scholarly journals Empiema bacteriano espontáneo como complicación de la cirrosis hepática: ¿cuándo sospecharlo y cómo tratarlo? Presentación de casos

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Martín Elizondo Barceló ◽  
Jimena Prieto Amorín ◽  
Julio César Medina Presentado ◽  
Solange Gerona Sangiovanni
Keyword(s):  
High Risk ◽  
Poor Prognosis ◽  
Turning Point ◽  
Decompensated Cirrhosis ◽  
Hepatic Hydrothorax ◽  
Short Term ◽  
Empirical Antibiotic Treatment ◽  
Transplant Program ◽  
Cirrhotic Patients ◽  
Spontaneous Bacterial Empyema

Spontaneous bacterial empyema is defined as infection of the liver hydrothorax in the cirrhotic patients. It is a rare cause of decompensated cirrhosis, with few bibliographic reports in the region, and its presence marks a turning point of inflection in the evolution of the disease with a poor prognosis in the short term. Two clinical cases of patients with this complication are presented, which were referred to the National Liver Transplant Program of Uruguay. The clinical features, a pathophysiology and a therapeutic approach of this pathology are reviewed. Special emphasis is placed on empirical antibiotic treatment based on the site of acquisition of the infection and local epidemiology, and in the opportunity for the resolution of the underlying hepatic hydrothorax, with a high risk of complications that may be associated with invasive treatments.

scholarly journals Spontaneous Bacterial Empyema in Cirrhotic patients with Hepatic hydrothorax.

2020 ◽  
Vol 27 (01) ◽  
pp. 115-119
Author(s):  
Ehsan Rahim Memon ◽  
Prem Kumar Maheshwari ◽  
Shabana Lakho ◽  
Huma Mehmood
Keyword(s):  
Cell Count ◽  
Cross Sectional Study ◽  
University Hospital ◽  
P Value ◽  
Hepatic Hydrothorax ◽  
Cross Sectional ◽  
Class B ◽  
Cirrhotic Patients ◽  
One Year ◽  
Spontaneous Bacterial Empyema

Objectives: To determine the frequency of spontaneous bacterial empyema in cirrhotic patients with hepatic hydrothorax. Study Design: Descriptive cross sectional study. Setting: Conducted in gastroenterology unit at Isra University Hospital, Hyderabad. Periods: One year from April 2016 to March 2017. Material & Methods: Sample of 174 patients of Hepatic Hydrothorax was taken. Patients were of both gender and age ≥ 18 years, having diagnosed cirrhosis since last 5 years and currently having child class B & C severity were included. Hepatic hydrothorax was confirmed on ultrasound chest. After aseptic measures 50ml of pleural fluid was aspirated and sent to Isra University Hospital laboratory following the ultrasound guidelines. Spontaneous bacterial empyema was assessed as “polymorph nuclear cell count” more than 500 cells/mm3 or +ve culture with PMN cell count more than 250 cells/mm3 without parapneumonic effusion. All the data was recorded in the proforma. Results: The mean ± SD age of patients was 53.52 ± 5.52 years. Males were 60.92% while 39.08% were females. The frequency of spontaneous bacterial empyema was about 14.9%. Frequency of spontaneous bacterial empyema was little more in male gender than females (p value = 0.391), while it was significantly increased with increasing age as most common in age group of 61-65 years (p-value = 0.017). Conclusion: It was concluded that spontaneous bacterial empyema in cirrhosis patients was 14.9%.

scholarly journals Number of Endoscopic Sessions to Eradicate Varices Identifies High Risk of Rebleeding in Cirrhotic Patients

2022 ◽  
Author(s):  
Huiwen Guo ◽  
Ming Zhang ◽  
Na Zhang ◽  
Xiaochun Yin ◽  
Yang Cheng ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Endoscopic Treatment ◽  
Standard Therapy ◽  
Endoscopic Therapy ◽  
Decompensated Cirrhosis ◽  
Aggressive Treatment ◽  
Simple Method ◽  
Rebleeding Rate ◽  
Cirrhotic Patients

