Severe hepatic encephalopathy and decrease in enhancement of hepatocellular carcinoma treatedwith sorafenib

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words: – – – .

Download Full-text

Complications of cirrhosis and portal hypertension

Emergencies in Gastroenterology and Hepatology ◽

10.1093/med/9780199231362.003.0016 ◽

2013 ◽

pp. 251-256 ◽

Cited By ~ 1

Author(s):

Daniel Marks ◽

Marcus Harbord

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Portal Hypertension ◽

Hepatic Encephalopathy ◽

Spontaneous Bacterial Peritonitis ◽

Early Stage ◽

Nodule Formation ◽

Architectural Distortion ◽

Bacterial Peritonitis ◽

Complications Of Cirrhosis

Causes and diagnosis of cirrhosis Causes and diagnosis of non-cirrhotic portal hypertension Ascites Spontaneous bacterial peritonitis Hepatorenal syndrome Variceal haemorrhage Hepatic encephalopathy Hepatopulmonary syndromes Hepatocellular carcinoma Cirrhosis occurs following progressive hepatic fibrosis, with architectural distortion of the liver and nodule formation. It is a histological diagnosis. Late-stage cirrhosis is irreversible, at which point only liver transplantation is curative. Early-stage cirrhosis has been shown to improve following treatment and may be asymptomatic....

Download Full-text

Hepatic encephalopathy induced by Lenvatinib and anti‑PD‑1 mAb in a patient with advanced hepatocellular carcinoma: A case report

Molecular and Clinical Oncology ◽

10.3892/mco.2021.2272 ◽

2021 ◽

Vol 14 (6) ◽

Author(s):

Zhen Liu ◽

Ying Meng ◽

Wenming Xiao ◽

Huijun Wang ◽

Li Sun ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Case Report ◽

Hepatic Encephalopathy ◽

Advanced Hepatocellular Carcinoma

Download Full-text

Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma

Biomedicines ◽

10.3390/biomedicines9111693 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1693

Author(s):

Daryl Ramai ◽

Khoi P. Dang-Ho ◽

Anjali Kewalramani ◽

Praneeth Bandaru ◽

Rodolfo Sacco ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Encephalopathy ◽

Length Of Stay ◽

Risk Score ◽

Cox Regression ◽

Surrogate Marker ◽

Hospital Length Of Stay ◽

Frail Patients ◽

Increased Risk ◽

The Impact

Frailty represents a state of vulnerability to multiple internal physiologic factors, as well as external pressures, and has been associated with clinical outcomes. We aim to understand the impact of frailty on patients admitted with hepatocellular carcinoma (HCC) by using the validated Hospital Frailty Risk Score, which is implemented in several hospitals worldwide. We conducted a nation-wide retrospective cohort study to determine the effect of frailty on the risk of in-patient mortality, hepatic encephalopathy, length of stay and cost. Frailty was associated with a 4.5-fold increased risk of mortality and a 2.3-fold increased risk of hepatic encephalopathy. Adjusted Cox regression showed that frailty was correlated with increased risk of in-patient mortality (hazard ratio: 2.3, 95% CI 1.9–2.8, p < 0.001). Frail HCC patients had longer hospital stay (median 5 days) vs. non-frail HCC patients (median 3 days). Additionally, frail patients had higher total costs of hospitalization ($40,875) compared with non-frail patients ($31,667). Frailty is an independent predictor of hepatic encephalopathy and in-patient mortality. Frailty is a surrogate marker of hospital length of stay and cost.

Download Full-text

Differences in complications between hepatitis B-related cirrhosis and alcohol-related cirrhosis

Open Medicine ◽

10.1515/med-2021-0401 ◽

2021 ◽

Vol 17 (1) ◽

pp. 46-52

Author(s):

Yu-Pei Zhuang ◽

Si-Qi Wang ◽

Zhao-Yu Pan ◽

Hao-Jie Zhong ◽

Xing-Xiang He

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Encephalopathy ◽

Hepatitis B ◽

Medical Records ◽

Odds Ratio ◽

Chronic Liver Failure ◽

Adjusted Risk ◽

B Virus ◽

Different Types ◽

Cirrhotic Patients

Abstract Objectives This study aimed to investigate the differences in complications between hepatitis B virus (HBV)-related and alcohol-related cirrhoses. Methods Medical records of patients with HBV-related and alcohol-related cirrhoses treated from January 2014 to January 2021 were, retrospectively, reviewed. The unadjusted rate and adjusted risk of cirrhotic complications between the two groups were assessed. Results The rates of hepatocellular carcinoma (HCC) and hypersplenism were higher in HBV-related cirrhosis (both P < 0.05), whereas the rates of hepatic encephalopathy (HE) and acute-on-chronic liver failure (ACLF) were higher in alcohol-related cirrhosis (both P < 0.05). After adjusting for potential confounders, HBV-related cirrhotic patients had higher risks of HCC (odds ratio [OR] = 34.06, 95% confidence interval [CI]: 4.61–251.77, P = 0.001) and hypersplenism (OR = 2.29, 95% CI: 1.18–4.42, P = 0.014), whereas alcohol-related cirrhotic patients had higher risks of HE (OR = 0.22, 95% CI: 0.06–0.73, P = 0.013) and ACLF (OR = 0.30, 95% CI: 0.14–0.73, P = 0.020). Conclusion Cirrhotic patients with different etiologies had different types of complications: HBV-related cirrhotic patients exhibited increased risks of HCC and hypersplenism and alcohol-related cirrhotic patients more readily developing HE and ACLF.

