scholarly journals RESPIRATORY AND SYMPTOMATIC IMPACT OF ASCITES RELIEF BY PARACENTESIS IN PATIENTS WITH HEPATIC CIRRHOSIS

2020 ◽  
Vol 57 (1) ◽  
pp. 64-68
Author(s):  
Verônica Lourenço WITTMER ◽  
Rozy Tozetti LIMA ◽  
Michele Coutinho MAIA ◽  
Halina DUARTE ◽  
Flávia Marini PARO
Keyword(s):  
Liver Cirrhosis ◽  
Tidal Volume ◽  
Hepatic Cirrhosis ◽  
Blood Pressure Reduction ◽  
Vital Signs ◽  
Meld Score ◽  
Minute Volume ◽  
Respiratory Pattern ◽  
Peripheral Oxygen Saturation ◽  
The Impact

ABSTRACT BACKGROUND: Liver cirrhosis is a highly prevalent disease that, at an advanced stage, usually causes ascites and associated respiratory changes. However, there are few studies evaluating and quantifying the impact of ascites and its relief through paracentesis on lung function and symptoms such as fatigue and dyspnea in cirrhotic patients. OBJECTIVE: To assess and quantify the impact of acute reduction of ascitic volume on respiratory parameters, fatigue and dyspnea symptoms in patients with hepatic cirrhosis, as well as to investigate possible correlations between these parameters. METHODS: Thirty patients with hepatic cirrhosis and ascites who underwent the following pre and post paracentesis evaluations: vital signs, respiratory pattern, thoracoabdominal mobility (cirtometry), pulmonary function (ventilometry), degree of dyspnea (numerical scale) and fatigue level (visual analog scale). RESULTS: There was a higher prevalence of patients classified as CHILD B and the mean MELD score was 14.73±5.75. The comparison of pre and post paracentesis parameters evidenced after paracentesis: increase of predominantly abdominal breathing pattern, improvement of ventilatory variables, increase of the differences obtained in axillary and abdominal cirtometry, reduction of dyspnea and fatigue level, blood pressure reduction and increased peripheral oxygen saturation. Positive correlations found: xiphoid with axillary cirtometry, degree of dyspnea with fatigue level, tidal volume with minute volume, Child “C” with higher MELD score, volume drained in paracentesis with higher MELD score and with Child “C”. We also observed a negative correlation between tidal volume and respiratory rate. CONCLUSION: Since ascites drainage in patients with liver cirrhosis improves pulmonary volumes and thoracic expansion as well as reduces symptoms such as fatigue and dyspnea, we can conclude that ascites have a negative respiratory and symptomatological impact in these patients.

Impact of the COVID-19 pandemic on patients with liver cirrhosis—the experience of a tertiary center in Germany

2021 ◽  
Vol 59 (09) ◽  
pp. 954-960
Author(s):  
Christoph Höner zu Siederdissen ◽  
Marie Schultalbers ◽  
Maximilian Wübbolding ◽  
Greta Sophie Lechte ◽  
Hans Laser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Liver Cirrhosis ◽  
Late Presentation ◽  
Meld Score ◽  
Northern Germany ◽  
Duration Of Symptoms ◽  
Tertiary Center ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
The Impact

Abstract Background The COVID-19 pandemic has caused a significant impact on the medical care of many diseases and has led to reduced presentations to the emergency department. Reduced presentations may be due to overwhelmed capacities of hospitals or collateral damage from fear of infection, lockdown regulations, or other reasons. The effect on patients with liver cirrhosis is not established. Objective We aim to assess the impact on the care of patients with liver cirrhosis in a tertiary center in Northern Germany. Methods All patients presenting to the emergency department with a diagnosis of cirrhosis between March 1 and May 31 from 2015–2020 were included. Reasons for presentation, duration of symptoms, the severity of liver disease, and 30-day mortality were assessed and compared between patients presenting during the COVID-19 pandemic and pre-COVID-19. Results Overall, 235 patients were included. Despite an overall decline in presentations to the emergency department by 11.7%, the frequency of patients presenting with liver cirrhosis has remained stable (non-significant increase by 19.5%). No significant difference could be detected for the MELD score, the CLIF-organ failure subscores, and the 30-day mortality before and during the COVID-19 pandemic. Up to 75% of patients with liver cirrhosis had symptoms >24 h before presenting to the emergency department. Conclusion Despite the overall trend of reduced emergency presentations during the COVID-19 pandemic, the frequency of presentations of patients with liver cirrhosis did not decline. Morbidity and mortality were not affected in a setting of disposable healthcare resources. The late presentation to the emergency department in many cirrhotic patients may open opportunities for interventions (i.e., with early telemedicine intervention).

