Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,...Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,having a tool to identify patients at higher risk of complications and mortality is an ideal goal.Currently,the validated scores for this purpose are the model for end-stage liver disease score and the Child-Pugh score.However,these scores have limitations,as they do not account for other factors associated with liver cirrhosis that are equally relevant from a prognostic perspective.Among these,alterations in body composition,particularly sarcopenia,increase the risk of mortality and should therefore be considered in the comprehensive assessment of patients with liver cirrhosis.展开更多
Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). MHE is considered as a preclinical stage of HE and is part of a wide spectrum of typical neurocognitive alterations char...Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). MHE is considered as a preclinical stage of HE and is part of a wide spectrum of typical neurocognitive alterations characteristic of patients with liver cirrhosis, particularly involving the areas of attention, alertness, response inhibition, and executive functions. MHE can be detected by testing the patients’ psychometric performance, attention, working memory, psychomotor speed, and visuospatial ability, as well as by means of electrophysiological and other functional brain measures. MHE is very frequent, affecting from 20% up to 80% of patients tested, depending of the diagnostic tools used. Although subclinical, MHE is considered to be clinically relevant. In fact, MHE has been related to the patients’ falls, fitness to drive, and working ability. As a consequence, MHE affects the patients and caregivers lives by altering their quality of life and even their socioeconomic status. Recently sarcopenia, a very common condition in patients with advanced liver disease, has been shown to be strictly related to both minimal and overt HE. Aim of this review is to summarize the most recently published evidences about the emerging relationship between sarcopenia and cognitive impairment in cirrhotic patients and provide suggestions for future research.展开更多
Hepatitis C virus(HCV)infection is widespread and affects 71 million people worldwide.Although hepatic manifestations are the most frequent,ranging from chronic hepatitis to cirrhosis and hepatocellular carcinoma,it i...Hepatitis C virus(HCV)infection is widespread and affects 71 million people worldwide.Although hepatic manifestations are the most frequent,ranging from chronic hepatitis to cirrhosis and hepatocellular carcinoma,it is also associated with several extrahepatic manifestations.Infected patients may present nonspecific neurological symptoms,regardless of the presence of liver cirrhosis.Several pathogenetic mechanisms underlying neurological symptoms have been hypothesized:neuroinvasion,immune-mediated damage,neurotransmitter alterations and cryoglobulinemia.Alterations of the central nervous system include cerebral vasculopathy,acute or subacute encephalopathy and inflammatory disorders.HCV infection may be responsible for neuropathies,of which the most frequent form is symmetrical axonal sensory or sensory-motor polyneuropathy which causes loss of leg sensitivity and weakness.Up to 50%of patients with HCV infection may experience cognitive decline and psychological disorders,such as depression and fatigue.HCV associated neurocognitive disorder is independent of the presence of liver cirrhosis and affects different domains than in patients with hepatic encephalopathy.It can be studied using specific tests that mainly explore executive functions,verbal learning and verbal recall.These disorders significantly reduce the quality of life.The new antiviral therapies improve the extrahepatic symptoms of HCV infection and their success depends on the achievement of sustained virological response.However,the effect of therapy may differ depending on the type of organ involved;neurological symptoms can be irreversible if there is organic liver damage.The aim of this review is to provide a critical overview of physiopathological mechanisms,diagnostic and therapeutic strategies of the neurological and psychiatric effects of HCV infection.展开更多
The metanalysis by Tantai and collaborators highlights the role of sarcopenia in cirrhosis by demonstrating that the presence of muscular alterations is independently related with a mortality(HR 2.61)(1).Sarcopenia is...The metanalysis by Tantai and collaborators highlights the role of sarcopenia in cirrhosis by demonstrating that the presence of muscular alterations is independently related with a mortality(HR 2.61)(1).Sarcopenia is confirmed as a condition with high prevalence in patients with cirrhosis(37.5%),being more representative in males than females(41.9%vs.37.8%)and in subjects with alcoholic etiology(49.6%)or with more advanced degree of liver disease(Child Pugh C 46.7%).Interestingly,authors demonstrate that sarcopenia was associated with mortality in subjects with MELD<15 or>15(HR 2.34)as well evaluating only on studies that excluded patients with hepatocellular carcinoma(HCC),risk of mortality was similar to that of the main analysis(2.35)(1).展开更多
文摘Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,having a tool to identify patients at higher risk of complications and mortality is an ideal goal.Currently,the validated scores for this purpose are the model for end-stage liver disease score and the Child-Pugh score.However,these scores have limitations,as they do not account for other factors associated with liver cirrhosis that are equally relevant from a prognostic perspective.Among these,alterations in body composition,particularly sarcopenia,increase the risk of mortality and should therefore be considered in the comprehensive assessment of patients with liver cirrhosis.
