scholarly journals A study of clinical profile and factors affecting mortality in patients with acute on chronic liver failure in a tertiary hospital in north east India

2021 ◽  
Vol 9 (2) ◽  
pp. 577
Author(s):  
Mallika Bhattacharyya ◽  
Narendra Nath Barman ◽  
Bhabadev Goswami ◽  
Bikash Narayan Choudhury
Keyword(s):  
Liver Disease ◽  
Hepatitis B ◽  
Liver Failure ◽  
Acute Hepatitis ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Precipitating Factors ◽  
Chronic Liver Failure ◽  
North East India ◽  
North East

Background: Data regarding Acute on Chronic Liver Failure (ACLF) patients from North East India is scarce and presentation to hospital is often late. We aim to study their clinical profile, aetiology of underlying chronic liver disease, precipitating factors, predictors of mortality and their short term outcome (3 months).Methods: Among 1000 consecutive patients of any form of acute decompensation, 245 patients diagnosed as ACLF were prospectively studied. Comparison was done between survivors versus non survivors of ACLF and between ACLF and Non ACLF patients.Results: Mean age of ACLF patients was 44.2±10.3 years and male:female ratio was 13.4:1. Common causes of underlying cirrhosis in ACLF was alcoholic liver disease, 210 (85.7%), Hepatitis B virus related cirrhosis, 20 (8.2%), Hepatitis C virus related cirrhosis, 6 (2.4%) and cryptogenic in 8 (3.3%). Precipitating causes were alcoholic hepatitis in 98 (46.6%) among alcoholic cirrhosis, acute flare of Hepatitis B infection in 12 patients (60%) among Hepatitis B related cirrhosis, recent use of drugs in 110 (44.8%), sepsis in 71 (28.9%), spontaneous bacterial peritonitis (SBP) in 36 (14.7%), urinary tract infection in 36 (14.7%), acute hepatitis A in 5 (2%) and acute hepatitis E in 3 (1.2%). hepatic encephalopathy, low sodium, high International Normalised Ratio (INR) were found to be significantly associated with high mortality. Increasing number of organ failures is associated with increasing risk of death.Conclusions: ACLF is characterized by rapid deterioration especially when multiorgan failure sets in due to certain precipitating factors in a previously diagnosed or undiagnosed chronic liver disease. 

scholarly journals Etiological study of acute on chronic liver failure among patients admitted in medicine ward in Chittagong Medical College Hospital

2015 ◽  
Vol 9 (2) ◽  
pp. 77-82 ◽  
Author(s):  
Ummay Fatema Khatun ◽  
Abu Sayeed ◽  
Sk Md Bahar Hussain ◽  
Sujat Paul ◽  
Narjis Maliha Kawsar ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis B ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Chronic Liver Failure ◽  
College Hospital ◽  
Medical College

Introduction: Acute on chronic liver failure (ACLF) is defined as acute hepatic insult manifesting as jaundice and coagulopathy complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease. It has various etiology and manifestations, as well as high mortality. These etiologies vary depending on geographical region - from east to west. For example, infectious etiologies predominate in the east whereas alcohol and drugs constitute the majority of acute insults in west. In Asian region, reactivation of hepatitis B virus and superinfection with hepatitis E virus are more common among the infectious etiologies. Objective: As the incidence of chronic liver disease is increasing day by day and the etiology of acute decompensation of underlying chronic liver disease varies depending on geographical location, so it may be different in Bangladesh from other Asian countries. A very few studies have been published so far showing etiological prevalence of Acute on Chronic Liver Failure (ACLF) in Bangladesh. This study has been conducted to address the etiology of ACLF in our perspective. Methods: A cross sectional longitudinal study carried out in the department of Medicine, Chittagong Medical College Hospital. Thirty patients admitted with ACLF as defined by Asia Pacific Association for Study of Liver Disease (APASL) were consecutively included. Detailed history, complete physical examination and laboratory investigations were done for each patient. 77 JAFMC Bangladesh. Vol 9, No 2 (December) 2013 Results: From January 2009 to December 2009, among thirty patients 6 cases (20%) of ACLF was caused by HEV super infection followed by Sepsis (16.67%), variceal bleeding (13.33%) and hepatotoxic drugs (3.33%) respectively. Multiple factors were found in (16.67%) cases while no cause could be identified in (30%) cases. In our study common causes of chronic liver diseases were hepatitis B (50%), hepatitis C (26.67%) and alcohol (16.67%). Among thirty patients five died within forty eight hours of hospital admission. In hospital mortality was 16.67%. Conclusion: Acute on Chronic Liver Failure (ACLF) is one of the commonest causes of mortality, morbidity and socio-economic burden particularly in Bangladesh. Early detection and proper management of acute events that lead to ACLF would alleviate mortality and morbidity. However due to high treatment cost, proper management of chronic liver diseases as well as ACLF cannot be afforded by most people in our country. DOI: http://dx.doi.org/10.3329/jafmc.v9i2.21837 Journal of Armed Forces Medical College Bangladesh Vol.9(2) 2013

scholarly journals Imaging Software-Based Sarcopenia Assessment in Gastroenterology: Evolution and Clinical Meaning