Vagal control of respiratory pattern during hyperpnea in domestic fowl

1984 ◽  
Vol 56 (6) ◽  
pp. 1650-1654 ◽  
Author(s):  
M. Gleeson ◽  
J. H. Brackenbury
Keyword(s):  
Body Temperature ◽  
Tidal Volume ◽  
Domestic Fowl ◽  
Ventilatory Response ◽  
Normal Animal ◽  
Minute Volume ◽  
Respiratory Frequency ◽  
Respiratory Pattern ◽  
Varied Pattern ◽  
Before And After

Minute volume, tidal volume, and respiratory frequency were measured during hyperpnea induced by exercise, increased body temperature, and CO2 inhalation. Ventilatory characteristics were compared before and after the vagus nerve had been blocked. In normal birds exercise produced increases in both tidal volume and respiratory frequency; hyperthermia produced a typical thermal polypnea consisting of greatly increased respiratory frequency and reduced tidal volume; CO2 inhalation produced increases in tidal volume and respiratory frequency when the birds were euthermic but a slowing of respiratory rate when the birds were hyperthermic. After vagal block these pronounced differences in the pattern of ventilatory response to the various respiratory stimuli were abolished. Instead there was a uniform ventilatory response to all three stimuli consisting mainly of increases in tidal volume combined with small increases in respiratory frequency. It is concluded that in the normal animal control of the varied pattern of ventilatory response to different respiratory stimuli is dependent on vagal fiber activity.

scholarly journals The association between vital signs and clinical outcomes in emergency department patients of different age categories

2022 ◽  
pp. emermed-2020-210628
Author(s):  
Bart GJ Candel ◽  
Renée Duijzer ◽  
Menno I Gaakeer ◽  
Ewoud ter Avest ◽  
Özcan Sir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Older Patients ◽  
Vital Signs ◽  
Risk Scores ◽  
Case Mix ◽  
Peripheral Oxygen Saturation ◽  
The Impact

BackgroundAppropriate interpretation of vital signs is essential for risk stratification in the emergency department (ED) but may change with advancing age. In several guidelines, risk scores such as the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) scores, commonly used in emergency medicine practice (as well as critical care) specify a single cut-off or threshold for each of the commonly measured vital signs. Although a single cut-off may be convenient, it is unknown whether a single cut-off for vital signs truly exists and if the association between vital signs and in-hospital mortality differs per age-category.AimsTo assess the association between initial vital signs and case-mix adjusted in-hospital mortality in different age categories.MethodsObservational multicentre cohort study using the Netherlands Emergency Department Evaluation Database (NEED) in which consecutive ED patients ≥18 years were included between 1 January 2017 and 12 January 2020. The association between vital signs and case-mix adjusted mortality were assessed in three age categories (18-65; 66-80; >80 years) using multivariable logistic regression. Vital signs were each divided into five to six categories, for example, systolic blood pressure (SBP) categories (≤80, 81–100, 101–120, 121–140, >140 mm Hg).ResultsWe included 101 416 patients of whom 2374 (2.3%) died. Adjusted ORs for mortality increased gradually with decreasing SBP and decreasing peripheral oxygen saturation (SpO2). Diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) had quasi-U-shaped associations with mortality. Mortality did not increase for temperatures anywhere in the range between 35.5°C and 42.0°C, with a single cut-off around 35.5°C below which mortality increased. Single cut-offs were also found for MAP <70 mm Hg and respiratory rate >22/min. For all vital signs, older patients had larger increases in absolute mortality compared with younger patients.ConclusionFor SBP, DBP, SpO2 and HR, no single cut-off existed. The impact of changing vital sign categories on prognosis was larger in older patients. Our results have implications for the interpretation of vital signs in existing risk stratification tools and acute care guidelines.