文摘Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). MHE is considered as a preclinical stage of HE and is part of a wide spectrum of typical neurocognitive alterations characteristic of patients with liver cirrhosis, particularly involving the areas of attention, alertness, response inhibition, and executive functions. MHE can be detected by testing the patients’ psychometric performance, attention, working memory, psychomotor speed, and visuospatial ability, as well as by means of electrophysiological and other functional brain measures. MHE is very frequent, affecting from 20% up to 80% of patients tested, depending of the diagnostic tools used. Although subclinical, MHE is considered to be clinically relevant. In fact, MHE has been related to the patients’ falls, fitness to drive, and working ability. As a consequence, MHE affects the patients and caregivers lives by altering their quality of life and even their socioeconomic status. Recently sarcopenia, a very common condition in patients with advanced liver disease, has been shown to be strictly related to both minimal and overt HE. Aim of this review is to summarize the most recently published evidences about the emerging relationship between sarcopenia and cognitive impairment in cirrhotic patients and provide suggestions for future research.
文摘Hepatitis C virus(HCV)infection is widespread and affects 71 million people worldwide.Although hepatic manifestations are the most frequent,ranging from chronic hepatitis to cirrhosis and hepatocellular carcinoma,it is also associated with several extrahepatic manifestations.Infected patients may present nonspecific neurological symptoms,regardless of the presence of liver cirrhosis.Several pathogenetic mechanisms underlying neurological symptoms have been hypothesized:neuroinvasion,immune-mediated damage,neurotransmitter alterations and cryoglobulinemia.Alterations of the central nervous system include cerebral vasculopathy,acute or subacute encephalopathy and inflammatory disorders.HCV infection may be responsible for neuropathies,of which the most frequent form is symmetrical axonal sensory or sensory-motor polyneuropathy which causes loss of leg sensitivity and weakness.Up to 50%of patients with HCV infection may experience cognitive decline and psychological disorders,such as depression and fatigue.HCV associated neurocognitive disorder is independent of the presence of liver cirrhosis and affects different domains than in patients with hepatic encephalopathy.It can be studied using specific tests that mainly explore executive functions,verbal learning and verbal recall.These disorders significantly reduce the quality of life.The new antiviral therapies improve the extrahepatic symptoms of HCV infection and their success depends on the achievement of sustained virological response.However,the effect of therapy may differ depending on the type of organ involved;neurological symptoms can be irreversible if there is organic liver damage.The aim of this review is to provide a critical overview of physiopathological mechanisms,diagnostic and therapeutic strategies of the neurological and psychiatric effects of HCV infection.
文摘The metanalysis by Tantai and collaborators highlights the role of sarcopenia in cirrhosis by demonstrating that the presence of muscular alterations is independently related with a mortality(HR 2.61)(1).Sarcopenia is confirmed as a condition with high prevalence in patients with cirrhosis(37.5%),being more representative in males than females(41.9%vs.37.8%)and in subjects with alcoholic etiology(49.6%)or with more advanced degree of liver disease(Child Pugh C 46.7%).Interestingly,authors demonstrate that sarcopenia was associated with mortality in subjects with MELD<15 or>15(HR 2.34)as well evaluating only on studies that excluded patients with hepatocellular carcinoma(HCC),risk of mortality was similar to that of the main analysis(2.35)(1).
