Features of management of patients with liver diseases in the conditions of the COVID-19 pandemic

Liver dysfunction is common with COVID-19 infection, and the prevalence is higher in men as well as in the elderly. Manifestations of liver damage such as high aspartate aminotransferase and alanine aminotransferase activity, increased bilirubin levels, low albumin levels, and prolonged prothrombin time are associated with severe COVID-19 infection. Mortality in patients with diffuse liver diseases without cirrhosis with COVID-19 infection was 12 %, in the presence of liver cirrhosis up to 40%, decompensated liver cirrhosis up to 4363%. The mechanisms of liver damage in COVID-19 include direct hepatotoxicity and indirect liver damage (due to systemic inflammation with impaired immunity, sepsis, hypoxia, ischemia, coagulopathy, endotheliitis, right ventricular failure, worsening of the course of existing liver diseases, drug liver damage). Treatment of patients with diffuse liver diseases includes lifestyle and nutritional modification, the use of hepatoprotective drugs, and means of correcting the intestinal barrier (bibliography: 30 refs).

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Novel Findings for the Development of Drug Therapy for Various Liver Diseases: Current State and Future Prospects for Our Liver Regeneration Therapy Using Autologous Bone Marrow Cells for Decompensated Liver Cirrhosis Patients

Journal of Pharmacological Sciences ◽

10.1254/jphs.10r13fm ◽

2011 ◽

Vol 115 (3) ◽

pp. 274-278 ◽

Cited By ~ 10

Author(s):

Taro Takami ◽

Shuji Terai ◽

Isao Sakaida

Keyword(s):

Bone Marrow ◽

Liver Cirrhosis ◽

Drug Therapy ◽

Liver Diseases ◽

Bone Marrow Cells ◽

Autologous Bone Marrow ◽

Future Prospects ◽

Decompensated Liver Cirrhosis ◽

Current State ◽

Autologous Bone

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Complex ultrasonography in the assessment of intrarenal hemodynamic impairments in patients with portal hypertension

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2021-13-1-25-32 ◽

2021 ◽

Vol 13 (1) ◽

pp. 25-32

Author(s):

L. V. Donova ◽

M. S. Novruzbekov ◽

V. E. Syutkin

Keyword(s):

Liver Transplantation ◽

Liver Cirrhosis ◽

Portal Hypertension ◽

Renal Dysfunction ◽

Liver Diseases ◽

Hepatorenal Syndrome ◽

Resistive Index ◽

Vein Thrombosis ◽

Relationship Of ◽

Diffuse Liver Diseases

Rationale. Hepatorenal syndrome is a threatening complication in patients with liver cirrhosis and portal hypertension. The occurrence of renal dysfunction associated with hepatorenal syndrome manifestations significantly affects the condition severity, the disease duration, and the survival time during the waiting period for liver transplantation.The study purpose was to investigate the potential of a complex ultrasonography examination in the assessment of intrarenal hemodynamic impairments in patients with various diffuse liver diseases.Material and methods. The ultrasound examination results of 167 patients were analyzed. The 1st group included 28 patients with confirmed diffuse liver diseases of viral etiology who did not have signs of cirrhosis formation, the 2nd group included 139 patients with liver cirrhosis due to diffuse liver diseases of various etiologies, and the 3-rd group included 137 patients who had previously been in the 2nd group in whom orthotopic liver transplantation was performed.Results. The study revealed a statistically significant increase in the incidence of secondary hemodynamic impairments in kidney function in patients with liver cirrhosis and no relationship of their severity and incidence to the disease etiology, and also to such markers of the portal hypertension severity as splenomegaly, ascites, and portal vein thrombosis.Conclusions. The resistive index measured on the renal arterial branches by Doppler ultrasound, has a certain predictive value in relation to hepatorenal syndrome in patients with liver cirrhosis of various origins. This also makes it possible to timely identify a group of patients at a high risk of developing severe renal dysfunction and to assess the efficacy of the treatment that has been given.

