scholarly journals The Pattern of Liver Dysfunction in Patients with COVID-19: A Retrospective Study

2020 ◽  
Author(s):  
Chunyan wang ◽  
Yihui Rong ◽  
Lei Wei ◽  
Huanwei Zheng ◽  
Jing Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Liver Function ◽  
Liver Dysfunction ◽  
Normal Liver ◽  
Normal Liver Function ◽  
Viral Shedding ◽  
Type 3

Abstract Background. Information about liver dysfunction in patients with COVID-19 is scarce. We aimed to explored the pattern and risk factors of liver dysfunction in patients with COVID-19.Methods. In this retrospective study, we included all consecutive confirmed patients with COVID-19 in Fuyang Second People’s Hospital between January 20 and February 25, 2020 and collected clinical characteristics until discharge. The pattern and risk factors of liver dysfunction, viral shedding and outcome were analyzed.Results. Totally, 146 patients were analyzed. The median age was 44.9 years and 54.1% were men, 43.8% patients presented liver dysfunction (22.6% on admission, 21.2% during hospitalization). The percentage of elevated ALT (15.1% on admission and 24.7% during hospitalization) were significantly higher than ALP (2.1% on admission and 3.4% during hospitalization) (P < 0.001). Four clinical types were identified, type 1 (persistent normal liver function, 56.2%), type 2 (normal liver function on admission developed to liver dysfunction during hospitalization, 21.2%), type 3 (liver dysfunction on admission restored to normal on discharge, 13.0%) and type 4 (persistent liver dysfunction, 9.6%). The median duration of viral shedding was 12.0 (type 1), 15.0 (type 2), 14.0 (type 3) and 18.0 (type 4) days (P < 0.001). Prolonged viral shedding and severity were potential risk factors associated with liver dysfunction. Conclusions. The incidence of liver dysfunction in patients with COVID-19 is common but not severe, which mainly due to SARS-CoV-2-mediated immune injury on hepatocyte rather than cholangiocyte, DILI and underlying chronic liver disease should not be neglect.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract BackgroundWe investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.MethodsA prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.ResultsA total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.ConclusionSmall papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Effects of grade B liver dysfunction on the level of free hexafluoroisopropanol of sevoflurane metabolites in patients with abdominal surgery

2020 ◽  
Author(s):  
Xiao-lin Yang ◽  
Ming Li ◽  
Yan Feng ◽  
Guo-Yuan Zhang
Keyword(s):  
Liver Function ◽  
Liver Dysfunction ◽  
Normal Liver ◽  
Time Orientation ◽  
Peak Time ◽  
Normal Liver Function ◽  
Time Points ◽  
Extubation Time ◽  
Group A ◽  
Group B

Abstract Background: Study shows the metabolite, hexafluoroisopropanol (HFIP) from sevoflurane, has a strong inhibition on the central nervous system. This study aims to compare the level of free HFIP in the blood after inhaled a same concentration of sevoflurane in patients with normal liver function versus grade B liver dysfunction and observe its effect on patients’ recovery quality.Methods: Twenty four patients with normal liver function and twenty four patients with grade B liver dysfunction undergoing elective abdominal surgery were selected and assigned to group A and group B, respectively. All patients were inhaled sevoflurane (1.5MAC) for anesthesia about 3 h. The free HFIP concentration was determined at the time points of 0.5 h, 1 h, 2 h, 3 h after inhaled sevoflurane and 0.5 h, 1 h, 2 h, 4 h after discontinuation of sevoflurane, respectively. Patients’ eyes opening time, orientation recovery time, command response time and extubation time were observed after operation. The visual analogue scale (VAS) and Ramsay sedation score (RSS) were also evaluated at different time points after extubation. Results: Although the peak time of free HFIP in group B was 1 h later than that in group A, no significant differences were found in the peak concentration and other corresponding time points’ free HFIP concentrations between the two groups (P<0.05). All the eyes opening time, orientation recovery time, command response time and extubation time in group B were longer than those in group A (P<0.05). Compared to group A, a lower VAS score and a higher RSS score were found in group B at 0 min, 15 min, 30 min,1 h, 2 h and 3 h after extubation, respectively (P<0.05). Conclusion: The status of patients with grade B liver dysfunction does not affect the degree of sevoflurane metabolism. However, it can significantly prolong the peak time of free HFIP when compared with normal liver function.Trial registry number: Identified as ChiCTR 2000028901at http://www.chictr.org.cn/