Download Full-text

Chronic Hepatic Failure

DeckerMed Surgery ◽

10.2310/surg.2413 ◽

2019 ◽

Author(s):

Derek J Erstad ◽

Motaz Qadan

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Portal Hypertension ◽

Hepatic Encephalopathy ◽

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

End Stage Liver Disease ◽

End Stage

Continued hepatic injury by genetic or environmental factors results in a state of chronic inflammation, fibrosis, and progressive hepatocyte dysfunction that can progress to cirrhosis and end stage liver disease (ESLD). Cirrhosis is the eighth leading cause of mortality in the United States, while the burden of disease is even greater in regions with endemic viral hepatitis. Common risk factors include a history of hepatitis; alcohol or IV drug abuse; use of certain medications; and other risk factors associated with transmission of viral hepatitis, including tattoos, sexual promiscuity, and incarceration. Although many patients with cirrhosis are asymptomatic and remain undiagnosed, many will eventually develop secondary complications from chronic liver failure, which can be difficult to manage and are associated with significant morbidity, including: portal hypertension, variceal bleeding, coagulopathy, hepatic encephalopathy, and renal failure. In addition, hepatocellular carcinoma (HCC) is estimated to be 30 times more common among patients with cirrhosis, which can be an aggressive malignancy with 5-year overall survival of less than 15%. In this chapter, we provide a comprehensive overview of chronic liver failure, including the epidemiology of cirrhosis, pathophysiology of liver injury, and assessment and management of cirrhosis and associated downstream complications. Finally, we discuss the role of liver transplantation for both ESLD and HCC. This review contains 6 figures, 9 tables, and 53 references. Key Words: chronic liver failure, cirrhosis, coagulopathy, end stage liver disease, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, liver transplantation, portal hypertension, varices

Download Full-text

Hepatic encephalopathy and orotic aciduria associated with hepatocellular carcinoma in a noncirrhotic liver

Hepatology ◽

10.1002/hep.1840080116 ◽

1988 ◽

Vol 8 (1) ◽

pp. 78-81 ◽

Cited By ~ 12

Author(s):

Lennox J. Jeffers ◽

Richard A. Dubow ◽

Leslie Zieve ◽

K. Rajender Reddy ◽

Alan S. Livingstone ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Encephalopathy ◽

Noncirrhotic Liver ◽

Orotic Aciduria

Download Full-text

Carbon-ion radiotherapy subsequent to balloon-occluded retrograde transvenous obliteration for hepatocellular carcinoma with hepatic encephalopathy: a multidisciplinary approach

Clinical Journal of Gastroenterology ◽

10.1007/s12328-021-01395-6 ◽

2021 ◽

Author(s):

Naoto Osu ◽

Shintaro Shiba ◽

Kei Shibuya ◽

Shohei Okazaki ◽

Yuhei Miyasaka ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Encephalopathy ◽

Local Recurrence ◽

Liver Function ◽

Single Case ◽

Survival Rates ◽

Single Case Report ◽

Disturbance Of Consciousness ◽

Old Japanese ◽

Serum Ammonia

AbstractRadical treatments of hepatocellular carcinoma (HCC) with hepatic encephalopathy (HE) can be often difficult due to poor liver function or disturbance of consciousness. An effective treatment requires a combinatorial approach incorporating a treatment for HE and radical therapy for HCC that does not compromise liver function. Here, we report a case of a 78-year-old Japanese male with HCC and HE caused by splenorenal shunt. Serum ammonia levels were high. He was not suitable for surgery, percutaneous radiofrequency ablation, or transarterial chemoembolization due to the location of the tumor and poor liver function, which included HE. Thus, he underwent BRTO, with an immediate improvement in both HE and serum ammonia levels. After BRTO, he received C-ion RT as a radical treatment for HCC. After treatment, HCC was well controlled; however, at 35 months post-initiation of C-ion RT, he developed local recurrence without a further reduction in liver function status. Therefore, we repeated C-ion RT. The patient remains alive at 3 months post-treatment, with no evidence of local recurrence, distant metastasis, or toxicity. Although this is a single case report, it suggests that a combinatorial treatment consisting of BRTO and C-ion RT may increase survival rates of patients with HCC and HE.

Download Full-text

Severe Hypercalcemia as an Initial Presenting Manifestation of Hepatocellular Carcinoma

Canadian Journal of Gastroenterology ◽

10.1155/2002/651582 ◽

2002 ◽

Vol 16 (9) ◽

pp. 607-609 ◽

Cited By ~ 11

Author(s):

Michel William Ghobrial ◽

John George ◽

Sunitha Mannam ◽

Samia R Henien

Keyword(s):

Hepatocellular Carcinoma ◽

Weight Loss ◽

Parathyroid Hormone ◽

Hepatic Encephalopathy ◽

White Woman ◽

Hormone Level ◽

Metastatic Bone Disease ◽

Parathyroid Hormone Level ◽

Severe Hypercalcemia ◽

Parathyroid Hormone Related Peptide

An 80-year-old white woman who presented with fatigue, weakness, weight loss, constipation and polydipsia is reported. The patient was given a diagnosis of severe hypercalcemia and was subsequently found to have clinical, roentgenographic and pathological evidence of hepatocellular carcinoma. Further studies revealed a low parathyroid hormone level, excluding the possibility of primary hyperparathyroidism, and a negative bone survey, precluding metastatic bone disease. The patient’s hypercalcemia was believed to emanate from the humoral secretion of a parathyroid hormone-related peptide, which was found to be elevated, and was abated with conservative management while her cancer was being treated with chemotherapy. The details of this rarely documented presentation, which can easily be mistaken for hepatic encephalopathy, are provided.

Download Full-text