Role Of Neo-Adjuvant TIPS in Child Pugh Class A And B
Cirrhotic Patients Undergoing Elective Intra-Abdominal
Surgery

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

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Safety and Efficacy of Bariatric Surgery in Patients with Cirrhosis

10.1093/med/9780190608347.003.0021 ◽

2018 ◽

Author(s):

Hideharu Shimizu ◽

Tomasz G. Rogula ◽

Philip R. Schauer

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Metabolic Diseases ◽

Bariatric Procedure ◽

Morbidly Obese ◽

Class A ◽

Bariatric Patients ◽

Pugh Class ◽

Cirrhotic Patients ◽

Perioperative Risks

Perioperative risks for morbidly obese patients with cirrhosis are significant, and surgeons should consider these risks carefully in deciding on the type of bariatric procedure to be performed. The benefits of bariatric surgery for cirrhotic patients include substantial weight loss, improvements in metabolic diseases, and potential regression of fibrosis, which can also increase their eligibility and candidacy for liver transplantation. There is currently a lack of strong evidence, but the restrictive bariatric procedures are the safest options for carefully selected patients with cirrhosis. Sleeve gastrectomy is likely the best bariatric procedure for obtaining good outcomes without a prohibitive complication rate or mortality for patients with compensated, Child-Pugh class A cirrhosis without portal hypertension. Roux-en-Y gastric bypass is also appropriate for patients who are not suitable for sleeve gastrectomy. Surgeons should be prepared in case they see bariatric patients with cirrhosis diagnosed preoperatively or intraoperatively.

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Refusal of Endoscopy in Cirrhotic Patients With Child-Pugh Class A Without Prior Variceal Bleeding: An Internist Dilemma

Archives of Internal Medicine ◽

10.1001/archinte.162.8.947-a ◽

2002 ◽

Vol 162 (8) ◽

pp. 947-a-948 ◽

Cited By ~ 2

Author(s):

A. K. Ghosh

Keyword(s):

Variceal Bleeding ◽

Class A ◽

Pugh Class ◽

Cirrhotic Patients

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Correlation of global longitudinal strain with disease severity in liver cirrhosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.155 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Dimitroglou ◽

C Aggeli ◽

A Alexopoulou ◽

T Alexopoulos ◽

D Patsourakos ◽

...

Keyword(s):

Liver Cirrhosis ◽

Disease Severity ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/purpose Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic dysfunction and has been correlated with cirrhosis severity and prognosis. Global longitudinal strain (GLS) is a sensitive marker of cardiac dysfunction which is considered relatively independent of preload and afterload conditions and thus may be of high diagnostic significance in this special population. We sought to investigate alterations of GLS relating to disease severity in cirrhotic patients. Methods Echocardiographic analysis of 51 consecutive cirrhotic patients was performed. Images were acquired and analyzed off-line. GLS was calculated with a semi-automatic way using dedicated software. Clinical and biochemical examination were used to assess severity of liver disease by calculating Child-Pugh class (class C patients have more severe disease than class B and A patients) and MELD-Na score (increased score as the disease progresses). Results Mean age was 58.4 ± 8.7 years, 38 (74.5%) were males. Among patients, 22 (43.1%) were Child-Pugh class A, 17 (33.3%) Child-Pugh B and 12 (23.5%) Child-Pugh C and mean MELD-Na score was 15.3 ± 7.5. Mean left ventricular end-systolic volume (LVEDV) was 117 ± 29ml, mean stroke volume (SV) 72.5 ± 19.9ml , mean left ventricular ejection fraction (LVEF) 61.0 ± 5.0%, mean systolic blood pressure (SBP) 128 ± 13mmHg, mean ratio of peak transmitral to peak annular (septal) velocity during early diastole (E/e’ ratio) 10.4 ± 4.5, mean left atrial volume index (LAVI) 37.4 ± 11.8 ml/cm2 and mean GLS -21.6 ± 2.6%. GLS of Child-Pugh class A patients (-20.3 ± 2.4) was higher (less negative) than GLS of Child-Pugh class B (-22.2 ± 2.2) and class C (-23.0 ± 2.8) patients. Difference between groups B and C was non-significant (figure). Severity of cirrhosis as determined by higher MELD-Na score correlated with LAVI (r = 0.592, p < 0.001), SV (r = 0.554, p < 0.001), GLS (r=-0.441, p = 0.001) and LVEDV (r = 0.428, p = 0.002). GLS correlated with SV (r=-0.369, p = 0.008) but not with preload (LVEDV), or afterload (SBP). In a linear regression model, GLS was independently associated with Meld-Na score when adjusting for age, SBP, LVEDV and NASH etiology [B=-0.139 (-0.252; -0.025), p = 0.018]. Conclusions GLS is lower (more negative) in patients with liver cirrhosis as disease progresses a relation not affected by preload and afterload conditions. Further research works are required to explain the underlying pathophysiology and to assess prognostic significance of reduced GLS values in patients with advanced cirrhosis. Abstract Figure. GLS stratified by Child-Pugh score

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Association of thromboelastography profile with severity of liver cirrhosis and portal venous system thrombosis

BMC Gastroenterology ◽

10.1186/s12876-021-01832-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yanglan He ◽

Shanshan Yuan ◽

Xiaozhong Guo ◽

Fangfang Yi ◽

Xiangbo Xu ◽

...

