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2022 ◽  
Vol 11 (3) ◽  
pp. 45-52
Author(s):  
V.  V. Breder ◽  
D.  T. Abdurakhmanov ◽  
V.  V. Petkau ◽  
P.  V. Balakhnin ◽  
M.  V. Volkonsky ◽  
...  

There is a number of unresolved issues regarding the systemic therapy administration for hepatocellular carcinoma (HCC). Their solution is facilitated by accumulating real‑world study results. Lenvatinib therapy is a recognized drug with a good efficacy and safety profile for the treatment of HCC. Subanalyses of the REFLECT study showed that the absence of stratification by baseline AFP and baseline liver function, as well as the lack of options for subsequent drug therapy after lenvatinib, also affects the outcomes. Once these factors are taken into account, the hypothesis of superiority of lenvatinib to sorafenib and other drugs can be tested. Real‑world clinical studies have demonstrated positive results of lenvatinib therapy in patients with Child‑Pugh class B liver function, provided recommendations on the sequence of systemic therapy after lenvatinib and on the use of lenvatinib in patients with BCLC stage B, along with considering the possibility of lenvatinib monotherapy and the prospects for its use in patients with nHCC. Further real‑world studies of lenvatinib for HCC in the Russian population are required.


2021 ◽  
Vol 8 ◽  
Author(s):  
Shun Liu ◽  
Kai-Cai Liu ◽  
Wei-Fu Lv ◽  
Dong Lu ◽  
Xian-Hai Zhu ◽  
...  

Objective: Apatinib is a inhibitor of vascular endothelial growth factor receptor-2. To explore the efficacy and prognostic factors of transarterial chemoembolization (TACE) combined with apatinib in the treatment of Barcelona Clinic Liver Cancer stage C (BCLC C) hepatocellular carcinoma (HCC).Methods: Clinical data of 146 HCC patients with BCLC stage C admitted to our hospital were collected and analyzed retrospectively, of which 76 cases were treated with TACE combined with apatinib (TACE-apatinib) and 70 with TACE alone. The tumor response, survival time, and adverse events were compared between the two groups, and the factors affecting the prognosis were analyzed.Results: The objective response rate (ORR) and disease control rate (DCR) in the TACE-apatinib group were higher than in the TACE-alone group (ORR: 42.10 vs. 25.71%, P = 0.03; DCR: 84.21 vs. 55.71%, P = 0.001). The median time to progression (TTP) and overall survival (OS) in the TACE-apatinib group were longer than in the TACE-alone group (TTP: 5.5 vs. 3.7 months, P = 0.02; OS: 10.0 vs. 6.2 months, P = 0.01). Univariate and multivariate Cox regression analysis showed that tumor size, Child-Pugh class, and the presence of the portal vein tumor thrombus affect the prognosis of patients. Subgroup analysis revealed that TACE-apatinib therapy resulted in a higher OS in patients with tumor size <10 cm, without portal vein tumor thrombus, and with Child-Pugh class A (P < 0.05). The likelihood of adverse events (hand-foot syndrome, hypertension, oral ulcer) was significantly higher in the increased in the TACE-apatinib group than in the TACE alone group (P < 0.05).Conclusion: TACE-apatinib is an effective and safe method for the treatment of BCLC stage C HCC. Tumor size, Child-Pugh class, and portal vein tumor thrombus affect survival time in HCC patients with BCLC stage C.


2021 ◽  
Vol 22 (2) ◽  
pp. 100-106
Author(s):  
Tarana Yasmin ◽  
Sohely Sultana ◽  
Mahmuda Nusrat Ima ◽  
Md Quamrul Islam ◽  
Shyamal Kumar Roy ◽  
...  

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106


Author(s):  
Joel Ferreira-Silva ◽  
Pedro Costa-Moreira ◽  
Helder Cardoso ◽  
Rodrigo Liberal ◽  
Pedro Pereira ◽  
...  

<b><i>Introduction:</i></b> Transarterial chemoembolization (TACE) is the first-line treatment for patients with intermediate-stage hepatocellular carcinoma (HCC). For patients without an adequate response, current finding suggests that treatment with molecular target agents, approved for advanced stage, might present benefits. However, this requires a preserved liver function. This study aims to evaluate possible predictors of early deterioration of hepatic reserve, prior to TACE refractoriness, in a cohort of patients treated with TACE. <b><i>Methods:</i></b> Retrospective analysis of 99 patients with<b><i></i></b>Child-Pugh class A and intermediate-stage HCC who underwent TACE as the first-line treatment. All patients were submitted to a biochemical and medical evaluation prior to initial TACE and every month afterward. Response to initial TACE was evaluated at 1 month. The time to Child-Pugh class deterioration before TACE refractoriness was assessed. <b><i>Results:</i></b> Ninety-nine patients were included. Objective response rate (ORR) to initial TACE was assessed as present in 59 (63.4%) and as absent in 34 (36.6%) patients. Liver decompensated before TACE refractoriness in 51 (51.5%) patients, and the median time to liver decompensation was 14 (IQR 8–20) months after first TACE. In multivariate analysis, beyond up-to-7 criteria (HR 2.4, <i>p</i> = 0.031), albumin &#x3c;35 mg/dL (HR 3.5, <i>p</i> &#x3c; 0.001) and absence of ORR (HR 2.4, <i>p</i> = 0.020) were associated with decreased overall survival free of liver decompensation. Moreover, beyond up-to-7 criteria, albumin &#x3c;35 mg/dL and absence of ORR associated negatively with 6-month survival free of liver decompensation. Our model created using those variables was able to predict liver decompensation at 6 months with an AUROC of 0.701 (<i>p</i> = 0.02). <b><i>Conclusions:</i></b> The absence of ORR after initial TACE, beyond up-to-7 criteria and albumin &#x3c;35 mg/dL, was a predictive factor for early liver decompensation before TACE refractoriness in our population. Such patients might benefit from treatment escalation to systemic therapy, in monotherapy or in combination with TACE.


