scholarly journals Hepatitis E Induced „Acute-On-Chronic” Liver Failure - Do We Transplant or Not?

2020 ◽  
Vol 39 (1) ◽  
pp. 28-30
Author(s):  
Petra Dinjar Kujundžić ◽  
Anna Mrzljak ◽  
Ivan-Budimir Bekan ◽  
Ana Ostojić ◽  
Adriana Vince ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Hepatitis E ◽  
Developed Countries ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Transmitted Infection ◽  
Source Of Infection ◽  
Industrialised Countries

Hepatitis E virus is a pathogen of worldwide significance. In developed countries, foodborne transmission of zoonotic genotypes is the most common route of infection. Transfusion transmitted infection is also an important source of infection, particularly in immunocompromised population. In most cases, HEV infection is asymptomatic or presents as an acute self-limiting hepatitis. Rarely it leads to fulminant hepatitis or „acute-on- chronic” liver failure in people with pre-existing chronic liver diseases. The aim of this report is to present the first documented case of HEV-related „acute-on-chronic” liver failure in Croatia in a patient with chronic liver disease listed for liver transplantation. Due to increasing incidence in industrialised countries, HEV infection should always be considered in the differential diagnosis of acute hepatitis and in patients with unexplained worsening of chronic liver disease.

scholarly journals Hepatitis E virus infection in a patient with alcohol related chronic liver disease: a case report of acute-on-chronic liver failure

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anabella Fantilli ◽  
Sarah Daniela López Villa ◽  
Alina Zerega ◽  
Guadalupe Di Cola ◽  
Luis López ◽  
...  
Keyword(s):  
Liver Disease ◽  
Virus Infection ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Chronic Liver ◽  
Virus Hepatitis ◽  
Chronic Liver Failure ◽  
History Of

Abstract Background The hepatitis E virus (HEV) infection has been described as a causing factor for acute-on-chronic-liver-failure (ACLF) in patients with underlying chronic liver disease (CLD), such as chronic hepatitis or cirrhosis, which could end in the failure of one or more organs and high short-term mortality. There are scarce data about the association of HEV in patients with chronic liver disorders in South America. Case presentation A 56-year-old hypertensive male with a history of type 2 diabetes was diagnosed with alcohol-related-liver cirrhosis in February 2019. A year later, the patient was admitted to hospital due to fatigue, jaundice and acholia. No evidence of hepatitis A virus, hepatitis B virus, hepatitis C virus, Epstein–Barr virus, herpes zoster virus and cytomegalovirus infections were found. Nevertheless, in February and March, 2020 the patient was positive for HEV-IgM and HEV-IgG, and HEV genotype 3 RNA was detected in sera. Afterwards, he presented grade I hepatic encephalopathy and, therefore, was diagnosed with acute hepatitis E-on-chronic liver disease. The patient reported a recent travel to the Argentine coast, where he consumed seafood. Besides, he reveled to have consumed pork meat and had no history of blood transfusion. Conclusion This report describes a unique case of hepatitis E virus infection in a patient with alcohol-related cirrhosis. This is the first report of a patient with HEV-related ACLF in Argentina and it invokes the importance of HEV surveillance and treatment among patients with CLD, such as alcohol-related cirrhosis.

scholarly journals Imaging Software-Based Sarcopenia Assessment in Gastroenterology: Evolution and Clinical Meaning

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Giovanni Marasco ◽  
Sinan Sadalla ◽  
Giulio Vara ◽  
Rita Golfieri ◽  
Davide Festi ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Sarcopenia is gaining attention as a negative prognostic factor in different fields of medicine, including chronic liver failure. However, the assessment of sarcopenia in patients with liver diseases is often neglected due to unawareness of reliable tools and methods and thus is limited to research studies. Cross-sectional imaging is a diffuse diagnostic tool and is commonly performed in patients with chronic liver failure. The last advancements in radiology image analysis using dedicated software allow an easy and standardized method to assess skeletal muscle volume. Several measures can be obtained from cross-sectional imaging analysis to evaluate sarcopenia in patients affected by chronic liver disease. We aimed to review the recent advances in imaging-based sarcopenia assessment, in particular in patients with chronic liver diseases. As a result, we found that the skeletal muscle index (SMI) seems to be a reliable method to assess sarcopenia in cirrhotic patients. Even if further studies are needed to validate proper cut-offs for each clinical endpoint, physicians are invited to consider the assessment of sarcopenia in the work-up of patients with chronic liver disease.

scholarly journals Role of Hepatitis E Virus Infection in Acute-on-Chronic Liver Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Mario Frias ◽  
Pedro López-López ◽  
Antonio Rivero ◽  
Antonio Rivero-Juarez
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Hepatic Decompensation ◽  
End Stage ◽  
The Impact

