scholarly journals Malnutrition in Patients with Liver Cirrhosis

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 540
Author(s):  
Julia Traub ◽  
Lisa Reiss ◽  
Benard Aliwa ◽  
Vanessa Stadlbauer
Keyword(s):  
Liver Cirrhosis ◽  
Health Care Professionals ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
Diagnostic Tools ◽  
Screening Methods ◽  
Nutrient Metabolism ◽  
Oral Nutritional Supplements ◽  
Cirrhotic Patients

Liver cirrhosis is an increasing public health threat worldwide. Malnutrition is a serious complication of cirrhosis and is associated with worse outcomes. With this review, we aim to describe the prevalence of malnutrition, pathophysiological mechanisms, diagnostic tools and therapeutic targets to treat malnutrition. Malnutrition is frequently underdiagnosed and occurs—depending on the screening methods used and patient populations studied—in 5–92% of patients. Decreased energy and protein intake, inflammation, malabsorption, altered nutrient metabolism, hypermetabolism, hormonal disturbances and gut microbiome dysbiosis can contribute to malnutrition. The stepwise diagnostic approach includes a rapid prescreen, the use of a specific screening tool, such as the Royal Free Hospital Nutritional Prioritizing Tool and a nutritional assessment by dieticians. General dietary measures—especially the timing of meals—oral nutritional supplements, micronutrient supplementation and the role of amino acids are discussed. In summary malnutrition in cirrhosis is common and needs more attention by health care professionals involved in the care of patients with cirrhosis. Screening and assessment for malnutrition should be carried out regularly in cirrhotic patients, ideally by a multidisciplinary team. Further research is needed to better clarify pathogenic mechanisms such as the role of the gut-liver-axis and to develop targeted therapeutic strategies.

scholarly journals Nutritional Assessment of Patients with Liver Cirrhosis by Nutrition Screening Tool and Anthropometry at a Tertiary Care Center

2019 ◽  
Vol 41 (2) ◽  
pp. 21-25
Author(s):  
Tshering W Sherpa ◽  
Rahul Pathak ◽  
Prem K Khadga ◽  
Sashi Sharma ◽  
Rabin Hamal ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
Tertiary Care ◽  
Anthropometric Measurements ◽  
Nutrition Screening ◽  
Female Ratio ◽  
Number Of Patients ◽  
Cirrhotic Patients ◽  
Nutrition Screening Tool

Introduction: Malnutrition is one of the most common complications of liver cirrhosis. Yet, little attention is paid in evaluating nutrition in this group of patients. This study aims to assess malnutrition among cirrhotic patients using a nutrition screening tool and anthropometry. Methods: This was a prospective, observational study of admitted patients with liver cirrhosis. In the study duration of 3months, 50 patients met the inclusion criteria and were included. Nutritional assessment was performed using the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), BMI and standard anthropometry including TSF,MUAC and MAMC. Results: The mean age was 51.56 ± 11.50 with a Male to Female ratio of 3:2. Chronic alcohol consumption (72%) was the most common etiology while management of tense as cites (40%) was the most common reason for hospital admission. 58% had Child Pugh Class C cirrhosis while the remaining 42% were Class B. The average MELD Nascore was 19.64 ± 6. Significant differences in anthropometric measurements including BMI, MUAC, TSF and MAMC were found between Child B and C cirrhosis. Similarly, those patients who had low, moderate and high-risk of malnutrition by the RFH-NPT had significant differences in anthropometric measurements between them. Conclusion: A significant number of patients had moderate to severe risk of malnutrition that correlated well with anthropometric measurements. The degree of malnutrition is parallel with the severity of liver disease among these patients. Both the RFH-NPT and anthropometry are relatively easy to perform and effective. Hence, they can be used as a practical means for identifying malnutrition among cirrhotic patients in routine clinical practice.

FIBRINOPEPTIDE B6 15-42 IN LIVER CIRRHOSIS: A SENSITIVE INDICATOR OF MILD FIBRINOLYSIS ACTIVATION

1987 ◽  
Author(s):  
F Marongiu ◽  
M R Acca ◽  
G Mulas ◽  
M Conti ◽  
G Sorano ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Plasminogen Activators ◽  
Fibrinopeptide A ◽  
A Posteriori ◽  
Plasmin Activity ◽  
Coagulation Activation ◽  
Cirrhotic Patients ◽  
Student’S T ◽  
Student’S T Test

