scholarly journals Early postoperative serum aspartate aminotransferase for prediction of post-hepatectomy liver failure

2021 ◽  
Author(s):  
Watoo Vassanasiri ◽  
Narongsak Rungsakulkij ◽  
Wikran Suragul ◽  
Pongsatorn Tangtawee ◽  
Paramin Muangkaew ◽  
...  
Keyword(s):  
At Risk ◽  
Liver Failure ◽  
Laboratory Data ◽  
Elevated Serum ◽  
International Normalized Ratio ◽  
Active Management ◽  
Serum Aminotransferase ◽  
Serum Aspartate Aminotransferase ◽  
Patients At Risk ◽  
Icg R15

Abstract Background Post-hepatectomy liver failure (PHLF) is a serious complication of hepatectomy. The current criteria for PHLF diagnosis (ISGLS consensus) require laboratory data on or after postoperative day (POD) 5, which may delay treatment for patients at risk. The present study aimed to determine the associations between early postoperative (POD1) serum aminotransferase levels and PHLF. Methods The medical records of patients who underwent hepatectomy at Ramathibodi Hospital from January 2008 to December 2019 were retrospectively examined. Patients were classified into PHLF and non-PHLF groups. Preoperative characteristics, intraoperative findings, and early postoperative laboratory data (serum AST, ALT, bilirubin, and international normalized ratio (INR) on POD0 to POD5) were analyzed. Results A total of 890 patients were included, of whom 31 (3.4%) had PHLF. Cut-off points for AST of 260 U/L and ALT of 270 U/L on POD1 were predictive of PHLF. In multivariate analysis, AST >260 U/L on POD1, ICG-R15, major hepatectomy, blood loss, and INR were independently associated with PHLF. Conclusions Early warning from elevated serum AST on POD1, before a definitive diagnosis of PHLF is made on POD5, can help alert physicians that a patient is at risk, meaning that active management and vigilant monitoring can be initiated as soon as possible.

scholarly journals Role of Integrated Functional Assessment Pathway Using 99m Tc -Mebrofinate SPECT-CT Scan, ICG, Elastography and HVPG in Patients at Risk of Post Hepatectomy Liver Failure

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S38
Author(s):  
B.V. Dasari ◽  
P. Kadam ◽  
K.J. Roberts ◽  
R.P. Sutcliffe ◽  
N. Chatzizacharias ◽  
...  
Keyword(s):  
At Risk ◽  
Liver Failure ◽  
Ct Scan ◽  
Functional Assessment ◽  
Patients At Risk

Seizures Associated with High Maprotiline Serum Concentrations

1983 ◽  
Vol 28 (7) ◽  
pp. 555-556 ◽  
Author(s):  
George Molnar
Keyword(s):  
At Risk ◽  
Elevated Serum ◽  
Seizure Threshold ◽  
Blood Levels ◽  
Serum Concentrations ◽  
Induction Mechanism ◽  
Patients At Risk ◽  
Tetracyclic Antidepressant ◽  
Antidepressant Use ◽  
Therapeutic Doses

Maprotiline is a tetracyclic antidepressant which appears to have accounted for a relatively large proportion of the seizures associated with antidepressant use. The literature proposes two mechanisms of seizure induction: interaction with other medications and concomitant medical conditions lowering the seizure threshold. Observations during a study of maprotiline blood levels suggest that elevated serum concentrations achieved with therapeutic doses may also be linked to the seizure-induction mechanism. Monitoring of maprotiline blood levels may help to identify patients at risk.

Polymorphisms in the IL‐1 gene cluster influence systemic inflammation in patients at risk for acute‐on‐chronic liver failure

Hepatology ◽  
2016 ◽  
Vol 65 (1) ◽  
pp. 202-216 ◽  
Author(s):  
José Alcaraz‐Quiles ◽  
Esther Titos ◽  
Mireia Casulleras ◽  
Marco Pavesi ◽  
Cristina López‐Vicario ◽  
...  
Keyword(s):  
At Risk ◽  
Liver Failure ◽  
Gene Cluster ◽  
Systemic Inflammation ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Patients At Risk

scholarly journals Elevated serum microRNA 483-5p levels may predict patients at risk of post-operative atrial fibrillation

2016 ◽  
Vol 51 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Leanne Harling ◽  
Jonathan Lambert ◽  
Hutan Ashrafian ◽  
Ara Darzi ◽  
Nigel J. Gooderham ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
At Risk ◽  
Elevated Serum ◽  
Serum Microrna ◽  
Post Operative Atrial Fibrillation ◽  
Patients At Risk

Hypoprothrombinemia Associated with Cefmetazole

1997 ◽  
Vol 31 (2) ◽  
pp. 180-184 ◽  
Author(s):  
Gail A Breen ◽  
Wendy L St Peter
Keyword(s):  
At Risk ◽  
Vitamin K ◽  
Clinical Symptoms ◽  
The Elderly ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Endstage Renal Disease ◽  
Populations At Risk ◽  
Increased Risk ◽  
Patients At Risk

