCC in cirrhosis.List of abbreviations: AFP, alpha-fetoprotein; aPTT, activated partial thromboplastin time; CP, Child-Pugh; FXa, activated factor X; GAGS, glycosaminoglycans; Hb, hemoglobin; HCC, hepatocellular carcinoma; HVPG, hepatic venous pressure gradient; INR, International normalized ratio; LMWHs, low molecular weight heparins; MELD, Model for End-stage Liver Disease; PPP, platelet-poor plasma; PRBC, packed red blood cells; PT, prothrombin time; SBP, sponataneous bacterial peritonitis; TEG, thromboelastography; WBC, white blood cells.

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Low Dose Albumin Versus Standard Dose Albumin in Spontaneous Bacterial Peritonitis With Acute Kidney Injury.

Case Medical Research ◽

10.31525/ct1-nct04273373 ◽

2020 ◽

Author(s):

Keyword(s):

Acute Kidney Injury ◽

Spontaneous Bacterial Peritonitis ◽

Low Dose ◽

Standard Dose ◽

Kidney Injury ◽

Bacterial Peritonitis

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Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

Journal of Clinical Medicine ◽

10.3390/jcm10061175 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1175

Author(s):

Emaad M. Abdel-Rahman ◽

Faruk Turgut ◽

Jitendra K. Gautam ◽

Samir C. Gautam

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Complete Recovery ◽

Severe Form ◽

Clinical Syndrome ◽

Current Evidence ◽

Clinical Predictors ◽

End Stage

Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.

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