scholarly journals Prognosis factors of survival in patients with liver cirrhosis and portal hypertension

2019 ◽  
Vol 91 (2) ◽  
pp. 67-72
Author(s):  
E R Olevskaya ◽  
A I Dolgushina ◽  
A N Tarasov ◽  
A O Hihlova
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Endoscopic Treatment ◽  
Prognosis Factors ◽  
Multifactor Model ◽  
Risk Of Death ◽  
Treatment And Prevention ◽  
Single Factor Analysis ◽  
Pugh Class

Aim. To study prognostic factors for survival in patients of liver cirrhosis (LC) with portal hypertension (PG). Materials and methods. 155 patients (women - 49.4%, men - 50.6%, median age 56.4 years [51.3; 61.6]) were follow up for 36 months. Viral LC was diagnosed in 33.8%, alcohol LC - 22.1%, autoimmune LC - 15.6%, other causes and cryptogenic causes noted in - 28.5%. More than half of the patients had a class В of Child-Pugh (51.9%). Results and discussion. During the study period 42 patients (28.3%) died. The analysis of survival by various factors for Kaplan-Mayer was carried out. Significant predictors: Child-Pugh class, LC etiology, comorbidity in Charlson scores, adherence to endoscopic treatment of esophageal varices were included in the model of proportional Cox risks. In a single-factor analysis, the risk of death is higher in patients who violate the timing of endoscopic treatment, but this factor has lost significance in the multifactor model. Patient with Child-Pugh C, alcoholic LC, comorbidity more 5 points by Charlson score have a higher mortality risk. Conclusion. Identification of risk factors that affect the survival of LC patients will allow to use of an individual plan for the LC treatment and prevention of PG complications.

scholarly journals Validation of a new prognostic model to predict short and medium-term survival in patients with liver cirrhosis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tomasz Dziodzio ◽  
Robert Öllinger ◽  
Wenzel Schöning ◽  
Antonia Rothkäppel ◽  
Radoslav Nikolov ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Risk Score ◽  
Meld Score ◽  
Medium Term ◽  
Term Survival ◽  
Risk Of Death ◽  
Class B ◽  
Pugh Class ◽  
End Stage

Abstract Background MELD score and MELD score derivates are used to objectify and grade the risk of liver-related death in patients with liver cirrhosis. We recently proposed a new predictive model that combines serum creatinine levels and maximum liver function capacity (LiMAx®), namely the CreLiMAx risk score. In this validation study we have aimed to reproduce its diagnostic accuracy in patients with end-stage liver disease. Methods Liver function of 113 patients with liver cirrhosis was prospectively investigated. Primary end-point of the study was liver-related death within 12 months of follow-up. Results Alcoholic liver disease was the main cause of liver disease (n = 51; 45%). Within 12 months of follow-up 11 patients (9.7%) underwent liver transplantation and 17 (15.1%) died (13 deaths were related to liver disease, two not). Measures of diagnostic accuracy were comparable for MELD, MELD-Na and the CreLiMAx risk score as to power in predicting short and medium-term mortality risk in the overall cohort: AUROCS for liver related risk of death were for MELD [6 months 0.89 (95% CI 0.80–0.98) p < 0.001; 12 months 0.89 (95% CI 0.81–0.96) p < 0.001]; MELD-Na [6 months 0.93 (95% CI 0.85–1.00) p < 0.001 and 12 months 0.89 (95% CI 0.80–0.98) p < 0.001]; CPS 6 months 0.91 (95% CI 0.85–0.97) p < 0.01 and 12 months 0.88 (95% CI 0.80–0.96) p < 0.001] and CreLiMAx score [6 months 0.80 (95% CI 0.67–0.96) p < 0.01 and 12 months 0.79 (95% CI 0.64–0.94) p = 0.001]. In a subgroup analysis of patients with Child-Pugh Class B cirrhosis, the CreLiMAx risk score remained the only parameter significantly differing in non-survivors and survivors. Furthermore, in these patients the proposed score had a good predictive performance. Conclusion The CreLiMAx risk score appears to be a competitive and valid tool for estimating not only short- but also medium-term survival of patients with end-stage liver disease. Particularly in patients with Child-Pugh Class B cirrhosis the new score showed a good ability to identify patients not at risk of death.