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Giovanni Marasco ◽  
Sinan Sadalla ◽  
Giulio Vara ◽  
Rita Golfieri ◽  
Davide Festi ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Sarcopenia is gaining attention as a negative prognostic factor in different fields of medicine, including chronic liver failure. However, the assessment of sarcopenia in patients with liver diseases is often neglected due to unawareness of reliable tools and methods and thus is limited to research studies. Cross-sectional imaging is a diffuse diagnostic tool and is commonly performed in patients with chronic liver failure. The last advancements in radiology image analysis using dedicated software allow an easy and standardized method to assess skeletal muscle volume. Several measures can be obtained from cross-sectional imaging analysis to evaluate sarcopenia in patients affected by chronic liver disease. We aimed to review the recent advances in imaging-based sarcopenia assessment, in particular in patients with chronic liver diseases. As a result, we found that the skeletal muscle index (SMI) seems to be a reliable method to assess sarcopenia in cirrhotic patients. Even if further studies are needed to validate proper cut-offs for each clinical endpoint, physicians are invited to consider the assessment of sarcopenia in the work-up of patients with chronic liver disease.

scholarly journals Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Manman Xu ◽  
Ming Kong ◽  
Pengfei Yu ◽  
Yingying Cao ◽  
Fang Liu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Asian Pacific ◽  
Long Term Mortality

Background and Aims: Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver disease with high short-term mortality. The inclusion or exclusion of previously decompensated cirrhosis (DC) in the diagnostic criteria of ACLF defined by the Asian Pacific Association for the Study of the Liver (APASL-ACLF) has not been conclusive. We aimed to evaluate the prognostic impact of decompensated cirrhosis in ACLF.Methods: We retrospectively collected a cohort of patients with a diagnosis of APASL-ACLF (with or without DC) hospitalized from 2012 to 2020 at three liver units in tertiary hospitals. Baseline characteristics and survival data at 28, 90, 180, 360, 540, and 720 days were collected.Results: Of the patients assessed using APASL-ACLF criteria without the diagnostic indicator of chronic liver disease, 689 patients were diagnosed with ACLF, of whom 435 had no decompensated cirrhosis (non-DC-ACLF) and 254 had previously decompensated cirrhosis (DC-ACLF). The 28-, 90-, 180-, 360-, 540-, and 720-day mortality were 24.8, 42.9, 48.7, 57.3, 63.4, and 68.1%, respectively, in DC-ACLF patients, which were significantly higher than in non-DC-ACLF patients (p < 0.05). DC was independently associated with long-term (180/360/540/720 days) but not short-term (28/90 days) mortality in patients with ACLF. Age, total bilirubin, international normalized ratio, and hepatic encephalopathy were independent risk factors for short- and long-term mortality risk in ACLF patients (p < 0.05).Conclusions: Patients with DC-ACLF have a higher mortality rate, especially long-term mortality, compared to non-DC-ACLF patients. Therefore, DC should be included in the diagnostic criteria of APASL-ACLF and treated according to the ACLF management process.

scholarly journals Significance of anti-HBc IgM in acute hepatitis and hepatitis B associated chronic liver disease.

RADIOISOTOPES ◽  
1984 ◽  
Vol 33 (10) ◽  
pp. 686-690
Author(s):  
Yukio KUSUMOTO ◽  
Makoto GOTO ◽  
Heiichiro TAJIMA ◽  
Keisuke NAKATA ◽  
Ryuji FURUKAWA ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis B ◽  
Acute Hepatitis ◽  
Chronic Liver Disease ◽  
Chronic Liver

scholarly journals Detection of Precipitating Factors of Hepatic Encephalopathy in Chronic Liver Disease Patients in a Tertiary Hospital

2017 ◽  
Vol 19 (1) ◽  
pp. 10-14
Author(s):  
Md Asadul Kabir ◽  
Jewel Chowdhury ◽  
Md Anwarul Bari ◽  
Kazi Bodruddoza ◽  
Asim Kumer Saha ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Disease Patient ◽  
Chronic Liver ◽  
Control Measures ◽  
Electrolyte Imbalance ◽  
Precipitating Factors

Background: Chronic liver disease (CLD) is commonly encountered by physicians in hospital practice. Hepatic encephalopathy is a serious complication of chronic liver disease, arising most commonly in those with advanced liver cirrhosis. In patients with otherwise stable cirrhosis, hepatic encephalopathy often follows clearly identifiable precipitating events. The aim of study is to find out the precipitating factors and their frequency in patients of CLD presenting with hepatic encephalopathy to prevent mortality and morbidity.Methods: This descriptive observational study was carried out to identify the precipitating factors and their frequency among 50 cases of diagnosed chronic liver disease presenting with hepatic encephalopathy at department of Medicine of Sir Salimullah Medical College & Mitford hospital, Dhaka from July 2012 to December 2012 for a period of 6 months.Results: Among 50 patients, 36 patients (72%) were male, 14 (28%) were female. Study showed that age frequency 14 (28%) were from 41-50 years and 08 (16%) were from 51-60 years, 12 (24%) >60 years of age. Out of 50 patients, the etiology of liver cirrhosis was hepatitis B virus in 28 (56%), hepatitis C virus in 4 (8%), both Hepatitis B & C in 02 (4%) Among 50 patients, 13 (26%)were in Grade-3 and 11 (22%) in Grade-2 Hepatic encephalopathy. According to Child-Pugh scoring 16 (32%) in Grade-C & 09 (18%) in Grade-B. The most common precipitating factors were identified as GI bleeding (28%), Infection (26%), mixed (16%) & unknown (20%). In this study, mortality rate was 32% most of the patients from Child-Pugh class-C.Conclusions: Commonest precipitating factors of hepatic encephalopathy in this study were upper G.I. bleeding, infection, mixed factor and electrolyte imbalance. To prevent hepatic encephalopathy caution must be exercised in putting chronic liver disease patient on diuretics. Early and effective infection control measures and better hygienic conditions in government hospitals are needed to be maintained.J MEDICINE Jan 2018; 19 (1) : 10-14

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