Chronic liver disease (CLD) with a variety of causes is currently reported to be one of the main causes of death worldwide. Patients with CLD experience deteriorating liver function and fibrosis, progressing to cirrhosis, chronic hepatic decompensation (CHD), end-stage liver disease (ESLD), and death. Patients may develop acute-on-chronic liver failure (ACLF), typically related to a precipitating event and associated with increased mortality. The objective of this review was to analyze the role of acute hepatitis E virus (HEV) infection in patients with CLD, focusing on the impact of this infection on patient survival and prognosis in several world regions.

scholarly journals Immunological Manifestations of Hepatitis E-Associated Acute and Chronic Liver Failure and Its Regulatory Mechanisms

2021 ◽  
Vol 8 ◽  
Author(s):  
Jian Wu ◽  
Bai Ling ◽  
Naizhou Guo ◽  
Guanghua Zhai ◽  
Meifen Li ◽  
...  
Keyword(s):  
Liver Failure ◽  
Public Health Problem ◽  
Hepatitis E ◽  
Developed Countries ◽  
Oral Route ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Important Public Health Problem ◽  
Immunological Mechanism ◽  
Global Population

Hepatitis E virus (HEV) is a common cause of viral hepatitis in developing countries, most commonly transmitted through the fecal-oral route. The virus is mainly of genotypes (GT) 1 and GT2 genotypes, and patients usually show symptoms of acute hepatitis. Due to the rising trend of HEV serological prevalence in global population, HEV has become an important public health problem in developed countries. Severe hepatitis caused by HEV includes acute and chronic liver failure (ACLF). ACLF frequently occurs in developed countries and is caused by overlapping chronic liver diseases of HEV with genotypes GT3 and GT4. Because the onset of hepatitis E is closely associated with immunity, it is critical to understand the immunological mechanism of hepatitis E associated with acute and chronic liver failure (HEV-ACLF). This review discusses the immunological manifestations and mechanisms of HEV-ACLF, intrahepatic immune microenvironment and treatment, and raises outstanding questions about the immunological mechanism and treatment of the disease.

scholarly journals Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Manman Xu ◽  
Ming Kong ◽  
Pengfei Yu ◽  
Yingying Cao ◽  
Fang Liu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Asian Pacific ◽  
Long Term Mortality

Background and Aims: Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver disease with high short-term mortality. The inclusion or exclusion of previously decompensated cirrhosis (DC) in the diagnostic criteria of ACLF defined by the Asian Pacific Association for the Study of the Liver (APASL-ACLF) has not been conclusive. We aimed to evaluate the prognostic impact of decompensated cirrhosis in ACLF.Methods: We retrospectively collected a cohort of patients with a diagnosis of APASL-ACLF (with or without DC) hospitalized from 2012 to 2020 at three liver units in tertiary hospitals. Baseline characteristics and survival data at 28, 90, 180, 360, 540, and 720 days were collected.Results: Of the patients assessed using APASL-ACLF criteria without the diagnostic indicator of chronic liver disease, 689 patients were diagnosed with ACLF, of whom 435 had no decompensated cirrhosis (non-DC-ACLF) and 254 had previously decompensated cirrhosis (DC-ACLF). The 28-, 90-, 180-, 360-, 540-, and 720-day mortality were 24.8, 42.9, 48.7, 57.3, 63.4, and 68.1%, respectively, in DC-ACLF patients, which were significantly higher than in non-DC-ACLF patients (p < 0.05). DC was independently associated with long-term (180/360/540/720 days) but not short-term (28/90 days) mortality in patients with ACLF. Age, total bilirubin, international normalized ratio, and hepatic encephalopathy were independent risk factors for short- and long-term mortality risk in ACLF patients (p < 0.05).Conclusions: Patients with DC-ACLF have a higher mortality rate, especially long-term mortality, compared to non-DC-ACLF patients. Therefore, DC should be included in the diagnostic criteria of APASL-ACLF and treated according to the ACLF management process.

National mortality rates from chronic liver disease and consumption of alcohol and pig meat

2009 ◽  
Vol 138 (2) ◽  
pp. 174-182 ◽  
Author(s):  
H. R. DALTON ◽  
R. P. BENDALL ◽  
C. PRITCHARD ◽  
W. HENLEY ◽  
D. MELZER
Keyword(s):  
Liver Disease ◽  
Alcohol Consumption ◽  
Chronic Liver Disease ◽  
Meat Consumption ◽  
Hepatitis E ◽  
Developed Countries ◽  
Mortality Rates ◽  
Chronic Liver ◽  
Per Capita ◽  
Pig Meat

