scholarly journals The Association Between Decompensated Liver Cirrhosis and Deep Neck Infection: Real-World Evidence

2019 ◽  
Vol 16 (20) ◽  
pp. 3863 ◽  
Author(s):  
Ming-Shao Tsai ◽  
Geng-He Chang ◽  
Wei-Ming Chen ◽  
Chia-Yen Liu ◽  
Meng-Hung Lin ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Risk Factor ◽  
Primary Study ◽  
Deep Neck Infection ◽  
Research Database ◽  
Decompensated Liver Cirrhosis ◽  
Neck Infection ◽  
Patient Database ◽  
Cirrhotic Patients ◽  
Cox Proportional Hazard Regression

Background: Deep neck infection (DNI) can progress to become a life-threatening complication. Liver cirrhosis, which is related to poor immune conditions, is a likely risk factor for DNI. This study investigated the risk and mortality of DNI in patients with decompensated liver cirrhosis (DLC). Methods: We performed a nationwide cohort study using the National Health Insurance Research Database (NHIRD) in Taiwan. We included a total of 33,175 patients with DLC between 2000 and 2013, from the Catastrophic Illness Patient Database, a subsection of the NHIRD, along with 33,175 patients without cirrhosis who were matched in a 1:1 proportion for age, sex, and socioeconomic status. The occurrence of DNI was the primary study outcome. The risk, treatment, and mortalities of DNI were evaluated in the study and comparison cohorts. Results: DLC Patients had a significantly higher incidence of DNI than noncirrhotic patients (p < 0.001). The adjusted Cox proportional hazard regression showed that DLC was associated with a significantly higher risk of DNI (adjusted hazard ratio, 4.11; 95% confidence interval, 3.16–5.35, p < 0.001). The mortality rate in cirrhotic patients with DNI was not significantly higher than that in noncirrhotic patients with DNI (11.6% vs. 9.8%; p = 0.651). Conclusions: This study is the first to investigate the correlation between DLC and DNI. The study findings strongly indicate that DLC is an independent risk factor for DNI. Cirrhotic patients with DNI do not have a significantly poorer survival rate than noncirrhotic patients with DNI. Therefore, physicians should be alert to potential DNI occurrence in DLC patients. Besides this, intensive care and appropriate surgical drainage can yield similar survival outcomes in DLC-DNI and noncirrhosis-DNI patients.

scholarly journals Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence

2021 ◽  
Vol 18 (6) ◽  
pp. 3191
Author(s):  
Meng-Chang Ding ◽  
Cheng-Ming Hsu ◽  
Stanley Yung-Chuan Liu ◽  
Yi-Chan Lee ◽  
Yao-Hsu Yang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Health Insurance ◽  
Sleep Apnea ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Treatment Modalities ◽  
Deep Neck Infection ◽  
Research Database ◽  
Neck Infection

(1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide retrospective cohort study on the sleep apnea–DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort (p < 0.001). A strong sleep apnea–DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28–2.28; p < 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged < 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.

scholarly journals High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study

2018 ◽  
Vol 7 (11) ◽  
pp. 385 ◽  
Author(s):  
Geng-He Chang ◽  
Meng-Chang Ding ◽  
Yao-Hsu Yang ◽  
Yung-Hsiang Lin ◽  
Chia-Yen Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Cohort Study ◽  
Type 1 Diabetes Mellitus ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Deep Neck Infection ◽  
Research Database ◽  
Neck Infection