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Peculiarities of cerebral blood flow in patients with chronic diffuse liver diseases of viral etiology

Kazan medical journal ◽

10.17816/kmj1994 ◽

2014 ◽

Vol 95 (6) ◽

pp. 859-865 ◽

Cited By ~ 1

Author(s):

T S Morozova ◽

I F Grishina ◽

I A Gurikova

Keyword(s):

Blood Flow ◽

Liver Cirrhosis ◽

Cerebral Blood Flow ◽

Liver Diseases ◽

Vascular System ◽

Cerebral Arteries ◽

Vascular Wall ◽

Viral Etiology ◽

The Brain ◽

Diffuse Liver Diseases

Aim. To study the features of cerebral blood flow at different structural and functional levels of the brain vascular system in patients with chronic hepatitis and cirrhosis of viral etiology. Methods. A comprehensive ultrasound examination of the brain vascular system using an algorithm of cerebral arterial and venous blood flow examination based on the concept of the brain vascular system construction considering five structural and functional levels was performed in 65 chronic viral hepatitis patients and 61 patients with liver cirrhosis of viral etiology. The examination of the main brain arteries was performed using duplex scanning ultrasound SSD-5500 scanner («Aloka», Japan) with 5-12 MHz linear transducers. Examination of intracranial vessels was performed by transcranial color duplex scanning using ultrasonic SSD-5500 and «Sonoline G60» scanners («Siemens», Germany) with linear and phased 2.1-2.5 MHz transducers. Control group consisted of 50 healthy persons. Results. Remodeling of the cerebral arteries: the expansion of the lumen of the main cerebral vessels, reduction of blood flow in the carotid and middle cerebral arteries, decreased elasticity and increased vascular wall rigidity and, as a consequence, a change in vascular resistance and cerebral blood flow disturbance occurs in patients with chronic viral liver diseases. Identified changes of blood flow parameters at all levels of structural and functional brain perfusion indicate the presence of cerebral microangiopathy and arteriopathy based on the development of arteriosclerosis of main arteries and all penetrating arteries and arterioles in patients with chronic diffuse liver diseases. Conclusion. Adaptive remodeling of the vascular wall of the main cerebral arteries which provides an adequate regulatory response is found in patients with hepatitis B and C-associated liver cirrhosis. The reduction of blood supply to the brain, depletion of functional vascular reserve and development of intracranial venous circulatory distress are seen in patients with liver cirrhosis associated with viral hepatitis.

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Serum Paraoxonase Activity: A New Additional Test for the Improved Evaluation of Chronic Liver Damage

Clinical Chemistry ◽

10.1093/clinchem/48.2.261 ◽

2002 ◽

Vol 48 (2) ◽

pp. 261-268 ◽

Cited By ~ 139

Author(s):

Natàlia Ferré ◽

Jordi Camps ◽

Eduard Prats ◽

Elisabet Vilella ◽

Antoni Paul ◽

...

Keyword(s):

Liver Cirrhosis ◽

Chronic Hepatitis ◽

Liver Damage ◽

Liver Diseases ◽

Chronic Liver ◽

Pon1 Activity ◽

Activity Measurement ◽

Chronic Liver Diseases ◽

Baseline Serum ◽

Serum Pon1 Activity

Abstract Background: Paraoxonase 1 (PON1) is an ester hydrolase present in serum and in the liver. The aims of the present study were to investigate the following: (a) the relationship between serum PON1 activity alterations and the degree of liver damage in patients with chronic liver disease; (b) the influence of genetic variability on serum PON1 activity; and (c) the efficacy of serum PON1 activity measurement, alone and in combination with standard liver function tests, in the assessment of liver damage. Methods: We studied 68 patients with liver cirrhosis, 107 patients with chronic hepatitis, and 368 apparently healthy volunteers. Baseline and salt-stimulated PON1 activities were measured by the hydrolysis of paraoxon. PON1 genotyping at positions 55 and 192 was analyzed by PCR and restriction isotyping. Results: Baseline and stimulated PON1 activities were decreased (P <0.001) in chronic hepatitis and in liver cirrhosis. PON1 activity was significantly correlated with serum total proteins, albumin, and bilirubin in patients but not in controls. There were no significant differences with respect to allele and genotype frequencies between patients and controls. The combination of baseline serum PON1 with five standard biochemical tests had a higher classification accuracy (94% of patients; 96% of controls) than the five standard tests alone (75% of patients; 96% of controls). ROC plots demonstrated a high diagnostic accuracy for baseline serum PON1 [area under the curve, 0.89 (95% confidence interval, 0.86–0.93) in chronic hepatitis and 0.96 (95% confidence interval, 0.94–0.99) in cirrhosis]. Baseline PON1 provided the highest ROC area for cirrhosis vs controls. Conclusions: The significant decrease of PON1 activity in chronic liver diseases is related to the degree of hepatic dysfunction and not to allelic or genotypic differences. Addition of serum PON1 activity measurement to the current battery of tests may improve the evaluation of chronic liver diseases.