Abstract Background and aims: Risk stratification to identify patients with high risk of variceal rebleeding is particularly important in patients with decompensated cirrhosis. In clinical practice, eliminating gastroesphageal varices thoroughly after sequential endoscopic treatment reduces the rebleeding rate, however, no simple method has been build to predict high risk of variceal rebleeding. We conducted this study to explore the value of the number of endoscopic sessions required to eradicate gastroesphageal varices in identifying high risk of rebleeding.Patients and methods: Consecutive cirrhotic patients received sequential endoscopic therapy between January 2015 to March 2020 were enrolled. Endoscopic treatment was performed every 1-4 weeks until the eradication of varices. The primary endpoint was variceal rebleeding.Results: A total of 146 patients were included of which 60 patients received standard therapy and 86 patients underwent sequential endoscopic treatment alone. The cut-off value of the number of sequential endoscopic sessions is 3.5 times. Variceal rebleeding was significant higher in patients with endoscopic sessions > 3 times vs. ≤ 3 times (61.5% vs. 17.5%, p<0.001). Variceal rebleeding of patients with endoscopic sessions ≤3 times was significant lower than patients with > 3 times in group of standard therapy (19.6% vs. 88.9%, p<0.001) and endoscopic therapy (15.9% vs. 47.1%, p=0.028) respectively. Conclusion: The number of sequential endoscopic sessions required to eradicate the varices is related to the risk of variceal rebleeding in patients with cirrhosis. If three times of endoscopic treatment can not eradicate the varices, a more aggressive treatment such as TIPS should be seriously considered.

Combined spontaneous bacterial empyema and peritonitis in cirrhotic patients with ascites and hepatic hydrothorax

2017 ◽  
Vol 18 (2) ◽  
pp. 104-107 ◽  
Author(s):  
Anwar Mohamed ◽  
Mohammed Atef ◽  
Ayman Alsebaey ◽  
Mahmoud Musa Elhabshy ◽  
Mohsen Salama
Keyword(s):  
Hepatic Hydrothorax ◽  
Cirrhotic Patients ◽  
Spontaneous Bacterial Empyema

scholarly journals A Prognostic Model of Acute-On-Chronic Liver Failure Based On Sarcopenia

2021 ◽  
Author(s):  
Hong Peng ◽  
Qian Zhang ◽  
Siyi Lei ◽  
Tingting Xiong ◽  
Li Long ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
High Risk ◽  
Liver Failure ◽  
Adverse Outcomes ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Skeletal Muscle Index ◽  
Cutoff Value

Abstract Background Acute-on-chronic liver failure (ACLF) is characterized by the development of a syndrome associated with a high risk of short-term death in patients with acute decompensated cirrhosis, and better biomarkers are needed to predict such outcomes. Sarcopenia, a common complication of cirrhosis, is tightly associated with poor prognosis and increased mortality. In this study, the skeletal muscle index of ACLF patients was measured to determine whether sarcopenia combined with clinical parameters helps in identifying those at high risk of progression. Methods A total of 314 hospitalized ACLF patients were included and allocated into groups of transplantation-free survival (n = 214) or progression (n = 100) within 90 days. Muscle mass was assessed based on the skeletal muscle index. The optimal cutoff value of the AMPAS1 model (age, MELD score, platelet count, alpha-fetoprotein level, sarcopenia and more than one complication combination) for progressive prediction was identified using receiver operating characteristic (ROC) analysis. Results Sarcopenia was an independent risk factor for progression in the ACLF population (HR 3.705 95%CI 2.131-6.441, P<0.001). AMPAS1 was a good predictor, with an area under the ROC curve of 0.908, and the cutoff value for poor outcome prediction was 0.21 (sensitivity 93.2%, specificity 71.1%). Conclusion We demonstrate that sarcopenia is a simple and objective biomarker for predicting short-term prognosis in patients with ACLF. Moreover, compared to conventional prognostic scores, AMPAS1 is a better model to predict 90-day adverse outcomes in ACLF patients.

scholarly journals Extremity Risk Factors of Sepsis for Gastrointestinal Endoscopy