scholarly journals Surveillance Program for Diagnosis of HCC in Liver Cirrhosis: Role of Ultrasound Echo Patterns

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Maurizio Soresi ◽  
Antonino Terranova ◽  
Anna Licata ◽  
Antonietta Serruto ◽  
Giuseppe Montalto ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Cumulative Risk ◽  
Liver Function Tests ◽  
Alpha Fetoprotein ◽  
Rank Test ◽  
Surveillance Program ◽  
Ultrasound Screening ◽  
Nodular Pattern

International guidelines suggest ultrasound surveillance for hepatocellular carcinoma (HCC) early diagnosis in liver cirrhosis (LC) patients, but 40% of nodules <2 cm escape detection. We investigated the existence of an ultrasound pattern indicating a higher risk of developing HCC in patients under surveillance. 359 patients with LC (Child-Pugh A-B8) underwent ultrasound screening (median follow-up 54 months, range 12–90 months), liver function tests, alpha-fetoprotein assay, and portal hypertension evaluation. Echo patterns were homogeneous, bright liver, coarse, coarse small nodular pattern, and coarse large nodular pattern. During follow-up 13.9% developed HCC. At multivariate analysis using Cox’s model alpha-fetoprotein, coarse large nodular pattern, portal hypertension, and age were independent predictors of HCC development. Kaplan-Meier estimates of HCC cumulative risk in relation to the baseline echo patterns showed risk of 75% in coarse large nodular pattern patients, 23% coarse small nodular pattern, 21% coarse pattern, 0% homogeneous, and bright liver echo patterns (log-rank test = 23.6, P<0.001). Coarse large nodular pattern indicates a major risk factor for HCC as 40.7% of patients with this pattern developed HCC. Homogeneous and bright liver echo patterns and the absence of portal hypertension were not related to HCC. This observation could raise the question of possibly modifying the follow-up timing in this subset of patients.

scholarly journals Treatment and prevention of bleeding from varicose veins of the esophagus

2021 ◽  
Vol 1 (215) ◽  
pp. 80-83
Author(s):  
Eduard Mogilevets ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
High Efficiency ◽  
Varicose Veins ◽  
Mortality Rates ◽  
Long Term Results ◽  
Recurrent Bleeding ◽  
Chronic Liver Diseases ◽  
Treatment And Prevention

Liver cirrhosis is the result of various chronic liver diseases. Portal hypertension is a serious complication of cirrhosis. Its consequences, in turn, along with other complications are gastroesophageal varicose bleeding, which cause high mortality rates. The article contains analysis of the results of laparoscopic esophagogastric devascularization without esophageal transsection and splenectomy in a patient with liver cirrhosis portal hypertension and recurrent bleeding from varicose veins of the esophagus. First successful surgery according to this method was introduced in the Grodno Municipal Clinical Hospital No. 4 in November 2011. Immediate and long-term results show a rather high efficiency of using this operation in the treatment and prevention of bleeding from varicose veins of the esophagus with cirrhosis. It is advisable to conduct further studies of the effectiveness of using this operation, despite the encouraging results of the use of this modification of laparoscopic esophagogastric devascularization.

Splenic Bed Laparoscopic Splenectomy Approach for Massive Splenomegaly Secondary to Portal Hypertension and Liver Cirrhosis

2018 ◽  
Vol 84 (6) ◽  
pp. 1033-1038 ◽  
Author(s):  
Guangjin Tian ◽  
Deyu Li ◽  
Haibo Yu ◽  
Yadong Dong ◽  
Huanzhou Xue
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Laparoscopic Splenectomy ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
Massive Splenomegaly ◽  
Conversion To Open Surgery ◽  
Transfusion Volume ◽  
Pugh Class ◽  
Short Gastric Vessels