CARBOHYDRATE AND LIPID EXCHANGE CHANGES UNDER THE INFLUENCE OF TREATMENT OF PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN COMBINATION WITH OBESITY USING ADEMETHIONINE, ARGININE GLUTAMATE AND ROSUVASTATIN

2021 ◽  
pp. 56-62
Author(s):  
N. R. Matkovska ◽  
N. H. Virstiuk ◽  
I. O. Kostitska
Keyword(s):  
Liver Cirrhosis ◽  
Carbohydrate Metabolism ◽  
Hdl Cholesterol ◽  
Pathological Process ◽  
Meld Score ◽  
Alcoholic Liver Cirrhosis ◽  
Significant Deterioration ◽  
Fat Depots ◽  
Hepatocyte Damage ◽  
Basic Treatment

Abstract. In Ukraine, among the causes of death because of digestive tract diseases, alcoholic liver disease (ALD) has the second place. Due to the significant prevalence of obesity and the growing incidence of ALD, methods are being sought to prevent the progression of the pathological process in the liver, the occurrence of complications and to improve the quality of life of such patients. The aim of the study: to examine the effect of complex treatment with ademethionine, arginine glutamate and rosuvastatin on changes in lipid and carbohydrate metabolism in patients with alcoholic liver cirrhosis (ALC) in combination with obesity. Methods. The study included 156 patients diagnosed with ALC in combination with obesity, including 18 women and 138 men aged (45.3±8.9) years and a median duration of disease (5.1±2.8) years. Patients were divided into subgroups depending on the stage of Child-Pugh decompensation and depending on the applied treatment. Results. At the stage of decompensation, lipid metabolism and leptin levels were low, which indicates the depletion of body fat depots as the disease progresses. It may be due to the progression of the liver dysfunction, as it is actively involved in regulating the formation, destruction and accumulation of fats. Changes in carbohydrate metabolism in patients with ALC in combination with obesity were characterized by a significant increase in IRI, HOMA-IR index and a decrease in the QUICKI index, indicating the presence of insulin resistance (p<0.05). In determining the adipocytokine values, it was found that in decompensated liver function, the leptin rates decreased and the levels of adiponectin increased. Higher leptin content in the stage of compensation and subcompensation is also associated with increased secretion of adipose tissue. At the stage of decompensation, fat depots are depleted, so leptin levels are reduced. This decrease is directly related to the Child-Pugh and MELD scores. Adiponectin levels were decreased in the stage of compensation and increased with the progression of the disease and correlated with disease severity and the MELD score. It is thought that an increased adiponectin level indicates the level of anti-inflammatory reaction in response to hepatocyte damage. Significant deterioration in carbohydrate metabolism, adiponectin and leptin in patients receiving basic treatment was accompanied by deterioration of their condition and increased the risk of 3-month mortality. After the course of treatment in patients of group receiving ademethionine, arginine, glutamate and rosuvastatin at the stage of compensation and subcompensation, the rates of lipid, carbohydrate metabolism, adiponectin and leptin significantly improved and differed from those in patients receiving basic treatment and combination of basic treatment, ademethionine and arginine glutamate (p<0.05). At the stage of decompensation in the scheme with the inclusion of rosuvastatin it was possible to normalize the levels of HDL cholesterol, VLDL cholesterol, atherogenic coefficient and leptin, reduce the levels of adiponectin, IRI, HOMA-IR, HbA1c and increase the QUICKI index, which was accompanied by a decrease in Child-Pugh severity score and 3 month mortality MELD score. Conclusions. In patients with ALC in combination with obesity, the inclusion in the treatment of ademethionine, arginine glutamate and rosuvastatin helps to improve the course of the disease according to the lipid and carbohydrate metabolism, Child-Pugh and MELD scores.

scholarly journals COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324879
Author(s):  
Luca Saverio Belli ◽  
Christophe Duvoux ◽  
Paolo Angelo Cortesi ◽  
Rita Facchetti ◽  
Speranta Iacob ◽  
...  
Keyword(s):  
Liver Disease ◽  
Respiratory Failure ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Cox Regression Analysis ◽  
Post Transplant ◽  
End Stage Liver Disease ◽  
Significant Difference ◽  
End Stage ◽  
The Impact

ObjectiveExplore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.DesignData from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.ResultsFrom 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170).ConclusionsIncreased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

The presence of liver cirrhosis is a strong negative predictor of survival for patients admitted to the intensive care unit – Cirrhosis in intensive care patients

2021 ◽  
Author(s):  
Jörg Bojunga ◽  
Mireen Friedrich-Rust ◽  
Alica Kubesch ◽  
Kai Henrik Peiffer ◽  
Hannes Abramowski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Cirrhosis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Treatment ◽  
Matched Cohort ◽  
Care Treatment ◽  
Cirrhotic Patients ◽  
The Impact ◽  
Cirrhotic Group

Abstract Background and Aims Liver cirrhosis is a systemic disease that substantially impacts the body’s physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions. Methods In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS). Results A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group.  Conclusions In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients’ outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.

