scholarly journals GAMBARAN GANGGUAN HEMOSTASIS PADA PENDERITA SIROSIS HATI YANG DI RAWAT DI RSUP PROF.DR.R.D.KANDOU PERIODE AGUSTUS 2013 – AGUSTUS 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Garry G. Saragih ◽  
Bradley J. Waleleng ◽  
Harlinda Haroen
Keyword(s):  
Liver Cirrhosis ◽  
Liver Dysfunction ◽  
Blood Clotting ◽  
Secondary Data ◽  
Liver Parenchyma ◽  
Age Group ◽  
Common Cause ◽  
Bleeding Manifestation ◽  
Cirrhotic Patients ◽  
Hemostatic Disorder

Abstract: Liver cirrhosis is a chronic disease characterized by changes in the structure and architecture of the liver parenchyma resulting in liver dysfunction. One of the liver dysfunction is changes in metabolism of proteins that play a role in blood clotting hemostasis). Therefore, one of the complications often found in liver cirrhosis is bleeding. This study aimed to obtain the profile of hemostatic disorder of cirrchosis patients treated in Prof. Dr. R. D. Kandou Hospital Manado from August 2013 toAugust 2015. This was a retrospective descriptive study using the secondary data of the Medical Record. The results showed that there were 75 patients with liver cirrhosis; 34 (45.7%) had impaired hemostasis. The highest proportion of cirrhotic patients with hemostasis disorder was male (67.6%); age group of 51-65 years (55.8%); the most common cause was HBV infection (35.3%); the most often bleeding manifestation was melena (61.7%); and the most common cause of bleeding was esophageal varices (44.1%), prolongation of PT (86.7%) and of APTT (46.7%). Low level of platelets count occured in 85,2% of patients. Conclusion: Almost half of the patients with liver cirrhosis had hemostasis disorders. Prolongation of PT occurred in most of the patients, however, no significant APTT prolongation was found. Thrombocytopenia frequently occured in patients with liver cirrhosis associated with hemostasis disorders. Keywords: hemostatic disorder, PT, thrombocytopenia, cirrchosis  Abstrak: Sirosis hati adalah penyakit hati kronis dimana terjadi perubahan struktur dan arsitektur dari parenkim hati sehingga hati tidak dapat berfungsi dengan baik. Salah satu fungsi hati yang terganggu ialah metabolisme protein yang berperan dalam mengatur fungsi pembekuan darah (hemostasis). Salah satu komplikasi yang sering dijumpai pada sirosis hati adalah perdarahan. Penelitian inin menggunakan metode retrospektif dengan mengambil data sekunder di Instalasi Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Dari hasil penelitian diperoleh pasien sirosis hati sebanyak 75 orang, dan 34 orang (45,7%) diantaranya mengalami gangguan hemostasis. Proporsi tertinggi pasien sirosis disertai gangguan hemostasis ialah laki-laki (67,6%); kelompok umur 51-65 tahun (55,8%); penyebab terbanyak infeksi HBV (35,3%); manifestasi perdarahan yang sering muncul ialah melena (61,7%) dengan penyebab perdarahan tersering adalah varises esofagus (44,1%); serta pemanjangan PT (86,7%) dan APTT (46,7%). Nilai trombosit dibawah normal (trombositopenia) terjadi pada 85,2% pasien. Simpulan: Hampir setengah pasien sirosis hati mengalami gangguan hemostasis. Pemanjangan PT terjadi pada sebagian besar pasien yang diperiksa sedangkan pemanjangan APTT tidak signifikan. Trombositopenia sering terjadi pada pasien sirosis hati disertai gangguan hemostasis. Kata kunci: Gangguan hemostasis, PT, trombositopenia, sirosis.

scholarly journals PROFIL PASIEN SIROSIS HATI YANG DIRAWAT INAP DI RSUP PROF. DR. R. D. KANDOU MANADO PERIODE AGUSTUS 2012 – AGUSTUS 2014

e-CliniC ◽  
2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Yunellia Z. Patasik ◽  
Bradley J. Waleleng ◽  
Frans Wantania
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Pathological Condition ◽  
Abdominal Distension ◽  
Hbv Infection ◽  
Nodule Formation ◽  
Age Group ◽  
Virus Hepatitis ◽  
Common Cause ◽  
Cirrhotic Patients