In order to detect even minimal fibrinolysis activation in liver cirrhosis and to investigate whether an increased plasmin activity is related to a mild blood coagulation activation, we measured fibrinopeptide A (FPA) (Mailinckrodt) and fibrinopeptide BB 15-42 (BB 15-42) (IMCO and SORIN Biomedica) in 26 patients (16 men and 10 women, mean age 55.8 ± 13.1 years) with histologically proven liver cirrhosis..Mann-Whitney test, Student’s t test and correlation coefficient r were employed for statistical analysis when appropriate.FPA and BB 15-42 were not normal distributed and thus their levels were exprsessed as median and range.FPA values were significantly different in cirrhotic patients (3.9, 0.9-24.2 ng/ml) from those of the controls (2.5, 0.5-3.9 ng/ml) (p < 0.01).BB 15-42 levels were significantly higher in cirrhotic patients (19.4, 7.1-103.1 ng/ml) than in controls (10.4, 5.1-15.4 ng/ml) (p < 0.01). A posteriori the patients were divided in two subgroups according to whether their FPA levels were high (subgroup 1, n=10, FPA>4.0 ng/ml) or normal (subgroup 2, n=16, FPA < 4.0 ng/ml).In patients with high FPA levels we found higher levels of BB 15-42 (22.2, 9.9-103.1 ng/ml) than in patients with normal FPA (13.6, 7.1-30.7 ng/ml ).Thvis difference was significant (p < 0.02) .There was no relationship between FPA and BB 15-42.Our data indicate that in liver cirrhosis a mild fibrinolysis activation may occur.The role of a chronic intravascular coagulation appears to be significant in this regard.However the impaired clearance of plasminogen activators, the decreased synthesis of fibrinolysis inhibitors and the decreased levels of hystidine rich glycoprotein may be also involved in determining fibrinolysis activation as suggested by the lack of correlation between FPA and BB 15-42.

scholarly journals Diagnosis and management challenges of acute mesenteric venous thrombosis in patients with liver cirrhosis: a single institution's experience

2017 ◽  
Vol 4 (6) ◽  
pp. 1837
Author(s):  
Hazem M. Zakaria ◽  
Khaled G. Ammar ◽  
Sherif M. Saleh ◽  
Mohammed Abbas ◽  
Nahla M. Gaballa ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Venous Thrombosis ◽  
Diagnostic Tools ◽  
Mesenteric Venous Thrombosis ◽  
Low Protein ◽  
Cirrhotic Patients ◽  
Coagulation Status ◽  
Triphasic Ct ◽  
Primary Resection And Anastomosis ◽  
Resection And Anastomosis

Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosis that requires prompt diagnosis and aggressive management for better outcome. The aim of this work was to study the diagnostic tools and the optimal management of acute MVT in patients with liver cirrhosis.Methods: It was a retrospective study including 40 patients with liver cirrhosis who were admitted to the surgical emergency and were eventually diagnosed as acute MVT between May 2011 to September 2016. The preoperative clinicopathological data, operative data and postoperative follow up were recorded.Results: Forty patients had acute MVT. Twenty five patients (62.5%) had prolonged prothrombin time, 18 patients (45%) had thrombocytopenia and 22 patients (55%) had low protein C. triphasic CT scan was the main diagnostic image in 28 patients, with sensitivity 100% and accuracy 96.9% in detection of intestinal infarction. Ten patients (25%) underwent conservative treatment with anticoagulant, while 30 patients (75%) were surgically explored and 28 patients of them had gangrenous bowel loops and underwent primary resection and anastomosis. Three patients underwent second look operation. Three patients had recurrent symptoms after 1 month of the first presentation. The overall 30- and 90-day mortality was 27.5% and 37.5% respectively.Conclusions: Cirrhotic patients may have hypercoagulable state and the usual laboratory tests don’t accurately assess the coagulation status in these patient. Acute MVT in cirrhotic patients has a high early morbidity and mortality that needs early diagnosis and urgent management with selective surgical intervention and proper anticoagulant.

scholarly journals The impact of PNPLA3 and TM6SF2 in cirrhosis related complications

2021 ◽  
Author(s):  
Haruki Uojima ◽  
Xue Shao ◽  
Taeang Arai ◽  
Yuji ogawa ◽  
Toru Setsu ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Odds Ratio ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Fibrosis Progression ◽  
Cirrhotic Patients ◽  
The Impact

