Study of endoscopic esophageal variceal ligation cases in Tishreen University Hospital: دراسة لحالات ربط دوالي المري تنظيرياً في مشفى تشرين الجامعي

2021 ◽  
Vol 5 (4) ◽  
pp. 64-54
Author(s):  
Seraj Elias Alhaddad, Hassan Zeizafoun, Milad Intanious Seraj Elias Alhaddad, Hassan Zeizafoun, Milad Intanious
Keyword(s):  
Liver Disease ◽  
Esophageal Varices ◽  
Primary Prophylaxis ◽  
University Hospital ◽  
Bleeding Events ◽  
Esophageal Variceal ◽  
Emergency Procedures ◽  
Cirrhotic Patients ◽  
End Stage ◽  
Grade Iii

Objective: The aim of this study is to estimate the effectiveness and complications of performing EVL in cirrhotic patients, and to assess the outcome of rebleeding events after EVL. Patients and Methods: An Observational Descriptive Study conducted for the period from January 2020 to January 2021 at Tishreen University Hospital in Lattakia- Syria, 45 Cirrhotic patients with esophageal varices who underwent 69 EVL sessions whether done as prophylactic or therapeutic followed up for three weeks. Results: The median age was 57 years, 66.70% of patients were male. The most common etiology was cryptogenic cirrhosis (40%), and 44.4% of patients had esophageal varices grade III. The most common indication for performing EVL was primary prophylaxis (46.4%). Initial control of bleeding was achieved in 95.2% of emergency procedures. The mortality rate during follow- up was 2.2%. Chest pain was the most common complication of EVL (31.9%). The incidence of re- bleeding events after EVL was 7.24%, more frequently in emergency procedures. Re- bleeding was significantly associated with alcoholic liver disease, poor liver condition (Child- Paugh C class), emergency procedures, coagulation disorders (low levels of PLT and high levels of INR) and presence of large varices (grade III and IV). Conclusion: EVL is feasible, safe, and effective for the management of esophageal varices in patients with end stage liver disease.

scholarly journals The model for the end-stage liver disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding

2009 ◽  
Vol 66 (9) ◽  
pp. 724-728 ◽  
Author(s):  
Daniela Benedeto-Stojanov ◽  
Aleksandar Nagorni ◽  
Goran Bjelakovic ◽  
Dragan Stojanov ◽  
Bojan Mladenovic ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Survival Rate ◽  
Variceal Bleeding ◽  
Meld Score ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Background/Aim. Esophageal variceal bleeding is one of the most frequent and gravest complications of liver cirrhosis, directly life-threatening. By monitoring certain clinical and laboratory hepatocellular insufficiency parameters (Child-Pugh score), it is possible to determine prognosis in patients who are bleeding and evaluate further therapy. Recently, the Model for the End-Stage Liver Disease (MELD) has been proposed as a tool to predict mortality risk in cirrhotic patients. The aim of the study was to evaluate survival prognosis of cirrhotic patients by the MELD and Child-Pugh scores and to analyze the MELD score prognostic value in patients with both liver cirrhosis and variceal bleeding. Methods. We retrospectively evaluated the survival rate of a group of 100 cirrhotic patients of a median age of 57 years. The Child-Pugh score was calculated and the MELD score was computed according to the original formula for each patient. We also analyzed clinical and laboratory hepatocellular insufficiency parameters in order to examine their connection with a 15-month survival. The MELD values were correlated with the Child-Pugh scores. The Student's t-test was used for statistical analysis. Results. Twenty-two patients died within 15-months follow-up. Age and gender did not affect survival rate. The Child- Pugh and MELD scores, as well as ascites and encephalopathy significantly differed between the patients who survived and those who died (p < 0.0001). The International Normalized Ratio (INR) values, serum creatinine and bilirubin were significantly higher, and albumin significantly lower in the patients who died (p < 0.0001). The MELD score was significantly higher in the group of patients who died due to esophageal variceal bleeding (p < 0.0001). Conclusion. In cirrhotic patients the MELD score is an excellent survival predictor at least as well as the Child-Pugh score. Increase in the MELD score is associated with decrease in residual liver function. In the group of patients with liver cirrhosis and esophageal variceal bleeding, the MELD score identifies those with a higher intrahospital mortality risk.