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Human Fetal Liver-Derived Stem Cell Transplantation as Supportive Modality in the Management of End-Stage Decompensated Liver Cirrhosis

Cell Transplantation ◽

10.3727/096368909x484707a ◽

2010 ◽

Vol 19 (4) ◽

pp. 409-418 ◽

Cited By ~ 106

Author(s):

Aleem A. Khan ◽

Mahaboob V. Shaik ◽

N. Parveen ◽

A. Rajendraprasad ◽

Mohammed A. Aleem ◽

...

Keyword(s):

Stem Cells ◽

Liver Cirrhosis ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Liver Diseases ◽

Fetal Liver ◽

Decompensated Liver Cirrhosis ◽

Human Fetal Liver ◽

End Stage

Liver transplantation is the only existing modality for treating decompensated liver cirrhosis. Several factors, such as nonavailability of donors, combined with operative risks, complications associated with rejection, usage of immunosuppressive agents, and cost intensiveness, make this strategy available to only a few people. With a tremendous upsurge in the mortality rate of patients with liver disorders worldwide, there is a need to search for an alternative therapeutic tool that can combat the above limitations and serve as a supportive therapy in the management of liver diseases. Cell therapy using human fetal liver-derived stem cells can provide great potential to conservatively manage end-stage liver diseases. Therefore, the present investigation aimed to study and prove the safety and efficacy of human fetal liver-derived stem cell transplantation in patients with end-stage liver cirrhosis. Twenty-five patients with liver cirrhosis of different etiologies were infused with human fetal liver-derived stem cells (EpCAM+ve) labeled with Tc-HMPAO through hepatic artery. Our high throughput analysis using flow cytometry, RT-PCR, and cellular characterization exemplifies fetal liver cells with their high proliferation rate could be the best source for rejuvenating the diseased liver. Further, no episodes related to hepatic encephalopathy recurred in any of the subjects following hepatic stem cell transplantation. There was marked clinical improvement observed in terms of all clinical and biochemical parameters. Further, there was decrease in mean MELD score ( p < 0.01) observed in 6 months follow-up in all patients. Therapy using human fetal liver stem/progenitor cells offers a potentially supportive modality to organ transplantation in the management of liver diseases.

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Wnt/β-Catenin Signaling as a Potential Target for the Treatment of Liver Cirrhosis Using Antifibrotic Drugs

International Journal of Molecular Sciences ◽

10.3390/ijms19103103 ◽

2018 ◽

Vol 19 (10) ◽

pp. 3103 ◽

Cited By ~ 23

Author(s):

Koji Nishikawa ◽

Yosuke Osawa ◽

Kiminori Kimura

Keyword(s):

Liver Cirrhosis ◽

Chronic Hepatitis ◽

Liver Disease ◽

Liver Fibrosis ◽

Liver Damage ◽

Liver Diseases ◽

Camp Response Element Binding ◽

Camp Response Element ◽

Element Binding Protein ◽

Antifibrotic Drugs

Cirrhosis is a form of liver fibrosis resulting from chronic hepatitis and caused by various liver diseases, including viral hepatitis, alcoholic liver damage, nonalcoholic steatohepatitis, and autoimmune liver disease. Cirrhosis leads to various complications, resulting in poor prognoses; therefore, it is important to develop novel antifibrotic therapies to counter liver cirrhosis. Wnt/β-catenin signaling is associated with the development of tissue fibrosis, making it a major therapeutic target for treating liver fibrosis. In this review, we present recent insights into the correlation between Wnt/β-catenin signaling and liver fibrosis and discuss the antifibrotic effects of the cAMP-response element binding protein/β-catenin inhibitor PRI-724.