Abstract: Cirrhosis hepatic is a pathological condition that describes the final stage of progressive hepatic fibrosis and characterized by distortion of the liver and regenerative nodule formation. Cirrhosis hepatic is a chronic liver disease caused by various factors such as infection by hepatitis B virus, hepatitis C and alcohol. Cirrhosis ranks eighteenth cause of death with a prevalence of 1.3% in the world. Methods: This study is a retrospective descriptive study by collecting secondary data from medical record of cirrhotic patients installation of medical records RSUP Prof. Dr. R. D. Kandou Manado, August 2012 to August 2014. The data were obtained amounted to 51 patients with cirrhosis hepatic. Results: The result showed that the highest proportion in cirrhotic patients by gender is male (62.7%), age group 50-59 years (31.4%), the most common cause is HBV infection (37.3%), ascites and abdominal distension (20%) is a clinical picture that often arise, increased AST (15%) and loss of albumin and hemoglobin (16%) is the laboratory results that often abnormal, and most complications are esophageal varices (23.5%). Conclusion: Cirrhosis affects many men, in the age group 50-59 years, HBV infection is the most common cause, ascites and abdominal distension as common clinical features, increased SGOT and a decrease in albumin and hemoglobin as the most common abnormal laboratory picture, and most complications namely esophageal varices.Keywords: profile, cirrhosis hepatic, hepatitisAbstrak: Sirosis hati merupakan keadaan patologis yang menggambarkan stadium akhir fibrosis hepatik yang berlangsung progresif ditandai dengan distorsi dari arsitektur hepar dan pembentukan nodulus regeneratif. Sirosis hati adalah penyakit hati kronis yang disebabkan oleh berbagai macam faktor seperti infeksi virus hepatitis B, hepatitis C dan alkohol. Di dunia sirosis menempati urutan kedelapan belas penyebab kematian dengan prevalensi 1,3%. Metode: Penelitian ini merupakan penelitian deskriptif retrospektif dengan cara mengumpulkan data sekunder berupa catatan rekam medik pasien sirosis di Instalasi Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado Periode Agustus 2012-Agustus 2014. Keseluruhan data yang diperoleh berjumlah 51 pasien sirosis hati. Hasil: Dari hasil penelitian diperoleh proporsi tertinggi pada pasien sirosis berdasarkan jenis kelamin adalah laki-laki (62,7%), kelompok umur 50-59 tahun (31,4%), penyebab terbanyak infeksi HBV (37,3%), asites dan distensi abdomen (20%) merupakan gambaran klinis yang sering muncul, peningkatan SGOT (15%) serta penurun albumin dan Hb (16%) merupakan gambaran laboratorium yang hasilnya sering abnormal, dan komplikasi terbanyak adalah varises esofagus (23,5%). Simpulan: Sirosis hati banyak diderita oleh laki-laki, pada kelompok umur 50-59 tahun, infeksi HBV adalah penyebab terbanyak, asites dan distensi abdomen sebagai gambaran klinis tersering, peningkatan SGOT serta penurunan albumin dan Hb sebagai gambaran laboratorium abnormal tersering, dan komplikasi terbanyak yaitu varises esofagus.Kata kunci: profil, sirosis hati, hepatitis

scholarly journals Glutathione and Related Antioxidant Capacities But Not Vitamin B-6 Had Significant Association with Severity of Liver Dysfunction in Liver Cirrhotic Patients

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1128-1128
Author(s):  
Yi-Chia Huang ◽  
Chia-Yu Lai ◽  
Shao-Bin Cheng ◽  
Hsiao-Tien Liu ◽  
Shih-Chien Huang
Keyword(s):  
Oxidative Stress ◽  
Liver Cirrhosis ◽  
Liver Dysfunction ◽  
Trolox Equivalent Antioxidant Capacity ◽  
Vitamin B ◽  
Double Blind ◽  
Antioxidant Capacities ◽  
Trolox Equivalent ◽  
Cirrhotic Patients