Objective: To investigate the risk of deep neck infection (DNI) in patients with type 1 diabetes mellitus (T1DM). Methods: The database of the Registry for Catastrophic Illness Patients, affiliated to the Taiwan National Health Insurance Research Database, was used to conduct a retrospective cohort study. In total, 5741 patients with T1DM and 22,964 matched patients without diabetes mellitus (DM) were enrolled between 2000 and 2010. The patients were followed up until death or the end of the study period (31 December 2013). The primary outcome was the occurrence of DNI. Results: Patients with T1DM exhibited a significantly higher cumulative incidence of DNI than did those without DM (p < 0.001). The Cox proportional hazards model showed that T1DM was significantly associated with a higher incidence of DNI (adjusted hazard ratio, 10.71; 95% confidence interval, 6.02–19.05; p < 0.001). The sensitivity test and subgroup analysis revealed a stable effect of T1DM on DNI risk. The therapeutic methods (surgical or nonsurgical) did not differ significantly between the T1DM and non-DM cohorts. Patients with T1DM required significantly longer hospitalization for DNI than did those without DM (9.0 ± 6.2 vs. 4.1 ± 2.0 days, p < 0.001). Furthermore, the patients with T1DM were predisposed to DNI at a younger age than were those without DM. Conclusions: T1DM is an independent risk factor for DNI and is associated with a 10-fold increase in DNI risk. The patients with T1DM require longer hospitalizations for DNI and are younger than those without DM.

Hepatocellular carcinoma in the non-cirrhotic liver

2021 ◽  
pp. 1-14
Author(s):  
Dong Yi ◽  
Wang Wen-Ping ◽  
Won Jae Lee ◽  
Maria Franca Meloni ◽  
Dirk-Andre Clevert ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Risk Factor ◽  
High Risk ◽  
Current Knowledge ◽  
Cirrhotic Liver ◽  
Imaging Features ◽  
Advanced Stage ◽  
High Risk Factor ◽  
Cirrhotic Patients

Liver cirrhosis is an established high-risk factor for HCC and the majority of patients diagnosed with HCC have cirrhosis. However, HCC also arises in non-cirrhotic livers in approximately 20 %of all cases. HCC in non-cirrhotic patients is often clinically silent and surveillance is usually not recommended. HCC is often diagnosed at an advanced stage in these patients. Current information about HCC in patients with non-cirrhotic liver is limited. Here we review the current knowledge on epidemiology, clinical features and imaging features of those patiens.

scholarly journals Fibrinogen-Fibrin Monomer Complexes in Cirrhosis of The Liver

1977 ◽  
Author(s):  
S. Coccheri ◽  
G. Palareti ◽  
M. Poggi ◽  
G. Oca
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Liver Biopsy ◽  
Plasma Samples ◽  
Severe Liver ◽  
Decompensated Liver Cirrhosis ◽  
Chronic Active Liver Disease ◽  
Fibrin Monomer ◽  
Cirrhotic Patients ◽  
Normal Controls

Positivity of paracoagulation tests in a previously studied group of 80 patients with chronic active liver disease did not exceed 5-10% of the cases. In the present study, plasma samples from 20 cases of decompensated liver cirrhosis, assessed by liver biopsy, were investigated by means of agarose cromatography. Fibrinogen related materials were measured immunologically and by Staphylococcal Clumping Test.First appearance of fibrinogen-like materials occurred at earlier fractions in cirrhotic patients in comparison with normal controls. The relative amount of soluble fibrin monomer complexes (SFMC) as referred to total fibrinogen was significantly increased. No correlation was found between the amount of SFMC and the severity of fibrinogen polymerisation defect.Circulating SFMC are therefore present in severe liver cirrhosis. However, DIC may not be the only proposed explanation for this finding.

scholarly journals End-stage renal disease: a risk factor of deep neck infection – a nationwide follow-up study in Taiwan

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Geng-He Chang ◽  
Ming-Shao Tsai ◽  
Chia-Yen Liu ◽  
Meng-Hung Lin ◽  
Yao-Te Tsai ◽  
...  
Keyword(s):  
Risk Factor ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Deep Neck Infection ◽  
Neck Infection ◽  
Follow Up Study ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Liver fibrosis assessment by transient elastography in patients with liver cirrhosis after hepatitis C virus eradication

2020 ◽  
Vol 11 (1) ◽  
pp. 26-37
Author(s):  
E. A. Nabatchikova ◽  
D. T. Abdurakhmanov ◽  
E. N. Nikulkina ◽  
T. P. Rozina ◽  
E. L. Tanaschuk ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Risk Factor ◽  
Hepatitis C ◽  
Independent Risk Factor ◽  
Transient Elastography ◽  
Albumin Level ◽  
Fibrosis Regression ◽  
Cirrhotic Patients ◽  
Group 2 ◽  
Group 1