Keyword(s):

Liver Cirrhosis ◽

Maximum Amplitude ◽

Cross Sectional Study ◽

Venous System ◽

High Rate ◽

Portal Venous System ◽

Cross Sectional ◽

Class A ◽

Pugh Class ◽

Cirrhotic Patients

Abstract Background and aim Hemostasis profile is often complicated in liver cirrhosis. Thromboelastography is a global viscoelastic test recommended by the current practice guideline and consensus. This cross-sectional study aimed to evaluate the association of thromboelastography profile with severity of liver cirrhosis and presence of portal venous system thrombosis (PVST). Methods Overall, 116 and 50 cirrhotic patients were included in the Shenyang and Xi’an cohorts, respectively. Thromboelastography parameters were compared between cirrhotic patients with Child–Pugh class A and B/C, those with and without decompensated events, and those with and without PVST. Hypercoagulability would be considered if at least two of the following thromboelastography parameters were met: shortened reactive time (R), shortened coagulation time (K), increased angle, and increased maximum amplitude (MA). Results In the Shenyang cohort, 16 patients had shortened R, of whom seven (43.75%) had prolonged K and 11 (68.75%) decreased MA. In the Xi’an cohort, 24 patients had shortened R, of whom seven (29.17%) had prolonged K and 15 (62.50%) decreased MA. In the Shenyang cohort, the prevalence of hypercoagulability was not significantly different between cirrhotic patients with Child–Pugh class A and B/C (3.85% vs. 6.25%, P = 0.873), those with and without decompensated events (5.49% vs. 4.00%, P = 1.000), and those with and without PVST (4.17% vs. 5.88%, P = 1.000), which were similar to the results obtained in the Xi’an cohort. Conclusion There is a high rate of discordance between R and other thromboelastography parameters. In addition, hypercoagulability may not be related to more advanced stage of liver cirrhosis or presence of PVST.

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Treatment of hepatitis C Cirrhotic patients with directly acting antivirals: A multicenter study

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666201019122205 ◽

2020 ◽

Vol 20 ◽

Author(s):

Asem Ahmed Elfert ◽

Sherief Abd-Elsalam ◽

Lobna Abo-Ali ◽

Taher Eldemerdash ◽

Sabry AbouSaif ◽

...

Keyword(s):

Hepatitis C ◽

Treatment Response ◽

Outcome Measures ◽

Secondary Outcome ◽

Genotype 4 ◽

Class A ◽

Number Of Patients ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients

Background &Aims: With the introduction of sofosbuvir based regimens, there have been achieved high cure rates and decreased duration. Several studies showed variances in SVR rates between different genotypes, with lower rates of SVR among cirrhotic patients . The aim of our study was to assess the safety and effectiveness of sofosbuvir-based antiviral regimens for the treatment of HCV-infected Egyptian cirrhotic patients. Methods: This was a retrospective observational comparative study. Nine hundred forty six cirrhotic patients with chronic HCV genotype 4 infection who were eligible for direct acting drugs (DAAs) therapy were enrolled. The primary outcome measures were the number of patients with successful eradication of the virus evidenced by SVR at 12 Weeks After discontinuation of therapy (SVR12) and the secondary outcome measures were the incidence of adverse effects associated with the tested HCV therapy. Results: Among the 946 patients enrolled in the study; 527 patients (55.7%) were males and 419 patients (44.3 %) were females with mean age 54.00±8.88 years. 20.2 % were diabetics and 19.1% were hypertensive. Patients were classified according to Child -Pugh classifications; 818 patients (86.46%) were Child-Pugh class A cirrhosis, 28 patients (13.53 %) were Child-Pugh class B cirrhosis. SVR12 rate was 96.93% (917 /946). Treatment response in the Child-Pugh class A cirrhosis was 794 (97%) after 12 weeks while treatment response in the Child-Pugh class B cirrhosis was 123 (96%). Mild side effects were observed in 76 patients. Conclusions: Sofosbuvir based regimens were effective and safe in the treatment of cirrhotic patients with chronic hepatitis C genotype 4.

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Increased Endotoxin Activity Is Associated with the Risk of Developing Acute-on-Chronic Liver Failure

Journal of Clinical Medicine ◽

10.3390/jcm9051467 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1467

Author(s):

Hiroaki Takaya ◽

Tadashi Namisaki ◽

Shinya Sato ◽

Kosuke Kaji ◽

Yuki Tsuji ◽

...

