Endoscopic treatment or balloon-occluded retrograde transvenous obliteration is safe for patients with esophageal/gastric varices in Child-Pugh class C end-stage liver cirrhosis

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.

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Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

Journal of Medicine ◽

10.3329/jom.v22i2.56698 ◽

2021 ◽

Vol 22 (2) ◽

pp. 100-106

Author(s):

Tarana Yasmin ◽

Sohely Sultana ◽

Mahmuda Nusrat Ima ◽

Md Quamrul Islam ◽

Shyamal Kumar Roy ◽

...

Keyword(s):

Liver Cirrhosis ◽

Doppler Ultrasound ◽

Hepatic Vein ◽

Wave Form ◽

Venous Blood Flow ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

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Successful management of complex open heart surgery in a patient with Child-Pugh class C liver cirrhosis: report of a case

Surgery Today ◽

10.1007/s00595-012-0325-3 ◽

2012 ◽

Vol 43 (3) ◽

pp. 335-338 ◽

Cited By ~ 3

Author(s):

Yasuhiko Kubota ◽

Taichi Sakaguchi ◽

Shigeru Miyagawa ◽

Hiroyuki Nishi ◽

Yasushi Yoshikawa ◽

...

Keyword(s):

Liver Cirrhosis ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Successful Management ◽

Pugh Class ◽

Class C

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Correlation of global longitudinal strain with disease severity in liver cirrhosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.155 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Dimitroglou ◽

C Aggeli ◽

A Alexopoulou ◽

T Alexopoulos ◽

D Patsourakos ◽

...

Keyword(s):

Liver Cirrhosis ◽

Disease Severity ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/purpose Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic dysfunction and has been correlated with cirrhosis severity and prognosis. Global longitudinal strain (GLS) is a sensitive marker of cardiac dysfunction which is considered relatively independent of preload and afterload conditions and thus may be of high diagnostic significance in this special population. We sought to investigate alterations of GLS relating to disease severity in cirrhotic patients. Methods Echocardiographic analysis of 51 consecutive cirrhotic patients was performed. Images were acquired and analyzed off-line. GLS was calculated with a semi-automatic way using dedicated software. Clinical and biochemical examination were used to assess severity of liver disease by calculating Child-Pugh class (class C patients have more severe disease than class B and A patients) and MELD-Na score (increased score as the disease progresses). Results Mean age was 58.4 ± 8.7 years, 38 (74.5%) were males. Among patients, 22 (43.1%) were Child-Pugh class A, 17 (33.3%) Child-Pugh B and 12 (23.5%) Child-Pugh C and mean MELD-Na score was 15.3 ± 7.5. Mean left ventricular end-systolic volume (LVEDV) was 117 ± 29ml, mean stroke volume (SV) 72.5 ± 19.9ml , mean left ventricular ejection fraction (LVEF) 61.0 ± 5.0%, mean systolic blood pressure (SBP) 128 ± 13mmHg, mean ratio of peak transmitral to peak annular (septal) velocity during early diastole (E/e’ ratio) 10.4 ± 4.5, mean left atrial volume index (LAVI) 37.4 ± 11.8 ml/cm2 and mean GLS -21.6 ± 2.6%. GLS of Child-Pugh class A patients (-20.3 ± 2.4) was higher (less negative) than GLS of Child-Pugh class B (-22.2 ± 2.2) and class C (-23.0 ± 2.8) patients. Difference between groups B and C was non-significant (figure). Severity of cirrhosis as determined by higher MELD-Na score correlated with LAVI (r = 0.592, p < 0.001), SV (r = 0.554, p < 0.001), GLS (r=-0.441, p = 0.001) and LVEDV (r = 0.428, p = 0.002). GLS correlated with SV (r=-0.369, p = 0.008) but not with preload (LVEDV), or afterload (SBP). In a linear regression model, GLS was independently associated with Meld-Na score when adjusting for age, SBP, LVEDV and NASH etiology [B=-0.139 (-0.252; -0.025), p = 0.018]. Conclusions GLS is lower (more negative) in patients with liver cirrhosis as disease progresses a relation not affected by preload and afterload conditions. Further research works are required to explain the underlying pathophysiology and to assess prognostic significance of reduced GLS values in patients with advanced cirrhosis. Abstract Figure. GLS stratified by Child-Pugh score

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Survival COVID-19 in Adult Patients with Liver Cirrhosis

The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy ◽

10.24871/2222021124-129 ◽

2021 ◽

Vol 22 (2) ◽

pp. 124-129

Author(s):

Gita Aprilicia ◽

Syahrizal Syarif ◽

Kemal Fariz Kalista ◽

Andri Sanityoso Sulaiman ◽

Irsan Hasan ◽

...