2021 ◽  
Vol 15 (11) ◽  
pp. 3467-3469
Author(s):  
Niaz Muhammad ◽  
Kashif Rafi ◽  
Hassan Nadeem ◽  
Muhammad Omer Farooq ◽  
Asmat Ullah ◽  
...  

Aim: To determine the quality of life score in patients with chronic liver disease using CLO questionnaire. Study Design: Cross sectional study Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital Lahore during from 14-June-2016to 15-December-2016. Methodology: 180 consecutive patients of chronic liver disease were selected after taking Informed consent. The diagnosis was confirmed according to the data of clinical, biochemical examinations and the results of percutaneous liver biopsy data in some selected cases. All patients were subjected to exam, LFT's, RFT's and CBC, ultrasound abdomen, esophagogastroscopy which were enrolled in this study. Anti HCV, HBsAg, ferritin, Cerruloplasmin and Autoimmune profile, was done to establish the etiology. Severity of liver disease was estimated by Child-Pugh Score (Annexed). The chronic liver disease questionnaire (CLDQ) was applied as the instrument for measuring quality of life. Results: The mean age of the patients was 35.28±7.26 years. Majority of the patients were male as there frequency was 142 (78.9%). 127 (70.60 %) cases were found to be having a child pugh grade c severity of disease. Mean quality of life score was 16.3±5.88. Mean quality of life score in males was 16.21±6.21 while in female was 16.63±4.48. Similarly the mean quality of life score in child pugh class B was 13.77±4.58 and in child pugh class C was 17.35±6.05. Conclusion: It is concluded that the quality of life was bad in the patients who had child pugh class C as compared to those who had class B. Keywords: Quality of Life, Chronic Liver Disease, Cirrhosis


Author(s):  
Jungnam Lee ◽  
Young-Joo Jin ◽  
Seung Kak Shin ◽  
Jung Hyun Kwon ◽  
Sang Gyune Kim ◽  
...  

2021 ◽  
Author(s):  
Baiguo Xu ◽  
Lian Jia ◽  
Anjing Liu ◽  
Ying Liu ◽  
Tao Han ◽  
...  

Abstract Aims. The relationship between hepatitis B core-related antigen (HBcrAg) and hepatitis B virus (HBV) DNA has already been adequately researched in patients with chronic hepatitis B (CHB) infection, but there are only a few researches yet on the correlations between HBcrAg and HBV DNA in treatment-naïve patients with hepatitis B cirrhosis. Here we explore the correlation between HBcrAg and HBV DNA in this population. Methods. Available data and samples of 98 untreated patients with hepatitis B cirrhosis between October 2018 and October 2019 were analysed. Statistical analyses included baseline characteristics, univariate analysis, stratification analysis, three different analytical models, and a generalized additive model. Results. After adjusting for all recorded confounders (sex, age, diagnosis of primary hepatic carcinoma, total bilirubin(TBIL), hepatitis B surface antigen (HBsAg), hepatitis B e antigen(HBeAg), Child–Pugh class, family history of HBV infection, family history of hepatocellular carcinoma(HCC), alcohol-related liver disease (ALD), and diabetes mellitus), a linear relationship was detected between HBcrAg and HBV DNA (β=0.59, 95%CI=0.34–0.84, P<0.0001). The variational trend of HBcrAg and HBV DNA in each stratified variable (sex, age, HBeAg, family history of HBV infection, family history of HCC, diabetes mellitus, diagnosis of primary hepatic carcinoma, Child–Pugh class, and ALD) were consistent. Conclusion. There was a linear and positive correlation between HBcrAg and HBV DNA in treatment-naïve patients with hepatitis B cirrhosis.