Abstract Objectives Liver cirrhosis is often associated with increased oxidative stress and decreased antioxidant capacities. Vitamin B-6 and glutathione (GSH) are antioxidant nutrients. Inadequate vitamin B-6 status may indirectly limit GSH synthesis and further affect the antioxidant capacities. The purpose of this study was to assess whether individual or the combination of vitamin B-6 and GSH supplementation had effects on antioxidant capacities and clinical outcomes in patients with liver cirrhosis. Methods This was a double-blind randomized clinical trial and a follow-up study. 61 liver cirrhotic patients were randomly assigned to placebo, vitamin B-6 (50 mg pyridoxine/d), GSH (500 mg/d) or B-6 + GSH groups for 12 weeks. After the end of supplementation, 61 patients were followed until the end of the study. Baseline and 12 weeks of fasting blood samples were drawn to measure levels of plasma GSH, oxidized GSH (GSSG), trolox equivalent antioxidant capacity (TEAC), activities of glutathione S-transferase (GSH-St), glutathione peroxidase (GSH-Px), glutathione reductase (GSH-Rd), superoxide dismutase (SOD) and catalase. The severity of liver dysfunction (Child-Turcotte-Pugh score) was evaluated at baseline, 12 weeks after baseline, and the end of the follow-up time. Results The median follow-up time was 984 d, 21 patients were lost of follow-up during follow-up period. After 12 weeks of supplementation, neither vitamin B-6 nor GSH supplementation had effects on indicators of oxidative stress and antioxidant capacities. However, high levels of GSH, GSH/GSSG ratio, and GSH-St activity at baseline (week 0) but not at week 12 had significant effect on low Child-Turcotte-Pugh scores at week 0, week12 and the end of follow-up in all patients after adjusting for potential confounders. Conclusions Although GSH supplementation had no significant effect on reducing oxidative stress and increase antioxidant capacities, the decreased glutathione and its related enzyme activity should be considered by clinicians in the treatment of liver cirrhotic patients. Funding Sources This study was funded by a grant from the Ministry of Science and Technology, Taiwan (MOST 104–2320-B-040–009-MY3) and Taichung Veterans General Hospital, Taiwan (TCVGH-1084601C).

scholarly journals Identification of potential metabolic biomarkers in predicting esophageal varices needing treatment in patients with liver cirrhosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chung-Man Moon ◽  
Yun-Young Lee ◽  
Suk-Hee Heo ◽  
Sang-Soo Shin ◽  
Yong-Yeon Jeong
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Liver Parenchyma ◽  
Resonance Spectroscopy ◽  
Single Voxel ◽  
Red Color ◽  
Cirrhotic Patients ◽  
Metabolic Biomarkers

AbstractThe goal of this study was to determine the diagnostic performance of in vivo quantitative proton magnetic resonance spectroscopy (1H-MRS) to identify the presence of esophageal varices needing treatment (VNT), as well as investigate its correlation with clinical characteristics in patients with liver cirrhosis. Forty cirrhotic patients without VNT showing the negative red color sign, and 40 cirrhotic patients with VNT showing positive red color sign underwent laboratory tests, esophago-gastro-duodenoscopy, and 1H-MRS with single-voxel localization in the cirrhotic liver parenchyma. The levels of lactate + triglyceride (TG) and choline in cirrhotic patients with VNT were significantly higher than those in cirrhotic patients without VNT. In multivariate analysis, spleen diameter, platelet count, and platelet count/spleen diameter ratio, as well as lactate + TG, and choline were associated with the presence of VNT. Moreover, lactate + TG and choline levels were positively correlated with spleen diameter and negatively correlated with platelet count in the combined group of cirrhotic patients with and without VNT. Our study demonstrated that higher hepatic lactate + TG and choline levels in cirrhotic patients in conjunction with longer spleen diameter, lower platelet counts, and lower ratios of platelet count to spleen diameter were associated with the presence of esophageal VNT and the risk of developing variceal bleeding. Therefore, in vivo 1H-MRS might be an effective tool for diagnosing and predicting esophageal VNT in patients with liver cirrhosis.

Analysis of Ascites-Challenged Blood in Patients with Liver Cirrhosis Using Rotational Thromboelastometry: How Robust Is the Evidence on Ascites-Attributed Fibrinolysis?

Digestion ◽  
2021 ◽  
pp. 1-6
Author(s):  
Sotiria Bedreli ◽  
Dimitrios Eleftheriadis ◽  
Michael Jahn ◽  
Ali Canbay ◽  
Fuat Saner ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Dilution Effect ◽  
Negative Control Group ◽  
Fresh Frozen Plasma ◽  
Negative Control ◽  
Control Group ◽  
Rotational Thromboelastometry ◽  
Antifibrinolytic Drugs ◽  
Fresh Frozen ◽  
Cirrhotic Patients