2021 ◽  
Author(s):  
Yi-Chia Chan ◽  
Chao-Long Chen ◽  
Chih-Chi Wang ◽  
Chih-Che Lin ◽  
Chee-Chien Yong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Validation Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Decompensated Cirrhosis ◽  
Hepatic Hydrothorax ◽  
Hepatic Decompensation ◽  
Gi Endoscopy ◽  
Donor Liver Transplantation ◽  
Cirrhotic Patients

Abstract Background: Upper and lower gastrointestinal (GI) endoscopy is performed to survey malignancy before living donor liver transplantation (LDLT). However, sepsis may occur following elective endoscopy. Methods: This retrospective study reviewed the medical records of 642 cirrhotic recipients who underwent endoscopy from 2008 to 2016. We analyzed the incidence and risk factors of post-endoscopy sepsis during 2008-2012 (experience cohort). Our protocol changed after 2013 (validation cohort) to include antibiotic prophylaxis.Results: In experience cohort, 36 cases (10.5%) of the 342 LDLT candidates experienced sepsis within 48 hours after endoscopy. The sepsis rate was significantly higher in patients with hepatic decompensation than patients without (22.2% vs. 9.6% vs. 2.6% in Child C/B/A groups respectively; x2= 20.97, P <0.001). Using multivariate logistic regression analysis, the factors related to post-endoscopy sepsis were the Child score (OR 1.46; 95% CI 1.24-1.71), Child classes B and C (OR 3.80 and 14.13; 95% CI 1.04-13.95 and 3.97-50.23, respectively), hepatic hydrothorax (OR 4.85; 95% CI 1.37-17.20), and antibiotic prophylaxis (OR 0.08; 95% CI 0.01-0.64). In validation cohort, antibiotics were given routinely, and all cases of hepatic hydrothorax (n=10) were drained. Consequently, 4 (1.3%) episodes of sepsis occurred among 300 LDLT candidates, and the incidence was significantly lower than before (1.3% vs. 10.5%, P <0.001).Conclusions: Patients with decompensated cirrhosis and hepatic hydrothorax have higher risk of sepsis following endoscopy. In advanced cirrhotic patients, antibiotic prophylaxis and drainage of hydrothorax may be required to prevent sepsis before elective GI endoscopy.

scholarly journals The Effect of Heterogenous Subregions in Glioblastomas on Survival Stratification: A Radiomics Analysis Using the Multimodality MRI

2021 ◽  
Vol 20 ◽  
pp. 153303382110330
Author(s):  
Lulu Yin ◽  
Yan Liu ◽  
Xi Zhang ◽  
Hongbing Lu ◽  
Yang Liu
Keyword(s):  
Poor Prognosis ◽  
Intratumor Heterogeneity ◽  
Short Term ◽  
Prognostic Information ◽  
Manual Delineation ◽  
Flair Sequence ◽  
The Poor ◽  
Contrast Enhanced ◽  
Mri Sequences

Intratumor heterogeneity is partly responsible for the poor prognosis of glioblastoma (GBM) patients. In this study, we aimed to assess the effect of different heterogeneous subregions of GBM on overall survival (OS) stratification. A total of 105 GBM patients were retrospectively enrolled and divided into long-term and short-term OS groups. Four MRI sequences, including contrast-enhanced T1-weighted imaging (T1C), T1, T2, and FLAIR, were collected for each patient. Then, 4 heterogeneous subregions, i.e. the region of entire abnormality (rEA), the regions of contrast-enhanced tumor (rCET), necrosis (rNec) and edema/non-contrast-enhanced tumor (rE/nCET), were manually drawn from the 4 MRI sequences. For each subregion, 50 radiomics features were extracted. The stratification performance of 4 heterogeneous subregions, as well as the performances of 4 MRI sequences, was evaluated both alone and in combination. Our results showed that rEA was superior in stratifying long-and short-term OS. For the 4 MRI sequences used in this study, the FLAIR sequence demonstrated the best performance of survival stratification based on the manual delineation of heterogeneous subregions. Our results suggest that heterogeneous subregions of GBMs contain different prognostic information, which should be considered when investigating survival stratification in patients with GBM.

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