scholarly journals Hepatic Hydrothorax—An Independent Decompensating Event Associated with Long-Term Mortality in Patients with Cirrhosis

2021 ◽  
Vol 10 (16) ◽  
pp. 3688
Author(s):  
Daniela Matei ◽  
Rares Craciun ◽  
Dana Crisan ◽  
Bogdan Procopet ◽  
Tudor Mocan ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Liver Disease ◽  
Cox Regression ◽  
Risk Groups ◽  
Decompensated Cirrhosis ◽  
Hepatic Hydrothorax ◽  
Term Survival ◽  
Long Term Survival ◽  
Grade Iii

Background: Hepatic hydrothorax (HH) is an understudied complication of decompensated cirrhosis. We aimed to evaluate the long-term prognosis of patients with HH by comparing them with a matched non-HH group. Methods: This retrospective study included 763 consecutive patients hospitalized for decompensated cirrhosis and ascites. Ninety-seven patients with HH were matched for survival analysis with non-HH patients based on liver disease severity. Results: The prevalence of HH was 13.1%. Patients with HH had significantly worse overall liver function. Upon matching, patients with HH had a lower long-term survival (15.4% vs. 30.9% at 5 years) with a mean overall survival of 22.2 ± 2.2 months for the HH group vs. 27.1 ± 2.6 months for the non-HH group (Log Rank–0.05). On multivariate survival analysis using Cox regression, the MELD-Na score, ALBI grade, hepato-renal syndrome, and grade III ascites had a significant impact on mortality in patients with HH. In patients with HH, a MELD-Na score ≥ 16, ALBI grade III, hepato-renal syndrome, or severe ascites delineated high-mortality risk groups. Conclusions: HH is consistently associated with more advanced liver disease. Patients with HH have worse long-term survival, their prognosis being closely intertwined with overlapping decompensating events.

scholarly journals Optimization of long-term prognosis of patients with alcoholic liver disease

2020 ◽  
pp. 176-181
Author(s):  
V. D. Lunkov ◽  
M. V. Maevskaya ◽  
V. T. Ivashkin
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Alcoholic Liver Disease ◽  
Psychological Assessment ◽  
Decompensated Cirrhosis ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival

Aim: to prove the effectiveness of combined physical and psychological assessment in improving the long-term outcome of patients with alcoholic liver disease (ALD).Materials and methods: the active outpatient follow-up (AOF) group included 29 patients with ALD consisted of active liver function and motivation assessment, motivational interviewing, liver panel lab tests with the rate once at 3 months. The AOF program consisted of dynamic monitoring of liver function at least 1 time in 3 months and psychological support provided by the hepatologist using brief interventional approach. The control of abstinence was provided by using self-reports and indirect biomarkers of alcohol consumption. The control group included 36 patients with ALD and history of two-years follow-up after first alcoholinduced liver injury who received comprehensive therapy and a simple advice to avoid alcohol.Results: the adherence to abstinence were significantly higher in AOF group compared with control group. The proportion of patients with decompensated cirrhosis was significantly lower in AOF group compared with control group at 12 and 24 months after enrollment. The long-term survival in AOF-group was significantly higher than in control group. The only parameter independently associated with long-term survival was the presence of AOF program.Conclusion: the combined physical and psychological assessment of patients with ALD, provided by internists improves adherence to abstinence, reduces the risk of decompensation of liver function, severity of ALD and improves patients survival in the long term period.

scholarly journals Undifferentiated Embryonal Sarcoma of the Liver in Children Versus Adults: A National Cancer Database Analysis

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2918
Author(s):  
Ioannis A. Ziogas ◽  
Irving J. Zamora ◽  
Harold N. Lovvorn III ◽  
Christina E. Bailey ◽  
Sophoclis P. Alexopoulos
Keyword(s):  
Surgical Treatment ◽  
Cox Regression ◽  
Clinicopathological Characteristics ◽  
National Cancer Database ◽  
Term Survival ◽  
Long Term Survival ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Embryonal Sarcoma

This study evaluates the clinicopathological characteristics and outcomes of children vs. adults with undifferentiated embryonal sarcoma of the liver (UESL). A retrospective analysis of 82 children (<18 years) and 41 adults (≥18 years) with UESL registered in the National Cancer Database between 2004–2015 was conducted. No between-group differences were observed regarding tumor size, metastasis, surgical treatment, margin status, and radiation. Children received chemotherapy more often than adults (92.7% vs. 65.9%; p < 0.001). Children demonstrated superior overall survival vs. adults (log-rank, p < 0.001) with 5-year rates of 84.4% vs. 48.2%, respectively. In multivariable Cox regression for all patients, adults demonstrated an increased risk of mortality compared to children (p < 0.001), while metastasis was associated with an increased (p = 0.02) and surgical treatment with a decreased (p = 0.001) risk of mortality. In multivariable Cox regression for surgically-treated patients, adulthood (p = 0.004) and margin-positive resection (p = 0.03) were independently associated with an increased risk of mortality. Multimodal treatment including complete surgical resection and chemotherapy results in long-term survival in most children with UESL. However, adults with UESL have poorer long-term survival that may reflect differences in disease biology and an opportunity to further refine currently available treatment schemas.