scholarly journals Predictive Value of the Model of End-Stage Liver Disease in Cirrhotic Patients with and without Spontaneous Bacterial Peritonitis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Bledar Kraja ◽  
Marsela Sina ◽  
Iris Mone ◽  
Fatjona Pupuleku ◽  
Adriana Babameto ◽  
...  
Keyword(s):  
Liver Disease ◽  
Predictive Value ◽  
Spontaneous Bacterial Peritonitis ◽  
Fatal Outcome ◽  
Meld Score ◽  
University Hospital ◽  
Bacterial Peritonitis ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Objective. We aimed to assess the predictive value of the model of end-stage liver disease (MELD) in hospitalized cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) and fatal outcome.Methods. A cross-sectional study included 256 consecutive patients (199 men and 57 women) diagnosed with cirrhosis and ascites who were hospitalized at the University Hospital Center in Tirana from January 2008 to December 2009. SBP was defined as a neutrophil count of ≥250 cells/mm3in ascitic fluid. MELD score was based on laboratory parameters determined by UNOS Internet site MELD calculator.Results. In multivariable-adjusted logistic regression models controlling for age, sex, diabetes, and etiology, there was evidence of a positive association of SBP with MELD score: the odds ratio (OR) for SBP for one unit increment of MELD score was 1.06 (95% Cl = 1.02–1.09). MELD score was significantly higher in fatal cases than nonfatal patients (mean age-adjusted score was 32.7 versus 18.4 overall; 34.8 versus 18.0 in SBP patients, and 32.0 versus 18.5 in non-SBP patients; allP<0.001).Conclusions. In this Albanian sample of hospitalized cirrhotic patients, MELD score was confirmed as a significant predictor of both SBP and fatal outcome.

scholarly journals Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease

2011 ◽  
Vol 48 (4) ◽  
pp. 248-251 ◽  
Author(s):  
Danielle Queiroz Bonilha ◽  
Lucianna Motta Correia ◽  
Marie Monaghan ◽  
Luciano Lenz ◽  
Marcus Santos ◽  
...  
Keyword(s):  
Liver Disease ◽  
Prospective Study ◽  
Esophageal Varices ◽  
Endoscopic Treatment ◽  
Advanced Liver Disease ◽  
Esophageal Variceal ◽  
Band Ligation ◽  
Diagnostic Endoscopy ◽  
Significant Difference ◽  
Cirrhotic Patients

CONTEXT: Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. OBJECTIVES: To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. METHODS: A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. RESULTS: After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 %) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. CONCLUSIONS: There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered as low-risk procedures regarding bacteremia even when performed on patients with advanced liver disease.

scholarly journals Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Ahmed Abdelrahman Mohamed Baz ◽  
Rana Magdy Mohamed ◽  
Khaled Helmy El-kaffas
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Meld Score ◽  
Hepatic Decompensation ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Us Findings ◽  
End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

scholarly journals RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenzhen Zhang ◽  
Guomin Xie ◽  
Li Liang ◽  
Hui Liu ◽  
Jing Pan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Poor Prognosis ◽  
Alcoholic Cirrhosis ◽  
Normal Liver ◽  
Neutrophil Infiltration ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

scholarly journals The use of MELD scores in critically ill cirrhotic patients

2016 ◽  
Vol 4 (16) ◽  
pp. 45
Author(s):  
Supannee Rassameehiran ◽  
Tinsay Woreta
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Critically Ill ◽  
Meld Score ◽  
Chronic Liver Failure ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

The Model for End-Stage Liver Disease (MELD) was originally created to predict survival following transjugular intrahepatic portosystemic shunt and was subsequently found to accurately predict mortality in patients with end-stage liver disease. It has been used in the United States for liver allocation since 2002, and implementation of the MELD score resulted in a reduction in total number of deaths on the waitlist and a reduction in waiting time. Critically ill cirrhotic patients have an in-hospital mortality greater than 50%. Although the MELD score was also found to be an accurate predictor of in-ICU mortality and in-hospital mortality after ICU admission in critically ill cirrhotic patients, the Sequential Organ Failure Assessment (SOFA) score appears to perform better in many studies. The Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score was later developed by using specific cut-points for each organ failure score system in CLIF patients to predict mortality in patients with ACLF. Neither the MELD nor SOFA score independently predicts post-liver transplantation mortality in cirrhotic patients with extrahepatic organ failure and should not be use as a delisting criterion for these patients. More data are needed to determine the accuracy of the CLIF-C ACLF score in predicting post-liver transplantation outcomes. Prospective evaluation of critically ill cirrhotic patients is needed to optimize liver organ allocation.