Introduction: For over 30 years, ascites has been postulated to facilitate fibrinolysis in patients with liver cirrhosis. In contrast to previous research employing conventional coagulation tests, this study aimed to characterize hemostatic interactions between blood and ascites using the rotational thromboelastometry (ROTEM). Methods: Blood samples – pure or mixed with ascites in a ratio of 1:1 – from cirrhotic patients (n = 10) were subjected to ROTEM analysis. In addition, a negative control group was built with cirrhotic patients (n = 10) whose blood was mixed with physiologic sodium chloride (0.9% NaCl) solution in a ratio of 1:1. Subsequently, ROTEM measurements were subjected to statistical analysis. Results: During ascites challenge, clotting time (CT, measured in seconds) was significantly prolonged in EXTEM (blood: 70.40 ± 20.40 vs. ascites/blood: 109.8 ± 47.7) and APTEM (blood: 66.50 ± 14.55 vs. ascites/blood: 138.7 ± 105.8), likely reflecting a dilution effect. However, CT in INTEM remained unchanged, suggesting a sustained intrinsic pathway function. Maximal clot firmness (measured in millimeters) in FIBTEM decreased significantly (blood: 14.70 ± 9.55 vs. ascites/blood: 6.00 ± 5.66), thus indicating depletion of fibrinogen in ascites. Strikingly, maximum lysis (measured in %) significantly decreased in EXTEM (blood: 9.30 ± 2.79 vs. ascites/blood: 5.50 ± 2.84), APTEM (blood: 8.50 ± 3.10 vs. ascites/blood: 5.60 ± 2.88), and INTEM (blood: 7.50 ± 2.27 vs. ascites/blood: 5.10 ± 3.48). Conclusions: ROTEM provided new evidence that ascites may not primarily induce fibrinolysis in cirrhotic patients. This finding seems to be of significant importance for the clinical management of cirrhotic patients experiencing complications, for example, abdominal hemorrhage after liver biopsy or paracentesis; here, replacement of prothrombin complex concentrates and/or fibrinogen concentrates may prove more beneficial than the use of fresh frozen plasma or antifibrinolytic drugs.

scholarly journals Dynamically remodeled hepatic extracellular matrix predicts prognosis of early-stage cirrhosis

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Yuexin Wu ◽  
Yuyan Cao ◽  
Keren Xu ◽  
Yue Zhu ◽  
Yuemei Qiao ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Basement Membrane ◽  
Type Iv Collagen ◽  
Patient Survival ◽  
Early Stage ◽  
Ecm Remodeling ◽  
Type Iv ◽  
Ecm Proteins ◽  
Stage Disease ◽  
Cirrhotic Patients

AbstractLiver cirrhosis remains major health problem. Despite the progress in diagnosis of asymptomatic early-stage cirrhosis, prognostic biomarkers are needed to identify cirrhotic patients at high risk developing advanced stage disease. Liver cirrhosis is the result of deregulated wound healing and is featured by aberrant extracellular matrix (ECM) remodeling. However, it is not comprehensively understood how ECM is dynamically remodeled in the progressive development of liver cirrhosis. It is yet unknown whether ECM signature is of predictive value in determining prognosis of early-stage liver cirrhosis. In this study, we systematically analyzed proteomics of decellularized hepatic matrix and identified four unique clusters of ECM proteins at tissue damage/inflammation, transitional ECM remodeling or fibrogenesis stage in carbon tetrachloride-induced liver fibrosis. In particular, basement membrane (BM) was heavily deposited at the fibrogenesis stage. BM component minor type IV collagen α5 chain expression was increased in activated hepatic stellate cells. Knockout of minor type IV collagen α5 chain ameliorated liver fibrosis by hampering hepatic stellate cell activation and promoting hepatocyte proliferation. ECM signatures were differentially enriched in the biopsies of good and poor prognosis early-stage liver cirrhosis patients. Clusters of ECM proteins responsible for homeostatic remodeling and tissue fibrogenesis, as well as basement membrane signature were significantly associated with disease progression and patient survival. In particular, a 14-gene signature consisting of basement membrane proteins is potent in predicting disease progression and patient survival. Thus, the ECM signatures are potential prognostic biomarkers to identify cirrhotic patients at high risk developing advanced stage disease.

The presence of liver cirrhosis is a strong negative predictor of survival for patients admitted to the intensive care unit – Cirrhosis in intensive care patients

2021 ◽  
Author(s):  
Jörg Bojunga ◽  
Mireen Friedrich-Rust ◽  
Alica Kubesch ◽  
Kai Henrik Peiffer ◽  
Hannes Abramowski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Cirrhosis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Treatment ◽  
Matched Cohort ◽  
Care Treatment ◽  
Cirrhotic Patients ◽  
The Impact ◽  
Cirrhotic Group

Abstract Background and Aims Liver cirrhosis is a systemic disease that substantially impacts the body’s physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions. Methods In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS). Results A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group.  Conclusions In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients’ outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.

scholarly journals Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Ahmed Abdelrahman Mohamed Baz ◽  
Rana Magdy Mohamed ◽  
Khaled Helmy El-kaffas
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Meld Score ◽  
Hepatic Decompensation ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Us Findings ◽  
End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

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