Direct-acting antivirals (DAAs) therapy is associated with fibrosis regression in patients with hepatitis C virus liver cirrhosis.Aim. To study the dynamic of liver fibrosis in cirrhotic patients with a DAAs-induced sustained virological response (SVR).Materials and methods. The retrospective cohort study included 80 cirrhotic patients (male — 43%, median age 54 years). Liver stiffness (LS) was measured by transient elastography before treatment and after SVR. Patients with LS improvement ≥30% were included in group 1, other patients — in group 2. Clinical, laboratory and instrumental parameters were assessed. Independent risk factors for the absence of LS improvement ≥30% were determined by binary logistic regression with the definition of odds ration (OR) and 95% confidence interval (CI).Results. LS reduced from 21.35 (15.2; 27.7) to 13.5 [10.1; 20.0] kPa (p < 0.001), the median reduction was 5.1 [2.6; 11.0] kPa. Regression of fibrosis from F4 to F2 and F3 stages was observed in 16 (20%) and 19 (24%) of cases, respectively. Overall, 36 patients were included in group 1, 44 patients — in group 2. Platelet counts increased in group 1 compared to group 2 by 24.5% vs 5.2% (p = 0.014), a disappearance or reducing the size of esophageal varices were observed in 72% vs. 35% of cases (p = 0.035). Significant differences in ALT, AST, albumin, prothrombin time dynamics were not observed. Baseline albumin level ≤35 g/l is an independent risk factor for the absence of significant improvement of LS: OR 6.7 (95% CI 1.7–25.9, p = 0.006).Conclusion. SVR leads to fibrosis regression to F2-F3 stages in 44% of patients. Baseline albumin level ≤35 g/l is an independent risk factor for the absence of significant improvement of LS.

scholarly journals Diagnostic Value of Plasma Cystatin C as a Glomerular Filtration Marker in Decompensated Liver Cirrhosis

2002 ◽  
Vol 48 (6) ◽  
pp. 850-858 ◽  
Author(s):  
Rocco Orlando ◽  
Michele Mussap ◽  
Mario Plebani ◽  
Pierpaolo Piccoli ◽  
Sara De Martin ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Plasma Creatinine ◽  
Decompensated Liver Cirrhosis ◽  
Creatinine Concentration ◽  
Plasma Creatinine Concentration ◽  
Calculated Creatinine Clearance ◽  
Cirrhotic Patients

Abstract Background: Plasma creatinine concentration and calculated creatinine clearance are of limited value as glomerular filtration rate (GFR) markers in patients with decompensated liver cirrhosis. We assessed plasma cystatin C as an indicator of GFR in such patients. Methods: We studied 36 patients with decompensated liver cirrhosis and 56 noncirrhotic controls, both groups including individuals with normal and impaired renal function. GFR was measured in all individuals by inulin clearance, with values &lt;72 mL · min−1 · 1.73 m−2 considered decreased. We measured cystatin C and creatinine in plasma and calculated (from plasma concentrations) and measured creatinine clearances, using for them decision points of 1.25 mg/L, 115 μmol/L, and 72 and 72 mL · min−1 · 1.73 m−2, respectively. Results: Plasma cystatin C concentrations were similar in controls and cirrhotics and, at the usual cutpoint, could detect decreased GFR with similar sensitivities in the two groups (73% and 88%, respectively). Serum creatinine was markedly lower in cirrhotics and remained mostly within the reference interval at all GFR values; the diagnostic sensitivity of creatinine was much lower in cirrhotics than in controls (23% vs 64%). Lower diagnostic sensitivity was also observed for calculated creatinine clearance (53% vs 100% in controls), whereas similar sensitivities were found for measured creatinine clearance (86% and 81%) in controls and cirrhotics, respectively. ROC analysis showed that all four variables had similar diagnostic accuracies in cirrhotic patients. However, it also revealed that good diagnostic accuracies for plasma creatinine and calculated creatinine clearance can be obtained only if reference intervals different from those used for the general population are adopted. Conclusions: Plasma cystatin C concentration is an accurate GFR marker in cirrhotic patients. Plasma creatinine concentration and calculated creatinine clearance are of no practical value, as their reference values vary with the severity of the liver disease.

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