Keyword(s):

Multivariate Analysis ◽

Liver Failure ◽

Predictive Biomarker ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Class A ◽

Increased Risk ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients

Acute-on-chronic liver failure (ACLF) leads to systematic inflammatory response syndrome and multiple organ failure. This study investigated the relationship between endotoxin (Et) and ACLF with the aim of determining whether Et activity (EA) is useful as a predictive biomarker of ACLF development and whether rifaximin treatment decreased the risk of ACLF development. Two hundred forty-nine patients with liver cirrhosis were enrolled in this study. Et concentration was determined in the whole blood by a semiquantitative EA assay. Predictive factors of ACLF development and the risk of ACLF development with and without rifaximin treatment were identified by univariate and multivariate analysis using Fine and Gray’s proportional subhazards model. EA level was higher in Child-Pugh class B than in class A patients, and class B patients had an increased risk of ACLF development compared with class A patients. Multivariate analysis showed that EA level was a predictive factor independently associated with ACLF development. Rifaximin decreased EA level and the risk of ACLF development in Child-Pugh class B patients. Et levels were associated with functional liver capacity and were predictive of ACLF development in cirrhotic patients. Rifaximin decreased Et level and the risk of ACLF development in advanced cirrhotic patients.

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Correlation of Grading of Esophageal Varices with Child Turcotte Pugh Class in Patients of Liver Cirrhosis

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24879 ◽

2018 ◽

Vol 16 (2) ◽

pp. 50-53

Author(s):

Anil Shrestha ◽

Dipendra Khadka ◽

Richa Shrestha

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

Cross Sectional ◽

Class A ◽

Red Color ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Small Varices

Background: Majority of cirrhotic patients develop varices over their lifetime and it is anticipated that roughly one third of varices will develop bleeding. Child Turcotte Pugh (CTP) class predicts the risk of variceal bleeding and has been used as a prognostic tool inpatients of liver cirrhosis. Objective: To correlate grade of esophageal varices in Upper Gastrointestinal endoscopy with Child Turcotte Pugh class in patients of liver cirrhosis. Material and method: This is a cross sectional descriptive study conducted in thedepartment of medicine of NGMCTH, Kohalpur between December 2017 to November 2018. A total of 97 patients were included inthe study who were diagnosed as cirrhosis of liver clinically and radio logically. Patient were classified into CTP class A, B and According to CTP score. UGI endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP classand the data were recorded and analysed. Result: Mean of patients was 50 years. Among 97 patients, 30 (30.9%) were in CTP class A,30 (30.9%) in CTP class B and 37 (38.1%) were in CTP class C. 25 (25.8%) had small varices, 50 (51.5%) had large varices with red colorsign, 20 (20.6%) had large varices without red color sign and 2 (2.1%) had no varices. Most of the patients in CTP class B and C hadlarge varices with red color sign whereas CTP class A had small varices. Conclusion: The cirrhotic patients in CTP class B and C havelarge varices with red color sign and have more chances of bleeding. Hence, routine screening is indicated to determine the presenceof varices. Porphylactic therapy after identifying large varices will decrease the incidence of bleeding leading to reduction inmortality rate.

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CT hepatic arterial perfusion index does not allow stratification of the degree of esophageal varices and bleeding risk in cirrhotic patients in Child–Pugh classes A and B

Abdominal Radiology ◽

10.1007/s00261-021-03259-6 ◽

2021 ◽

Author(s):

Felix Peisen ◽

Kaspar Ekert ◽

Michael Bitzer ◽

Hans Bösmüller ◽

Jan Fritz ◽

...

Keyword(s):

Liver Cirrhosis ◽

Correlation Coefficient ◽

Esophageal Varices ◽

Bleeding Risk ◽

Perfusion Index ◽

Arterial Perfusion ◽

Class A ◽

Significant Difference ◽

Pugh Class ◽

Cirrhotic Patients

Abstract Purpose To evaluate if the hepatic arterial perfusion index (HPI) in liver parenchyma of cirrhotic patients can serve as a surrogate parameter for stratifying the degree of esophageal varices and related bleeding risks. Methods CT image data of sixty-six patients (59 men; mean age 68 years ± 10 years) with liver cirrhosis (Child–Pugh class A (35/66, 53%), B (25/66, 38%), and C (6/66, 9%) who underwent perfusion CT (PCT) for hepatocellular carcinoma (HCC) screening between April 2010 and January 2019 were retrospectively identified. HPI, a parameter calculated by a commercially available CT liver perfusion analysis software that is based on the double maximum slope model, using time attenuation curve to determine perfusion, was correlated with the degree of esophageal varices diagnosed at endoscopy and the number of bleeding events. Results Eta correlation coefficient for HPI/presence of esophageal varices was very weak (0.083). Spearman-Rho for HPI/grading of esophageal varices was very weak (0.037 (p = 0.804)). Kendall-Tau-b for HPI/grading of esophageal varices was very weak (0.027 (p = 0.807)). ANOVA and Bonferroni post-hoc-tests showed no significant difference of HPI between different grades of esophageal varices (F (3, 62) = 1.676, p = 0.186). Eta correlation coefficient for HPI/bleeding event was very weak (0.126). Conclusion The stratification of the degree of esophageal varices and the related bleeding risk by correlation with the HPI as a surrogate parameter for portal venous hypertension was not possible for patients with liver cirrhosis in Child–Pugh class A and B. Graphic abstract

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