Patatin-like phospholipase domain-containing 3 (PNPLA3) and transmembrane 6-superfamily member 2 (TM6SF2) polymorphisms have major impact for fibrosis due to steatohepatitis. However, there are scant data about correlations between cirrhosis-related complications and the polymorphisms of these genes. Therefore, we aimed to determine the role of the PNPLA3 and TM6SF2 polymorphisms in fibrosis progression for patients with liver cirrhosis. A multicenter study was performed at six hospitals in Japan enrolling 400 patients with liver cirrhosis caused by virus (n = 157), alcohol (n = 104), nonalcoholic fatty liver disease (NAFLD) (n = 106), or autoimmune disease (n = 33). These cirrhotic patients included those with complications of variceal bleeding, hepatic ascites, and/or hepatic encephalopathy and those without. To assess the role of the PNPLA3 and TM6SF2 polymorphisms in patients with cirrhosis related complications, we calculated the odds ratio and relative risk for the rs738409 and rs58542926 polymorphisms. We also accessed whether or not the interaction between these two polymorphisms contributed to cirrhosis related complications. As a result, the odds ratio for complications in the NAFLD group significantly increased in the presence of the rs738409 GG genotype when the CC genotype was used as the reference. There were no significant risks between complications and the presence of the rs738409 G allele in the virus or alcohol groups. There were no significant risks of complications in the frequency of the rs58542926 T polymorphism regardless of the etiology of liver cirrhosis. The interaction between the trs738409 and rs58542926 polymorphisms had the highest odds ratio of 2.415 for complications in the rs738409 GG + rs58542926 (CT+TT) group when rs738409 (CC+CG) + TM6SF2 CC was used as the reference in the NAFLD group.

scholarly journals Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study

2019 ◽  
Vol 122 (12) ◽  
pp. 1368-1376 ◽  
Author(s):  
Alexandra Georgiou ◽  
Georgios V. Papatheodoridis ◽  
Alexandra Alexopoulou ◽  
Melanie Deutsch ◽  
Ioannis Vlachogiannakos ◽  
...  
Keyword(s):  
Liver Disease ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
Risk Index ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Risk Screening ◽  
Nutritional Risk Index ◽  
Nrs 2002 ◽  
Cirrhotic Patients

AbstractMalnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5–54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.

scholarly journals Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis

2015 ◽  
Vol 17 (1) ◽  
pp. 5 ◽  
Author(s):  
Adriana Bintintan ◽  
Romeo Ioan Chira ◽  
Vasile Virgil Bintintan ◽  
Georgiana Nagy ◽  
Roberta Maria Manzat-Saplacan ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Statistical Power ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
Non Invasive ◽  
Cirrhotic Patients ◽  
Ultrasound Parameters

Aims: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with he- patic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. Material and methods: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogas- troduodenoscopy. Results: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical signifi- cance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) ≥ 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. Conclusions: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.

scholarly journals Hepatic encephalopathy: issues relevant to clinical practice

2021 ◽  
pp. 104-108
Author(s):  
M. V. Maevskaya
Keyword(s):  
Liver Cirrhosis ◽  
Clinical Practice ◽  
Hepatic Encephalopathy ◽  
Clinical Signs ◽  
Ammonia Concentration ◽  
High Concentration ◽  
Expert Opinions ◽  
Diagnostic Role ◽  
Cirrhotic Patients

Hepatic encephalopathy (HE) remains one of the most serious complications of liver cirrhosis. Its clinical spectrum sometimes creates difficulties in the optimal diagnosis at the patient’s bedside and treatment. To present new data on the field of clinical management of cirrhotic patients with hepatic encephalopathy. The role of ammonia in the diagnosis of HE is still under discussion. In clinical practice, in patients with suspected overt HE, normal ammonia concentration can be used to exclude this diagnosis. In contrast, a high concentration of ammonia in the absence of clinical signs of HE should not serve as a criterion for this diagnosis and as a guide for treatment. A separate issue for discussion is the covert HE. The simplest and most affordable test for screening for covert HE and evaluating the effectiveness of therapy is the animal naming test, which can be done on bedside by physician or caregivers. Patients with covert HE need treatment that is similar in approach to overt HE. The diagnosis of overt HE and the methods of its therapy are well known. According to Russian recommendations, depending on the disease course in a certain patient, lactulose, rifaximin, L-ornithine L-aspartate can be used as first-line drugs, which is applicable to the treatment of both overt and latent PE. The main issues on the management of HE in liver cirrhosis relate to the diagnostic role of ammonia, optimal diagnosis and treatment strategy for covert HE, therapy of choice for both overt and latent HE. There are expert opinions and consensus documents on all these issues. Treatment of overt and latent PE is carried out according to the same principles. Drugs of choice: lactulose, rifaximin and L-Ornithine L-Aspartate.

scholarly journals Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Francesca Romana Ponziani ◽  
Barbara Funaro ◽  
Andrea Lupascu ◽  
Maria Elena Ainora ◽  
Matteo Garcovich ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Early Identification ◽  
Transcranial Doppler Ultrasound ◽  
Minimal Hepatic Encephalopathy ◽  
Diagnostic Tools ◽  
Cirrhotic Patients ◽  
Cerebral Vascular