Long-Term Survival Analysis of Pure Laparoscopic Versus Open Hepatectomy for Hepatocellular Carcinoma in Patients With Cirrhosis

2013 ◽  
Vol 257 (3) ◽  
pp. 506-511 ◽  
Author(s):  
Tan To Cheung ◽  
Ronnie T. P. Poon ◽  
Wai Key Yuen ◽  
Kenneth S. H. Chok ◽  
Caroline R. Jenkins ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Open Hepatectomy

Abstract 19408: Impact of Perioperative Liver Dysfunction on In-hospital Mortality and Long-term Survival in Infective Endocarditis Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mahmoud Diab ◽  
Christoph Sponholz ◽  
Michael Bauer ◽  
Andreas Kortgen ◽  
Philipp Scheffel ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Liver Dysfunction ◽  
Cox Regression ◽  
Term Survival ◽  
Long Term Survival ◽  
Aureus Infection

Background: Infective endocarditis (IE) is a dangerous disease with high mortality (20-40%). A leading cause of death is multi-organ failure (MODS) with liver dysfunction (LD) as major contributor. Data on LD in IE patients are scarce. We assessed the impact of preoperative - and newly occurring LD on in-hospital mortality and long-term survival in IE patients. Methods: We retrospectively reviewed our database for surgery of left-sided endocarditis between 1/07 and 4/13. We used the hepatic Sepsis-related Organ Failure Assessment (hSOFA) score to assess the degree of LD. We performed Chi-Square, Cox regression and multivariate analyses. Results: The 308 patients had a mean age of 62 ±13.9. Preoperative LD (hSOFA > 0, Bilirubin > 32 μmol/L) was present in 1/4 (n=81) of patients and was associated with severely elevated in-hospital mortality (51.9% vs.14.6% without preoperative LD, p<0.001). Newly-occurring postoperative LD developed in another quarter (n=57 of 227 patients without LD) of patients and was associated with elevated in-hospital mortality (24.6% vs. 11.2%, p<0.001). Kaplan-Meyer 5-year survival was significantly better in patients without LD (51% vs. 19.9%, p<0.01). Survival curves were practically identical after the perioperative phase was over (Fig.). Quality of life in survivors was also the same. Cox regression analysis revealed preoperative LD as independent predictor of long-term survival (adjusted hazard ratio 1.695, 95% confidence interval 1.160-2.477, p=0.009) and duration of cardiopulmonary bypass (CPB) and S. aureus infection as independent predictors of newly-occurring postoperative LD. Conclusions: LD in patients with endocarditis is a significant independent risk factor for in-hospital mortality. A considerable fraction of patients develop LD perioperatively, which is associated with cardiopulmonary bypass-duration and S. aureus infection. However, after surviving surgery, prognosis no longer seems to be predicted by LD.

scholarly journals NT-proBNP and postoperative heart failure in surgery for aortic stenosis

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001063 ◽  
Author(s):  
Huiqi Jiang ◽  
Farkas Vánky ◽  
Henrik Hultkvist ◽  
Jonas Holm ◽  
Yanqi Yang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Cox Regression ◽  
Preoperative Evaluation ◽  
Area Under The Curve ◽  
Term Survival ◽  
Long Term Survival ◽  
Clinical Endpoints ◽  
Long Term Consequences

ObjectivePostoperative heart failure (PHF) after aortic valve replacement (AVR) for aortic stenosis (AS) may initially appear mild and transient but has serious long-term consequences. Methods to assess PHF are not well documented. We studied the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and PHF after AVR for AS.MethodsThis is a prospective, observational, longitudinal study of 203 patients undergoing elective first-time AVR for AS. Plasma NT-proBNP was assessed at preoperative evaluation, the day before surgery, and the first (POD1) and third postoperative morning. A clinical endpoints committee, blinded to NT-proBNP results, used prespecified haemodynamic criteria to diagnose PHF. The mean follow-up was 8.6±1.1 years.ResultsNo patient with PHF (n=18) died within 30 days after surgery, but PHF was associated with poor long-term survival (HR 3.01, 95% CI 1.45 to 6.21, p=0.003). NT-proBNP was significantly higher in patients with PHF only on POD1 (6415 (3145–11 220) vs 2445 (1540–3855) ng/L, p<0.0001). NT-proBNP POD1 provided good discrimination of PHF (area under the curve=0.82, 95% CI 0.72 to 0.91, p<0.0001; best cut-off 5290 ng/L: sensitivity 63%, specificity 85%). NT-proBNP POD1 ≥5290 ng/L identified which patients with PHF carried a risk of poor long-term survival, and PHF with NT-proBNP POD1 ≥ 5290 ng/L emerged as a risk factor for long-term mortality in the multivariable Cox regression (HR 6.20, 95% CI 2.72 to 14.1, p<0.0001).ConclusionsThe serious long-term consequences associated with PHF after AVR for AS were confirmed. NT-proBNP level on POD1 aids in the assessment of PHF and identifies patients at particular risk of poor long-term survival.

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