Keyword(s):

Risk Factors ◽

Liver Cirrhosis ◽

Survival Rate ◽

Median Survival ◽

Adult Patients ◽

Rank Test ◽

P Value ◽

Pugh Class ◽

Independent Risk Factors ◽

Class C

Background: COVID-19 is a disease caused by infection of SARS-CoV-2 virus which leads to mortality due to respiratory failure. The progression of COVID-19 is more severe in patients with pre-existence morbidities, including liver disease. Recently, a few studie showed that liver cirrhosis patients with COVID-19 had a higher risk of mortality rather than liver cirrhosis patients without COVID-19 infection. Nevertheless, the study of survival COVID-19 in a patient with underlying liver cirrhosis is still limited. The aim of this study is to evaluate the survival of COVID-19 in adult patients with liver cirrhosisMethod: An observational study in Cipto Mangunkusumo Hospital was conducted. Patients with underlying liver cirrhosis between March 2020-January 2021 with positive confirmation of COVID-19 were enrolled in this study. Liver cirrhosis patients without COVID-19 were enrolled as a comparison. Both liver cirrhosis patients with and without COVID-19 were follow up at the time of hospital admission until 30 days outcome. Kaplan Meier and a log-rank test were conducted to evaluate the comparison of survival rate in liver cirrhosis patients with and without COVID-19. Multivariate Cox Proportional Hazard was conducted to identify the independent risk factors related to survival.Results: There were 22 liver cirrhosis patients with COVID-19 and 116 liver cirrhosis patients included in this study. Presentation of gender and age similar both of them. Predominantly males with average age were 57 years ± 13,60 for cirrhosis with COVID-19 patients and 53 years ± 12,75 for without COVID-19. The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19 (35.8% vs. 67.2%, p-value 0.001). Median survival of liver cirrhosis patients with COVID-19 was 4 days (95% CI: 1-8 days), while median survival of liver cirrhosis patients without COVID-19 couldn’t be reached since the survival rate of this group above 50%. Final model Cox PH showed that liver cirrhosis with COVID-19 (HR: 8.99; CI 95%: 4.55 – 17.80, p-value 0.001) and Child-Pugh class C (HR: 5.61; 95% CI: 2.76 – 11.40, p-value 0.001) were the independent risk factors associated with poor survival.Conclusion: The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19. Liver cirrhosis with COVID-19 and Child-Pugh class C were associated with poor survival.

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Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

10.53350/pjmhs211592943 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2943-2947

Author(s):

Muhammad Siddique ◽

Muhammad Abdul Quddus ◽

Tahir Iqbal ◽

Hefsa Qamar ◽

Muhammad Ikram Shah ◽

...

Keyword(s):

Liver Cirrhosis ◽

Bacterial Infections ◽

Spontaneous Bacterial Peritonitis ◽

Operational Definition ◽

Cross Sectional ◽

Bacterial Peritonitis ◽

Number Of Patients ◽

Class B ◽

Pugh Class ◽

Class C

Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

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STUDY THE RELATION BETWEEN SERUM SODIUM AND THE MODEL FOR END-STAGE LIVER DISEASE SCORE IN PATIENTS WITH LIVER CIRRHOSIS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1830 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Dhawal Vyas

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Serum Sodium ◽

Meld Score ◽

Disease Score ◽

Medical College ◽

End Stage Liver Disease ◽

Advanced Cirrhosis ◽

Pugh Class ◽

End Stage

Background: The aim of the study was to evaluate the prevalence of hyponatremia in liver cirrhosis and the correlation between serum sodium and the Model for End-Stage Liver Disease (MELD) score in patients with liver cirrhosis. Methods: We prospectively collected data of 200 patients of chronic liver disease hospitalized in medical and surgical gastroenterology department of Geetanjali medical college, Udaipur. Results: Serum sodium values were strongly associated with severity of cirrhosis, assessed by child Pugh class and MELD score. There was significant relationship between serum sodium, renal function (as assessed by serum creatinine) Conclusion: Hyponatremia is a common problem in liver cirrhosis, especially advanced cirrhosis. The study showed that there is an association between hyponatremia and the presence of certain complications of liver cirrhosis. Also hyponatremia was associated with a higher severity of cirrhosis assessed by MELD scores. Keywords: hyponatrenia, Liver cirrhosis, MELD score

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Progress in endoscopic treatment of gastric varices in patients with liver cirrhosis

World Chinese Journal of Digestology ◽

10.11569/wcjd.v26.i22.1355 ◽

2018 ◽

Vol 26 (22) ◽

pp. 1355-1359

Author(s):

Xia Liu ◽

An-Jiang Wang ◽

Bi-Min Li

Keyword(s):

Liver Cirrhosis ◽

Endoscopic Treatment ◽

Gastric Varices

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