SUMMARYA correlation between national pig-meat consumption and mortality rates from chronic liver disease (CLD) across developed countries was reported in 1985. One possible mechanism explaining this may be hepatitis E infection spread via pig meat. We aimed to re-examine the original association in more recent international data. Regression models were used to estimate associations between national pig-meat consumption and CLD mortality, adjusting for confounders. Data on CLD mortality, alcohol consumption, hepatitis B virus (HBV) and hepatitis C virus (HCV) seroprevalence for 18 developed countries (1990–2000) were obtained from WHO databases. Data on national pig-meat and beef consumption were obtained from the UN database. Univariate regression showed that alcohol and pig-meat consumption were associated with mortality from CLD, but beef consumption, HBV and HCV seroprevalence were not. A 1 litreper capitaincrease in alcohol consumption was associated with an increase in mortality from CLD in excess of 1·6 deaths/100 000 population. A 10 kg higher national annual averageper capitaconsumption of pork meat was associated with an increase in mortality from CLD of between 4 and 5 deaths/100 000 population. Multivariate regression showed that alcohol, pig-meat consumption and HBV seroprevalence were independently associated with mortality from CLD, but HCV seroprevalence was not. Pig-meat consumption remained independently associated with mortality from CLD in developed countries in the 1990–2000 period. Further work is needed to establish the mechanism.

scholarly journals Use of skeletal muscle index as a predictor of short-term mortality in patients with acute-on-chronic liver failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tongzeng Li ◽  
Manman Xu ◽  
Ming Kong ◽  
Wenyan Song ◽  
Zhongping Duan ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Serum Bilirubin ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Skeletal Muscle Index ◽  
Short Term Mortality

AbstractSarcopenia is a well-recognized factor affecting the prognosis of chronic liver disease, but its impact on acute decompensation underlying chronic liver disease is unknown. This study evaluated the impact of sarcopenia on short-term mortality in patients with acute-on-chronic liver failure (ACLF). One hundred and seventy-one ACLF patients who underwent abdominal CT between 2015 and 2019 were retrospectively included in this study. Skeletal muscle index at the third lumbar vertebrae (L3-SMI) was used to diagnose sarcopenia.The ACLF patients in this study had a L3-SMI of 41.2 ± 8.3 cm2/m2 and sarcopenia was present in 95/171 (55.6%) patients. Body mass index (BMI), cirrhosis, and higher serum bilirubin were independently associated with sarcopenia. Following multivariate Cox regression analysis, cirrhosis (hazard ratio (HR) 2.758, 95%CI 1.323–5.750), serum bilirubin (HR 1.049, 95%CI 1.026–1.073), and international normalized ratio (INR) (HR 1.725, 95%CI 1.263–2.355) were associated with 3-month mortality (P < 0.05), whereas L3-SMI and sarcopenia were not. A subgroup analysis of the factors related to sarcopenia showed that sarcopenia was still not predictive of short-term outcome in ACLF patients. L3-SMI and sarcopenia are not associated with short-term mortality in patients with ACLF.

scholarly journals Establishment of a Murine Model of Acute-on-Chronic Liver Failure with Multi-organ Dysfunction

2021 ◽  
Author(s):  
Nidhi Nautiyal ◽  
Deepanshu Maheshwari ◽  
Dhananjay Kumar ◽  
Rekha Kumari ◽  
Suchi Gupta ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Organ Dysfunction ◽  
Chronic Liver ◽  
Acute Injury ◽  
Hepatic Regeneration ◽  
Chronic Liver Failure ◽  
Hepatocyte Necrosis

Abstract Background and Aims: Acute-on-chronic liver failure (ACLF) is a distinct clinical entity with high probability of organ failure and mortality. Experimental models of ACLF are needed to understand the pathophysiology and natural course of the disease.Methodology and Results: To mimic the syndrome of ACLF, chronic liver disease was induced by intra-peritoneal administration of carbon tetrachloride (CCl4) for 10 weeks, followed by acute injury with acetaminophen (APAP) and lipopolysaccharide (LPS) administration. Blood, ascitic fluid and organs were collected to study cell death, regeneration and fibrosis. APAP/LPS induced second insult to the CCL4 animals showed progressive and significant increase in bilirubin (p < 0.05), prothrombin time (P < 0.0001) and blood ammonia (p < 0.001) post-acute injury similar to human ACLF. Ascites was noticed by day 11 (median serum-ascites albumin gradient, SAAG ((1.2(1.1–1.3) g/dL) suggestive of portal hypertension. At 24 hours post-APAP/LPS infusion, the liver tissue showed increased hepatocyte ballooning and endothelial cell TUNEL positivity. This was followed by progressive hepatocyte necrosis from perivascular region at day 7 to lobular region by day 11 acute injury. They also showed regression in fibrous septa (p < 0.005) in comparison to cirrhosis. A progressive loss of hepatic regeneration (proliferating cell nuclear antigen; p < 0.005) was also seen following APAP/LPS injury. These animals also showed a significant increase in serum creatinine (p < 0.05) levels and renal tubular injury by day 11 which was not present in cirrhotic animals.Conclusion: The CCL4/APAP/LPS (CALPS) model of ACLF mimics the clinical, biochemical and histological features of ACLF with demonstrable progressive hepatocyte necrosis, liver failure, impaired regeneration, development of portal hypertension and organ dysfunction in an animal with chronic liver disease.

Sign in / Sign up

Export Citation Format

Share Document