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 Extraction and Analysis of Respiratory Motion Using a Comprehensive Wearable Health Monitoring System

Sensors ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 1393
Author(s):  
Uduak Z. George ◽  
Kee S. Moon ◽  
Sung Q. Lee
Keyword(s):  
Tidal Volume ◽  
Respiration Rate ◽  
Spline Interpolation ◽  
Vital Signs ◽  
Area Under The Curve ◽  
Sensor Technology ◽  
Wearable Sensor ◽  
Lung Sound ◽  
Health Monitoring System ◽  
Electrocardiogram Ecg

Respiratory activity is an important vital sign of life that can indicate health status. Diseases such as bronchitis, emphysema, pneumonia and coronavirus cause respiratory disorders that affect the respiratory systems. Typically, the diagnosis of these diseases is facilitated by pulmonary auscultation using a stethoscope. We present a new attempt to develop a lightweight, comprehensive wearable sensor system to monitor respiration using a multi-sensor approach. We employed new wearable sensor technology using a novel integration of acoustics and biopotentials to monitor various vital signs on two volunteers. In this study, a new method to monitor lung function, such as respiration rate and tidal volume, is presented using the multi-sensor approach. Using the new sensor, we obtained lung sound, electrocardiogram (ECG), and electromyogram (EMG) measurements at the external intercostal muscles (EIM) and at the diaphragm during breathing cycles with 500 mL, 625 mL, 750 mL, 875 mL, and 1000 mL tidal volume. The tidal volumes were controlled with a spirometer. The duration of each breathing cycle was 8 s and was timed using a metronome. For each of the different tidal volumes, the EMG data was plotted against time and the area under the curve (AUC) was calculated. The AUC calculated from EMG data obtained at the diaphragm and EIM represent the expansion of the diaphragm and EIM respectively. AUC obtained from EMG data collected at the diaphragm had a lower variance between samples per tidal volume compared to those monitored at the EIM. Using cubic spline interpolation, we built a model for computing tidal volume from EMG data at the diaphragm. Our findings show that the new sensor can be used to measure respiration rate and variations thereof and holds potential to estimate tidal lung volume from EMG measurements obtained from the diaphragm.

Pathogenesis and Assessment of Renal Function in Patients With Liver Cirrhosis

Folia Medica ◽  
2012 ◽  
Vol 54 (4) ◽  
pp. 5-13 ◽  
Author(s):  
Bilyana H. Teneva
Keyword(s):  
Renal Function ◽  
Liver Cirrhosis ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Serum Markers ◽  
Meld Score ◽  
Kidney Damage ◽  
Early Assessment

Abstract In liver cirrhosis patients awaiting liver transplantation, it is prognostically equally important to assess the renal function before and after transplantation. This is evidenced by the inclusion of serum creatinine in the Model for End-Stage Liver Disease (MELD) score. Most of the causes of renal failure in liver cirrhosis are functional, the acute kidney damage including prerenal azotemia, acute tubular necrosis and hepatorenal syndrome. A major index of the renal function, the glomerular filtration rate (GFR) is determined in a specific way in patients with liver cirrhosis. Clinically, serum creatinine is considered the best indicator of kidney function, although it is rather unreliable when it comes to early assessment of renal dysfunction. Most of the patients with liver cirrhosis have several concomitant conditions, which are the reason for the false low creatinine levels, even in the presence of moderate to severe kidney damage. This also holds for the creatinine clearance and creatinine-based estimation equations for assessment of the glomerular filtration rate (the Cockroft-Gault and MDRD formulas), which overestimate the real glomerular filtration. Clearance of exogenous markers is considered a gold standard, but the methods for their determination are rather costly and hard to apply. Alternative serum markers (e.g., cystatin C) have been used, but they should be better studied in cases of liver cirrhosis assessment.

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