This study was performed to evaluate the feasibility of the splenic bed laparoscopic splenectomy approach (SBLS) for massive splenomegaly (≥30 cm) in patients with hypersplenism secondary to portal hypertension and liver cirrhosis. Patients who underwent laparoscopic splenectomy (LS) from January 2012 to December 2016 were retrospectively reviewed. We performed LS in 83 patients with massive splenomegaly (≥30 cm) secondary to portal hypertension and liver cirrhosis. Of these patients, 37 underwent the SBLS and 46 underwent anterior LS (ALS). Five patients in the ALS group and none in the SBLS group underwent conversion to open surgery. The operation time, intraoperative blood loss volume, transfusion volume, frequency of transfusion, hemorrhage of short gastric vessels, conversion rate, postoperative hospital stay, and incidence of pancreatic fistula were all significantly lower in the SBLS than ALS group (all P < 0.05). No death or postoperative bleeding occurred in the two groups, and there were no significant differences in age, gender, spleen size, hemoglobin level, platelet count, prothrombin time, Child-Pugh class, hypoproteinemia, or ascites (all P > 0.05). The SBLS is more feasible and effective than ALS in patients with massive splenomegaly (≥30 cm) secondary to portal hypertension and liver cirrhosis.

Bacterial DNA and its consequences in patients with cirrhosis and culture-negative, non-neutrocytic ascites

2008 ◽  
Vol 57 (12) ◽  
pp. 1533-1538 ◽  
Author(s):  
Mohammed Mahmoud El-Naggar ◽  
El-Sayed Abdul-Maksoud Khalil ◽  
Medhat Abdul Massih El-Daker ◽  
Mona Fouda Salama
Keyword(s):  
Liver Cirrhosis ◽  
Molecular Evidence ◽  
Necrosis Factor Alpha ◽  
Bacterial Dna ◽  
Risk Of Death ◽  
Group I ◽  
Group Ii ◽  
Culture Negative ◽  
First Admission

The detection of bacterial DNA in serum and ascitic fluid (AF) from patients with liver cirrhosis and ascites is interpreted as molecular evidence of intestinal bacterial translocation (BT) and considered sufficient to activate the cellular immune response leading to greater cytokine synthesis. We studied 34 patients with liver cirrhosis and culture-negative, non-neutrocytic ascites [22 patients without bacterial DNA (group I) and 12 patients with bacterial DNA (group II)]. History and clinical examination were done with the following investigations at first admission and followed up for 24 weeks: serum and AF tumour necrosis factor-alpha (TNF-α), AF polymorphonuclear leukocytes, AF cultivation and detection of blood and AF bacterial DNA. Serum and AF TNF-α were significantly higher in patients with bacterial DNA compared to those without bacterial DNA at first admission [54.5±22.56 vs 35.2±17.97 pg ml−1 (P=0.02) and 123.2±49.32 vs 82.6±29.58 pg ml−1 (P <0.005), respectively]. These changes became highly significant at the end of follow-up of both groups [119.3±27.19 vs 40.2±16.08 pg ml−1 (P <0.001) and 518.8±91.11 vs 97.6±17.81 pg ml−1 (P <0.001), respectively]. In group II, there was a significant increase in serum and AF TNF-α at the end of follow-up compared to at first admission (P <0.001). The relative risk of death, hepatorenal syndrome (HRS) and spontaneous bacterial peritonitis (SBP) was higher in patients with bacterial DNA compared to those without bacterial DNA. We conclude that cirrhotic patients with culture-negative, non-neutrocytic ascites and bacterial DNA have a significantly higher level of serum and AF TNF-α and higher risk of HRS, SBP and mortality compared to those without bacterial DNA, suggesting that bacterial DNA and TNF-α are implicated in these complications of liver cirrhosis.

Ambroxol chaperone therapy for Gaucher disease type I-associated liver cirrhosis and portal hypertension: a case report

2021 ◽  
Vol 21 ◽  
Author(s):  
Peng Zhang ◽  
Mei-Fang Zheng ◽  
Shi-Yuan Cui ◽  
Wei Zhang ◽  
Run-Ping Gao
Keyword(s):  
Liver Cirrhosis ◽  
Case Report ◽  
Portal Hypertension ◽  
Gaucher Disease ◽  
Liver Stiffness ◽  
Ultrasound Elastography ◽  
High Dose ◽  
Type I ◽  
Long Term Treatment