scholarly journals Model for End-Stage Liver Disease Score Predicts the Mortality of Patients with Coronary Heart Disease Who Underwent Percutaneous Coronary Intervention

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
You Chen ◽  
Min Han ◽  
Ying-Ying Zheng ◽  
Feng Zhu ◽  
Aikebai Aisan ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Liver Disease ◽  
Coronary Intervention ◽  
Meld Score ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
End Stage ◽  
Long Term Mortality

Background. Coronary heart disease (CHD) is caused by the blockage or spasm of coronary arteries. Evidence shows that liver disease is related to CHD. However, the correlation between the Model for End-Stage Liver Disease (MELD) score and outcomes in patients after percutaneous coronary intervention (PCI) was unclear. Method. A retrospective cohort study involved 5373 patients with coronary heart disease after PCI was conducted from January 2008 to December 2016. Participants were classified to four groups according to the MELD score by quartiles. The primary endpoint was long-term mortality including all-case mortality (ACM) and cardiac mortality (CM). Secondary endpoints included bleeding events, readmission, major adverse cardiovascular events (MACE), major adverse cardiovascular, and cerebrovascular events (MACCE). The longest follow-up time was almost 10 years. Results. There were significant differences in the incidences of ACM ( p = 0.038 ) and CM ( p = 0.027 ) among the four MELD groups, but there was no significant difference in MACEs ( p = 0.496 ), MACCEs ( p = 0.234 ), readmission ( p = 0.684 ), and bleeding events ( p = 0.232 ). After adjusting the age, gender, smoking, drinking status, and diabetes by a multivariable Cox regression analysis, MELD remains independently associated with ACM (HR:1.57, 95%CI 1.052–2.354, p = 0.027 ) and CM (HR:1.434, 95% CI 1.003–2.050, p = 0.048 ). Conclusion. This study indicated that the MELD score had a strong prediction for long-term mortality in CHD patients who underwent PCI.

scholarly journals Predictive power of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score for mortality in cirrhotic patients

2018 ◽  
Vol 4 (4) ◽  
pp. 240-246 ◽  
Author(s):  
Damian Piotrowski ◽  
Anna Sączewska-Piotrowska ◽  
Jerzy Jaroszewicz ◽  
Anna Boroń-Kaczmarska
Keyword(s):  
Liver Disease ◽  
Predictive Power ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

scholarly journals Metabolomic Signature as a Predictor of Liver Disease Events in Patients With HIV/HCV Coinfection

2020 ◽  
Vol 222 (12) ◽  
pp. 2012-2020
Author(s):  
Susanna Naggie ◽  
Sam Lusk ◽  
J Will Thompson ◽  
Meredith Mock ◽  
Cynthia Moylan ◽  
...  
Keyword(s):  
Liver Disease ◽  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Esophageal Variceal ◽  
Bacterial Peritonitis ◽  
Patients At Risk ◽  
Hcv Coinfection ◽  
End Stage ◽  
Nested Case Control

Abstract Background Advanced liver disease due to hepatitis C virus (HCV) is a leading cause of human immunodeficiency virus (HIV)-related morbidity and mortality. There remains a need to develop noninvasive predictors of clinical outcomes in persons with HIV/HCV coinfection. Methods We conducted a nested case-control study in 126 patients with HIV/HCV and utilized multiple quantitative metabolomic assays to identify a prognostic profile that predicts end-stage liver disease (ESLD) events including ascites, hepatic encephalopathy, hepatocellular carcinoma, esophageal variceal bleed, and spontaneous bacterial peritonitis. Each analyte class was included in predictive modeling, and area under the receiver operator characteristic curves (AUC) and accuracy were determined. Results The baseline model including demographic and clinical data had an AUC of 0.79. Three models (baseline plus amino acids, lipid metabolites, or all combined metabolites) had very good accuracy (AUC, 0.84–0.89) in differentiating patients at risk of developing an ESLD complication up to 2 years in advance. The all combined metabolites model had sensitivity 0.70, specificity 0.85, positive likelihood ratio 4.78, and negative likelihood ratio 0.35. Conclusions We report that quantification of a novel set of metabolites may allow earlier identification of patients with HIV/HCV who have the greatest risk of developing ESLD clinical events.

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