Abstract Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral blood flow, systemic hemodynamics as well as endothelial function of cirrhotic patients with MHE, and to verify their change after treatment with rifaximin. Fifty cirrhotic patients with or without MHE and an equal number of healthy controls underwent transcranial Doppler ultrasound (TCD), abdominal Doppler ultrasound (US), and measurement of flow mediated dilation (FMD). In cirrhotic patients diagnosed with MHE receiving rifaximin, the tests were repeated at the end of treatment. Middle (MCA) and posterior (PCA) cerebral artery resistive (RI) and pulsatility (PI) indices were higher in cirrhotic patients than controls, as well as renal and splenic artery RI. Conversely, FMD was reduced. MCA-RI and PI were even higher in cirrhotic patients with MHE compared to those without; a MCA-RI cut-off of 0.65 showed an accuracy of 74% in discriminating the presence of MHE, with 65% sensitivity and 76% specificity. Rifaximin treatment showed no efficacy in the modulation of cerebral vascular flow. In conclusion, cirrhotic patients with MHE have significantly increased cerebral vascular resistances that are not improved by rifaximin treatment. MCA-RI measurement has a good accuracy for the diagnosis of MHE and can be useful for the early identification of this harmful complication of liver cirrhosis.

Ernährung bei Leberzirrhose: wichtige Tipps für Klinik und Praxis

2019 ◽  
Vol 144 (18) ◽  
pp. 1267-1274
Author(s):  
Mathias Plauth
Keyword(s):  
Liver Cirrhosis ◽  
Tube Feeding ◽  
Hepatic Function ◽  
Nutrition Therapy ◽  
Dependent Manner ◽  
Systematic Screening ◽  
Oral Nutritional Supplements ◽  
Cirrhotic Patients ◽  
Adequate Provision ◽  
Third Line

AbstractLiver disease and nutritional status affect each other mutually. Hepatic function is impaired by malnutrition and can be improved by nutrition therapy. Liver cirrhosis leads to prognostically relevant malnutrition in a stage dependent manner. Protein depletion and sarcopenia are its key features. Patients with liver cirrhosis should undergo systematic screening for risk of malnutrition and if positive sarcopenia should be assessed and a nutrition plan devised. In cirrhotic patients, spontaneous food intake frequently does not meet requirements and prolonged (> 12 h) periods of fasting must be avoided. In a stepwise fashion nutritional counseling, oral nutritional supplements, enteral tube feeding and parenteral nutrition as third-line-therapy should be used. In cirrhotic patients, nutrition therapy can improve morbidity and mortality by ensuring the adequate provision of energy, protein and micronutrients.

scholarly journals The potential role of Transient Elastography in assessing patients with Primary Budd Chiari Syndrome

2020 ◽  
Author(s):  
Muriel Webb ◽  
Oren Shibolet ◽  
Yoav Lurie ◽  
Yakov Maor ◽  
Helena Katchman ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Potential Role ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
P Value ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Cirrhotic Patients

Abstract Background: Budd-Chiari syndrome (BCS) is a rare disease defined as hepatic venous outflow obstruction at any level from the hepatic venules up to the cavo-atrial junction. Transjugular Intrahepatic Portosystemic Shunt (TIPS) is performed as a decompressive treatment in some patients.Aim: To evaluate the potential role of Transient Elastography (TE) in assessing liver stiffness in patients with primary BCS.Methods: Twenty one BCS patients and 10 patients with liver cirrhosis with different underlying etiologies underwent abdominal ultrasound and TE.Results: Ninety-five percent of BCS patients had liver stiffness compatible with F4 with a median of 21 kPa, values which are usually obtained in patients with liver cirrhosis. Ten BCS and 10 cirrhotic patients underwent repeated TE with a median of 320 days between exams for BCS and 4.5 years for cirrhotic patients. The change of liver stiffness in BCS patients was 5.75 kPa (range − 0.4 to 26.6), compared with − 4.85 kPa (range − 15.6 to 15.0) in cirrhotic patients (p-value = 0.0029). Change in liver stiffness from baseline to follow-up in BCS patients who underwent TIPS (n = 4) was 0.2 kPa (range − 0.4 to 15.3), whereas in patients without intervention (n = 6) it was 6.75 kPa (range 1.3 to 26.6). The difference was not statistically significant.Conclusion: Liver stiffness in BCS patients is a dynamic progressive process with parameters of TE resembling liver cirrhosis. Even if TIPS seem to slow down the increment of liver stiffness, because of decreased liver congestion, it kept most patients with high score. The TE in BCS patients may be considered for monitoring for stable or upfront disease deterioration.

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