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ALGORITHM OF DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF CHRONIC DIFFUSE LIVER DISEASES (CHRONIC HEPATITIS AND LIVER CIRRHOSIS) IN DIFFICULT CLINICAL SITUATIONS, BASED ON DETERMINATION OF ENZYMATIC ACTIVITIES OF BLOOD SERUM

Nauka molodykh (Eruditio Juvenium) ◽

10.23888/hmj202084566-573 ◽

2020 ◽

Vol 8 (4) ◽

pp. 566-573

Author(s):

H.I. Yupatov ◽

◽

V.A. Pryshchepenko ◽

Keyword(s):

Differential Diagnosis ◽

Liver Cirrhosis ◽

Chronic Hepatitis ◽

Blood Serum ◽

Liver Diseases ◽

Laboratory Research ◽

Control Group ◽

Diagnostic Measures ◽

Diffuse Liver Diseases

Background. The search for non-invasive criteria for differential diagnosis of chronic hepatitis and liver cirrhosis is one of the urgent tasks of hepatology. Aim. Development of an algorithm for the diagnosis and differential diagnosis of chronic diffuse liver diseases (chronic hepatitis and liver cirrhosis) in difficult clinical situations, namely in patients with questionable results of routine laboratory research. Materials and Methods. 55 patients were examined who had a characteristic clinical picture of chronic diffuse liver diseases, however, the levels of AST and ALT were close to normal values. Chronic hepatitis was confirmed in 14 patients (mean age 55.0±11.2 years), liver cirrhosis in 40 patients (mean age 55.0±9.9 years). The control group included 43 practically healthy individuals (mean age – 52.8±4.2 years). All patients underwent determination of the levels of hyaluronidase, elastase, trypsin-like and deoxyribonuclease serum activities, as well as levels of alpha-1-defensin and interleukin-13 in blood serum. Results. An algorithm for the differential diagnosis of chronic hepatitis and cirrhosis of the liver was developed, which makes it possible to identify liver disease with odds ratio of 988.0 [CI95%=31.3-31207.7]. Conclusion. The algorithm allows to optimize diagnostic measures in difficult clinical situations.

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The Role of the Hepatic Tissue Remodeling Regulators MMP-9 and TIMP-1 in the Progression of Liver Cirrhosis

Health and Ecology Issues ◽

10.51523/2708-6011.2019-16-4-18 ◽

2019 ◽

pp. 88-94

Author(s):

A. G. Skuratov ◽

A. N. Lyzikov ◽

E. V. Voropaev ◽

O. V. Osipkina ◽

D. V. Tereshkov ◽

...

Keyword(s):

Liver Cirrhosis ◽

Chronic Hepatitis ◽

Liver Diseases ◽

Tissue Remodeling ◽

Hepatic Tissue ◽

Rapid Progression ◽

Viral Etiology ◽

Enzymelinked Immunosorbent Assay ◽

Diffuse Liver Diseases

Objective: to study the level of the hepatic tissue remodeling regulators MMP-9 and TIMP-1 in the blood of patients with the progression of chronic diffuse liver diseases.Material and methods. The object of the study was 80 patients with chronic diffuse liver diseases (chronic hepatitis and cirrhosis). The concentration of MMP-9 and TIMP-1 in the blood of the patients was determined by enzymelinked immunosorbent assay (ELISA).Results: As chronic diffuse liver diseases progressed, a statistically significant decrease in the level of MMP-9 in the blood of the patients was revealed, which was reflected in the decreased intensity of the extracellular matrix resorption processes and transformation of chronic hepatitis into liver cirrhosis. The activity of TIMP-1 which suppressed the fibrolytic effects of MMP-9, was statistically significantly higher in the viral etiology of liver cirrhosis, which probably led to more rapid progression of liver fibrosis associated with the presence of hepatitis C and В viruses.

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