Population Analysis of a Hemophilia Treatment (HTC) for Prevalence and Outcome of Cardiovascular Disease (CVD) in Patients with Congenital Bleeding Disorders (PWBD).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3999-3999
Author(s):  
Rekha Parameswaran ◽  
A. Greist ◽  
H. S. Lynn ◽  
C. P. Roberson ◽  
J. Kirk ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Patient Population ◽  
Bleeding Disorders ◽  
Cvd Risk ◽  
Type Iii ◽  
Coronary Syndrome ◽  
Type 3

Abstract CVD, acute coronary syndrome (ACS)/cerebrovascular accident (CVA), is a leading cause of morbidity and mortality in the US. Risk factors are hypertension, hypercholesterolemia (HC), smoking and diabetes. Therapeutic advances allow PWBD to live longer; CVD may emerge as in the general population. No data address prevalence and treatment of CVD in PWBD. Previous data suggest that hemophilia may protect against CVD. A single HTC analysis of PWBD for CVD prevalence and outcome was performed. Query of HTC database identified patients with hemophilia/ von Willebrand disease(vWD) with CVD and retrospective chart analysis performed for risk factors. Coronary risk assessment score, expressed as a percentage(Framingham model), was calculated; unknown HC values assigned level 1 (scale maximum level 3) to avoid bias. Age at CVD event was used for risk comparison to age/ sex matched general population. HTC population was analyzed for bleeding disorder, severity, age ≥ 40 yrs, sex and utilized as the denominator for population event analysis. PWBD demographics ≥ 40 yrs revealed 146 with FVIII deficiency (60 severe, 18 moderate, 68 mild); 99 with FIX deficiency (20 severe, 52 moderate, 27 mild); 164 vWD (106 Type 1, 48 Type 2, 10 Type 3). Twenty-four PWBD, all ≥ 40 yrs of age, had experienced 26 CVD events. These PWBD included 8 FVIII (0 severe, 1 moderate, 7 mild), 6 FIX (2 severe, 4 moderate, 0 mild), and 10 vWD (5 Type 1, 4 Type 2, 1 Type 3). Events included 20 ACS; 6 were CVA; two patients each had both ACS and CVA. Six were deceased at time of analysis; five deaths due to CVD; one death (type III vWD) due to lung cancer. Framingham risk scores were comparable to expected general population scores. Eight patients received anti-platelet therapy. Of these, two had major bleeds (CNS and GI bleed); one had a minor bleed (epistaxis). Approximately one in 20 US population over age 40 yrs has CVD. Given this prevalence, we would expect 20 patients with CVD in our patient population. If bleeding disorders, specifically hemophilia and vWD, conferred protection against CVD, then we would expect decreased prevalence of CVD in our patient population. This putative protective effect would likely manifest in PWBD with severe deficiencies than in PWBD with mild deficiencies. Interestingly, we identified three patients with severe deficiency (two severe FIX; one type III vWD) with CVD; one of whom (type III vWD) had a higher calculated CVD risk score that age matched general population. CVD patients with mild/moderate deficiencies appear more similar to the general population for CVD risk than their severely affected counterparts. CVD prevalence in the former group could approach expected general population prevalence given Framingham scores equal to or higher than expected compared to the general population. In fact, Framingham score for identified CVD patients revealed 10 year comparative risk of CVD similar to general population risk. Accurate prevalence rates will be determined through prospective risk factor screening/CVD evaluation in PWBD over 40 yrs. Further study is warranted as prophylaxis becomes more widely utilized converting patients with severe disease to a more moderate disease state and possibly altering CVD prevalence. Invasive procedure outcome and optimal CVD therapy in PWBD require prospective investigation. This single center analysis represents the largest reported registry of PWBD analyzed for CVD to date.

Normal hepatic function

2018 ◽  
Author(s):  
Satish Keshav ◽  
Palak Trivedi
Keyword(s):  
Liver Function ◽  
Liver Dysfunction ◽  
Functional Anatomy ◽  
Normal Liver ◽  
Hepatic Function ◽  
Lymphatic Drainage ◽  
Normal Liver Function ◽  
Biliary Anatomy ◽  
Liver Anatomy ◽  
Normal Hepatic Function

This chapter explores normal liver function, including liver anatomy (vasculature, biliary anatomy, lymphatic drainage, innervation of the liver, and functional anatomy of the liver), basic physiology, and mechanisms of liver dysfunction.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Introduction We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Method A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.Method A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Sign in / Sign up

Export Citation Format

Share Document