2021 ◽  
Vol 15 (10) ◽  
pp. 3157-3160
Author(s):  
Irshad Batool Abro ◽  
Prem Kumar ◽  
Imran Arshad ◽  
Shagufta Memon ◽  
Ali Akbar Siddiqui

Background: The hepatitis C virus (HCV) is a leading cause of chronic liver disease, including hepatic cirrhosis and hepatocellular cancer (HCC). Drugs that act directly on the virus, like as direct-acting antivirals (DAAs), are associated with improved long-term virologic responses and reduced treatment time. Pakistani patients with HCV-related cirrhosis receiving DAA medication were studied to see if they had an increased risk of hepatocellular carcinoma (HCC). Material and Methods: We conducted a prospective observational study at Isra University Hospital Hyderabad from July 2019 to August 2020. Three hundred fourteen patients met the inclusion criteria and were included. We recorded baseline demographic characteristics, Child-Pugh class, model for end-stage liver disease (MELD) score, alpha-fetoprotein level, and abdominal ultrasound/computed tomography (CT) scan before and after treatment. Results: Three hundred-fourteen individuals took part in the research. The average age of participant with hepatocellular carcinoma was 46.7 years. Twenty (sixty-nine) of the participants developing hepatocellular carcinoma were men, while nine (thirty-one percent) were women (p=0.221). Five (17.2%) of the HCC participants were diabetics, and seventeen (58.6%) were tobacco users (p=0.001). Twenty individuals (69%) developed HCC after receiving a combination of sofosbuvir and daclatasvir. A sofosbuvir/velpatasvir combination led to the development of HCC in nine (31%) of individuals (p=0.1). HCC was diagnosed in eight individuals under the age of forty (27.6%), but in 21 patients beyond the age of forty (72.6%) (p=0.55). HCC was found in 65.6 percent of Child-Turcotte-Pugh class A participants. Conclusion: DAAs have been linked to a higher risk of HCC. Participants receiving a combo of sofosbuvir/daclatasvir were more likely to develop HCC than those who received sofosbuvir/velpatasvir alone. Keywords: Velpatasvir, Hepatocellular carcinoma, Sofosbuvir, Cirrhosis,


2021 ◽  
Vol 10 (21) ◽  
pp. 4838
Author(s):  
Hiroaki Takaya ◽  
Tadashi Namisaki ◽  
Soichi Takeda ◽  
Kosuke Kaji ◽  
Hiroyuki Ogawa ◽  
...  

Mortality and recurrence rates of hepatocellular carcinoma (HCC) are high. Recent studies show that for patients with HCC beyond up-to-seven criteria, treatment with molecular-targeted agents (MTAs) is recommended because the treatment efficiency of transcatheter arterial chemoembolization (TACE) is poor; further, TACE increases decline in liver function. However, the relationship between TACE and liver function decline in patients with HCC within up-to-seven criteria has not been clarified. Hence, we aimed to investigate this relationship. This retrospective observational study included 189 HCC tumors within up-to-seven criteria in 114 Child–Pugh class A patients. Twenty-four (12.7%) tumors were changed from Child–Pugh class A to B after TACE, and 116 (61.4%) tumors exhibited recurrence within 6 months after TACE. Prothrombin time (PT) and albumin–bilirubin (ALBI) score before TACE were significantly associated with liver dysfunction from Child–Pugh class A to B. The combination of PT and ALBI score before TACE had high predictive ability for liver dysfunction from Child–Pugh class A to B after TACE (specificity = 100%, sensitivity = 91.7%). The combined use of pre-TACE PT and ALBI score has a high predictive ability for liver dysfunction after TACE for Child–Pugh class A patients with HCC within up-to-seven criteria.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saut Horas H. Nababan ◽  
Arif Mansjoer ◽  
Achmad Fauzi ◽  
Rino A. Gani

Abstract Background Acutely decompensated liver cirrhosis is associated with high medical costs and negatively affects productivity and quality of life. Data on factors associated with in-hospital mortality due to acutely decompensated liver cirrhosis in Indonesia are scarce. This study aims to identify predictors of in-hospital mortality and develop predictive scoring systems for clinical application in acutely decompensated liver cirrhosis patients. Methods This was a retrospective cohort study using a hospital database of acutely decompensated liver cirrhosis data at Cipto Mangunkusumo National General Hospital, Jakarta (2016–2019). Bivariate and multivariate logistic regression analyses were performed to identify the predictors of in-hospital mortality. Two scoring systems were developed based on the identified predictors. Results A total of 241 patients were analysed; patients were predominantly male (74.3%), had hepatitis B (38.6%), and had Child–Pugh class B or C cirrhosis (40% and 38%, respectively). Gastrointestinal bleeding was observed in 171 patients (70.9%), and 29 patients (12.03%) died during hospitalization. The independent predictors of in-hospital mortality were age (adjusted OR: 1.09 [1.03–1.14]; p = 0.001), bacterial infection (adjusted OR: 6.25 [2.31–16.92]; p < 0.001), total bilirubin level (adjusted OR: 3.01 [1.85–4.89]; p < 0.001) and creatinine level (adjusted OR: 2.70 [1.20–6.05]; p = 0.016). The logistic and additive scoring systems, which were developed based on the identified predictors, had AUROC values of 0.899 and 0.868, respectively. Conclusion The in-hospital mortality rate of acutely decompensated liver cirrhosis in Indonesia is high. We have developed two predictive scoring systems for in-hospital mortality in acutely decompensated liver cirrhosis patients.


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