Objective To report a case of hypoprothrombinemia associated with the use of cefmetazole sodium, define patients at risk for this adverse effect, and identify options to prevent this problem. Case Summary A malnourished patient with endstage renal disease received cefmetazole following a below-the-knee amputation of the right leg. Three days later, a prothrombin time (FT) and an international normalized ratio (INR) were obtained and were markedly elevated from baseline; however, the patient had no clinical symptoms of bleeding. Cefmetazole was discontinued. Vitamin K and fresh frozen plasma were administered. The PT and INR normalized within 24 hours and remained normal throughout the remainder of hospitalization. Discussion The incidence of hypoprothrombinemia associated with cefmetazole reported in the literature is conflicting and not consistent. There are three proposed mechanisms of cephalosporin-associated hypoprothrombinemia, two of which involve the N-methylthiotetrazole (NMTT) chain. The most plausible mechanism is NMTT inhibition of vitamin K epoxide reductase in the liver. Patients at an increased risk for this adverse event include those with low vitamin K stores, specifically patients who are malnourished, with low albumin concentrations and poor food intake. The elderly and patients with liver or renal dysfunction are examples of populations at risk. Conclusions Hypoprothrombinemia may occur with cephalosporins and is especially problematic with those containing an NMTT side chain. Clinicians need to identify patients at risk for developing antibiotic-associated hypoprothrombinemia, monitor them closely, and give vitamin K as prophylaxis accordingly.

scholarly journals Safety and Efficacy of Preoperative Portal Vein Embolization in Patients at Risk for Postoperative Liver Failure

2011 ◽  
Vol 140 (5) ◽  
pp. S-1018
Author(s):  
Kristen Massimino ◽  
Kenneth J. Kolbeck ◽  
C. Kristian Enestvedt ◽  
Susan L. Orloff ◽  
Kevin G. Billingsley
Keyword(s):  
At Risk ◽  
Portal Vein ◽  
Liver Failure ◽  
Portal Vein Embolization ◽  
Postoperative Liver Failure ◽  
Safety And Efficacy ◽  
Patients At Risk

Oral Vitamin K1: An Option To Reduce Warfarin'S Activity

1995 ◽  
Vol 29 (12) ◽  
pp. 1228-1232 ◽  
Author(s):  
Colleen C Harrell ◽  
Sandra S Kline
Keyword(s):  
At Risk ◽  
Vitamin K ◽  
Warfarin Therapy ◽  
Cost Effective ◽  
International Normalized Ratio ◽  
Extensive Literature ◽  
Oral Vitamin ◽  
Risk Of Bleeding ◽  
Case Summary ◽  
Patients At Risk

Objective: To report 6 patients taking oral vitamin K1 (phytonadione) to reduce warfarin's activity. Case Summary: Six patient cases are summarized in which oral vitamin K1 was used to reduce the international normalized ratio (INR) in patients at risk of bleeding. Discussion: The use of oral vitamin K1 to antagonize warfarin's effects is discussed, as well as the benefits of oral vitamin K1 administration and the disadvantages of parenteral vitamin K1 administration. In addition, an extensive literature review of the discovery and clinical development of warfarin and vitamin K1 is described. Conclusions: In patients receiving warfarin therapy who have an increased INR and are at risk of bleeding, oral vitamin K1 therapy may be safer, less painful, and more cost-effective than the traditional parenteral route of administration.

scholarly journals Safety and efficacy of preoperative right portal vein embolization in patients at risk for postoperative liver failure following major right hepatectomy

HPB ◽  
2012 ◽  
Vol 14 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Kristen P. Massimino ◽  
Kenneth J. Kolbeck ◽  
C. Kristian Enestvedt ◽  
Susan Orloff ◽  
Kevin G. Billingsley
Keyword(s):  
At Risk ◽  
Portal Vein ◽  
Liver Failure ◽  
Portal Vein Embolization ◽  
Postoperative Liver Failure ◽  
Right Hepatectomy ◽  
Safety And Efficacy ◽  
Patients At Risk

Prospective Identification of Patients at Risk for Massive Transfusion: An Imprecise Endeavor

2011 ◽  
Vol 77 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Marianne J. Vandromme ◽  
Russell L. Griffin ◽  
Gerald Mcgwin ◽  
Jordan A. Weinberg ◽  
Loring W. Rue ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Model ◽  
Predictive Value ◽  
Massive Transfusion ◽  
International Normalized Ratio ◽  
Trauma Patients ◽  
Civilian Trauma ◽  
Patients At Risk ◽  
Clinical Measurements ◽  
Clinical Measures

Most retrospective studies evaluating fresh-frozen plasma:packed red blood cell ratios in trauma patients requiring massive transfusion (MT) are limited by survival bias. As prospective resource-intensive studies are being designed to better evaluate resuscitation strategies, it is imperative that patients with a high likelihood of MT are identified early. The objective of this study was to develop a predictive model for MT in civilian trauma patients. Patients admitted to the University of Alabama at Birmingham Trauma Center from January 2005 to December 2007 were selected. Admission clinical measurements, including blood lactate 5 mMol/L or greater, heart rate greater than 105 beats/min, international normalized ratio greater than 1.5, hemoglobin 11g/dL or less, and systolic blood pressure less than 110 mmHg, were used to create a predictive model. Sensitivity (Sens), specificity (Spec), positive predictive value (PPV), and negative predictive value (NPV) were calculated for all possible combinations of clinical measurements as well as each measure individually. A total of 6638 patients were identified, of whom 158 (2.4%) received MT. The best-fit predictive model included three or more positive clinical measures (Sens: 53%, Spec: 98%, PPV: 33%, NPV: 99%). There was increased PPV when all clinical measurements were positive (Sens: 9%, Spec: 100%, PPV: 86%, NPV: 98%). All combinations or clinical measures alone yielded lower predictive probability. Using these emergency department clinical measures, a predictive model to successfully identify civilian trauma patients at risk for MT was not able to be constructed. Given prospective identification of patients at risk for MT remains an imprecise undertaking, appropriate resources to support these efforts will need to be allocated for the completion of these studies.

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