Protocol: Prospective observational study investigating the prevalence and clinical outcome of portopulmonary hypertension in Japanese patients with chronic liver disease

Background Portopulmonary hypertension (PoPH) is a subtype of the pulmonary arterial hypertension (PAH) associated with portal hypertension. There is a dissociation between the proportion of PoPH in PAH and that of PoPH in patients with liver cirrhosis, suggesting PoPH underdiagnosis and an incomplete understanding of this entity in the clinical setting. Specifically, real-world data in Japan is largely unknown as compared with in Europe and the United States. The present study aims to elucidate the prevalence and etiology of PoPH in Japanese patients with chronic liver disease. Methods and design In this prospective, single-center, observational investigation of PoPH patients with chronic liver disease, a targeted 2,500 Japanese adult patients regularly visiting Shinshu University Hospital in Matsumoto, Japan, for chronic liver disease will complete a standardized questionnaire on the presence of PoPH symptoms. If the respondent has signs of possible PoPH, ultrasound echocardiography (UCG) will be performed as a primary screening. In the case that UCG findings indicate pulmonary hypertension, the patient will be referred to a cardiologist for further evaluation, whereby a definitive diagnosis PoPH can be made. PoPH prevalence and etiology will be investigated at the time of diagnosis. Afterwards, patients with PoPH will be followed for five years for determination of survival rate. Discussion This study will reveal the prevalence, etiology, and 5-year survival rate of PoPH in Japanese patients with chronic liver disease. Trial registration This study is being performed at Shinshu University following registration as UMIN 000042287 on October 29, 2020.

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Chronic liver disease not a significant comorbid condition for COVID-19

Scientific Reports ◽

10.1038/s41598-021-91238-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jiahao Lin ◽

Bingting Bao ◽

Nigar Anjuman Khurram ◽

Kasey Halsey ◽

Ji Whae Choi ◽

...

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Chronic Liver Disease ◽

The United States ◽

Postmortem Examination ◽

Chronic Liver ◽

Critical Groups ◽

Comorbid Condition ◽

Central Vein ◽

Significant Difference

AbstractTo explore the role of chronic liver disease (CLD) in COVID-19. A total of 1439 consecutively hospitalized patients with COVID-19 from one large medical center in the United States from March 16, 2020 to April 23, 2020 were retrospectively identified. Clinical characteristics and outcomes were compared between patients with and without CLD. Postmortem examination of liver in 8 critically ill COVID-19 patients was performed. There was no significant difference in the incidence of CLD between critical and non-critical groups (4.1% vs 2.9%, p = 0.259), or COVID-19 related liver injury between patients with and without CLD (65.7% vs 49.7%, p = 0.065). Postmortem examination of liver demonstrated mild liver injury associated central vein outflow obstruction and minimal to moderate portal lymphocytic infiltrate without evidence of CLD. Patients with CLD were not associated with a higher risk of liver injury or critical/fatal outcomes. CLD was not a significant comorbid condition for COVID-19.

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Prevalence of restless legs syndrome in Japanese patients with chronic liver disease

Hepatology Research ◽

10.1111/j.1872-034x.2012.01043.x ◽

2012 ◽

Vol 42 (12) ◽

pp. 1221-1226 ◽

Cited By ~ 11

Author(s):

Toshihisa Matsuzaki ◽

Tatsuki Ichikawa ◽

Hideaki Kondo ◽

Naota Taura ◽

Hisamitsu Miyaaki ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Restless Legs Syndrome ◽

Japanese Patients ◽

Chronic Liver ◽

Restless Legs

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Shared Symptoms and Putative Biological Mechanisms in Chronic Liver Disease

Biological Research For Nursing ◽

10.1177/1099800414541541 ◽

2014 ◽

Vol 17 (2) ◽

pp. 222-229 ◽

Cited By ~ 3

Author(s):

Victoria Menzies ◽

Nancy Jallo ◽

Patricia Kinser ◽

Jo Lynne W. Robins ◽

Kyungeh An ◽

...

Keyword(s):

Quality Of Life ◽

Liver Disease ◽

Chronic Liver Disease ◽

Symptom Management ◽

Patient Population ◽

The United States ◽

Chronic Liver ◽

Biological Mechanisms ◽

Management Interventions

Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver–gut–brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.

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Kratom-Induced Cholestatic Liver Injury and Its Conservative Management

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619836138 ◽

2019 ◽

Vol 7 ◽

pp. 232470961983613 ◽

Cited By ~ 4

Author(s):

Christopher T. Fernandes ◽

Umair Iqbal ◽

Sean P. Tighe ◽

Aijaz Ahmed

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Chronic Liver Disease ◽

The United States ◽

Chronic Liver ◽

Herbal Supplement ◽

Herbal Supplements ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Analgesic Effects

Drug-induced liver injury (DILI) is a common cause of hepatotoxicity associated with prescription-based and over-the-counter exposure to medications and herbal supplements. Use of unapproved and inadequately tested herbal supplements can cause DILI. Therefore, thorough history-taking on exposure to herbal supplements must be an integral part of clinical evaluation of DILI. Kratom is an herbal supplement or remedy that has been known for its analgesic effects and has also been used for self-treatment of opiate withdrawals. A 52-year-old man was seen for evaluation of yellow discoloration of the eyes and skin. He reported taking kratom for right shoulder strain for at least a couple of months. On workup, his total bilirubin was noted to be 23.2 mg/dL, which peaked at 28.9 mg/dL. He was noted to have mild elevation of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Extensive laboratory tests were ordered and known causes of chronic liver disease ruled out. Magnetic resonance imaging of the abdomen was unremarkable without stigmata of portal hypertension or signs of chronic liver disease. He demonstrated no evidence of coagulopathy or hepatic encephalopathy during his illness. He underwent liver biopsy, which demonstrated histologic evidence of acute cholestatic hepatitis highly suspicious of DILI. He was advised to avoid kratom or other herbal supplements in future and prescribed ursodeoxycholic acid with significant improvement in his liver chemistries. Kratom is associated with significant liver enzymes derangements leading to DILI. Kratom is not approved for use in the United States and should be avoided.

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