Background: Gaucher disease (GD) is a rare autosomal recessive inherited disease caused by the deficiency of glucocerebrosidase and characterized by a broad spectrum of clinical manifestations, including hepatosplenomegaly, bone infiltration, and cytopenia. Moreover, it is even involved in the central nervous system. GD is classified into three phenotypes on the ground of neurologic involvement: type 1 (GD1), the commonly adult-onset, non-neuropathic variant; type 2 (GD2), the acute neuropathic form; and type 3 (GD3), the severe chronic neuro-visceral form. Recently, several studies have shown a promising outcome of ambroxol chaperone therapy for the treatment of GD, but its therapeutic role in GD1-associated liver cirrhosis and portal hypertension was not verified. Case presentation: A 36-year-old male patient was admitted for esophageal varices lasting for one year with a 34-year history of liver and spleen enlargement. The patient was diagnosed with GD1 with cirrhosis and portal hypertension based on the identification of Gaucher cells and advanced fibrosis in the liver biopsy tissue and two known pathogenic mutations on the glucocerebrosidase (GBA) gene. The patient received 660 mg/d of ambroxol for up to two years. At his six-month follow-up, the patient exhibited a remarkable increase in GBA activity (+35.5%) and decrease in liver stiffness (-19.5%) and portal vein diameter (-41.2%) as examined by ultrasound elastography and computer tomography, respectively. At two-year follow-up, the liver stiffness was further reduced (-55.5%) in comparison with untreated patients. Conclusion: This case report suggests that long-term treatment with high dose ambroxol may play a role in the reduction of hepatic fibrosis in GD1.

scholarly journals Serum keratin 19 (CYFRA21-1) links ductular reaction with portal hypertension and outcome of various advanced liver diseases

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Karim Hamesch ◽  
Nurdan Guldiken ◽  
Mahmoud Aly ◽  
Norbert Hüser ◽  
Daniel Hartmann ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Alcoholic Cirrhosis ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Ductular Reaction ◽  
Risk Of Death

Abstract Background Keratins (Ks) represent tissue-specific proteins. K18 is produced in hepatocytes while K19, the most widely used ductular reaction (DR) marker, is found in cholangiocytes and hepatic progenitor cells. K18-based serum fragments are commonly used liver disease predictors, while K19-based serum fragments detected through CYFRA21-1 are established tumor but not liver disease markers yet. Since DR reflects the severity of the underlying liver disease, we systematically evaluated the usefulness of CYFRA21-1 in different liver disease severities and etiologies. Methods Hepatic expression of ductular keratins (K7/K19/K23) was analyzed in 57 patients with chronic liver disease (cohort i). Serum CYFRA21-1 levels were measured in 333 Austrians with advanced chronic liver disease (ACLD) of various etiologies undergoing hepatic venous pressure gradient (HVPG) measurement (cohort ii), 231 French patients with alcoholic cirrhosis (cohort iii), and 280 hospitalized Germans with decompensated cirrhosis of various etiologies (cohort iv). Results (i) Hepatic K19 levels were comparable among F0–F3 fibrosis stages, but increased in cirrhosis. Hepatic K19 mRNA strongly correlated with the levels of other DR-specific keratins. (ii) In ACLD, increased serum CYFRA21-1 associated with the presence of clinically significant portal hypertension (CSPH; HVPG ≥ 10 mmHg) (OR = 5.87 [2.95–11.68]) and mortality (HR = 3.02 [1.78–5.13]; median follow-up 22 months). (iii) In alcoholic cirrhosis, elevated serum CYFRA21-1 indicated increased risk of death/liver transplantation (HR = 2.59 [1.64–4.09]) and of HCC (HR = 1.74 [1.02–2.96]) over the long term (median follow-up 73 months). (iv) In decompensated cirrhosis, higher serum CYFRA21-1 predicted 90-day mortality (HR = 2.97 [1.92–4.60]) with a moderate accuracy (AUROC 0.64), independently from established prognostic scores. Conclusions Hepatic K19 mRNA and serum CYFRA21-1 levels rise in cirrhosis. Increased CYFRA21-1 levels associate with the presence of CSPH and reliably indicate mortality in the short and long term independently of conventional liver biochemistry markers or scoring systems. Hence, the widely available serum CYFRA21-1 constitutes a novel, DR-related marker with prognostic implications in patients with different settings of advanced liver disease.

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