BACKGROUND Gallstones and gallbladder wall thickening(GBWT)are frequent findings in patients with cirrhosis,reflecting the critical interplay between hepatobiliary dysfunction and portal hypertension.AIM To assess the...BACKGROUND Gallstones and gallbladder wall thickening(GBWT)are frequent findings in patients with cirrhosis,reflecting the critical interplay between hepatobiliary dysfunction and portal hypertension.AIM To assess the prevalence of gallstones and asymptomatic GBWT in patients with cirrhosis.METHODS Hospitalized patients with cirrhosis who had undergone abdominal imaging studies during hospitalization were retrospectively analyzed.RESULTS A total of 128 patients were included.The patients had a mean age of 64±12.2 years,were predominantly male(73.4%),and most had decompensated liver cirrhosis(DeCi)(78.1%).Alcohol-associated liver disease(47.7%)and metabolic dysfunction-associated steatohepatitis(16.4%)are the leading causes of cirrhosis.Most patients were classified as Child-Pugh stage B(53.1%),followed by stage C(32%),and stage A(14.8%).A significant percentage of patients had cholelithiasis(39.8%),and DeCi patients were more likely to have gallstones(45%)than compensated patients(21.4%)(P=0.024).Furthermore,a significant number of patients had asymptomatic GBWT(32.8%),and almost half(42.9%)did not have concurrent cholelithiasis.Patients with DeCi were significantly more likely to have GBWT(39%)than those with compensated disease(10.7%)(P=0.005).There was no statistical correlation between cirrhosis etiology and cholelithiasis or Tsankof A et al.Gallstones and GBWT in patients with cirrhosis WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 GBWT.CONCLUSION This study underlines the high prevalence of radiologic gallbladder findings in patients with cirrhosis while simultaneously serving as a reminder to clinicians to refrain from accrediting these findings to a diagnosis of acute cholecystitis in the absence of symptoms.展开更多
To the Editor:Chylothorax is a serious disease characterized by rupture of the thoracic tube and milky exudation from the pleural cavity,which can lead to a variety of pathological symptoms and is life threatening[1]....To the Editor:Chylothorax is a serious disease characterized by rupture of the thoracic tube and milky exudation from the pleural cavity,which can lead to a variety of pathological symptoms and is life threatening[1].Chylothorax is common after thoracic surgery or trauma.The non-traumatic chylothorax is rare in the clinical practice,and the etiology is complex and often associated with the primary disease[2].Chylothorax is a rare complication of patients with advanced cirrhosis[3],most of which are manifested as dyspnea,cough,chest pain,and the medical treatment effect is relatively poor.We performed orthotopic liver transplantation(OLT)in a patient with advanced cirrhosis combined with massive chylothorax and chyloperitoneum.The 2-year follow-up showed that the patient’s liver function was stable and no recurrence of chylothorax.展开更多
BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized p...BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.展开更多
BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,...BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.展开更多
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,...Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.展开更多
The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of re...The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of restoring the structure and function of the liver,reducing the portal pressure with a positive effect on complications associated with portal hypertension and decreasing the risk of developing hepatocellular carcinoma after elimination of the etiological factor.To create a unified understanding the recompensation of decompensated LC,at the Baveno VII consensus workshop were developed criteria confirming it.At the moment,the efficacy of etiological therapy in achieving established criteria for recompensation has been evaluated only in patients with alcohol-related,as well as hepatitis B virus-related and hepatitis C virus-related decompensated LC.The purpose of the review is to provide up–to-date information on the role of etiological therapy in achieving recompensation of decompensated LC according to Baveno VII criteria.So far,only the first steps have been taken in studying this problem.To further understand it,research is needed to identify pathophysiological mechanisms,modifying factors,predictors,and potential noninvasive biomarkers of recompensation of decompensated LC.展开更多
In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for incr...In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population.Building upon their final observation regarding the importance of understanding this association,we will delve into the topic of infections in patients with liver cirrhosis.These patients exhibit intrinsic characteristics that make them particularly susceptible to infections,both bacterial and fungal.This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations,including the development of acute-on-chronic liver failure,which markedly worsens prognosis and mortality.Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections,multidrug-resistant organisms,and atypical clinical presentations.Delayed or inadequate management can lead to unfavorable outcomes,further complicating the course of their underlying liver disease.The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections.Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality.By raising awareness among clinicians about the complexity of these cases,we hope to contribute to optimizing the care of this high-risk population.展开更多
BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated l...BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.展开更多
We commend Worland et al for their work associating rifaximin-αuse with imp-roved muscle mass in individuals with liver cirrhosis.This observation adds momentum to the evolving gut-liver-muscle axis hypothesis.Howeve...We commend Worland et al for their work associating rifaximin-αuse with imp-roved muscle mass in individuals with liver cirrhosis.This observation adds momentum to the evolving gut-liver-muscle axis hypothesis.However,the retro-spective design and lack of functional outcomes invite caution in interpretation.Mechanistically,rifaximin may exert benefit beyond ammonia reduction through modulation of systemic inflammation,tumor necrosis factor alpha suppression,and restoration of myocyte integrity.Additionally,concerns about long-term anti-microbial resistance must be acknowledged.Overall,this study represents a valuable first step,but its implications require validation in future,prospective,mechanistically informed clinical trials.展开更多
BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders...BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders(VEs),and vasoactive agents are used to manage patients with cirrhosis.Despite numerous clinical trials,a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited.This study provides the current and comprehensive synthesis of evidence,offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.AIM To systematically update available data on therapies of liver cirrhosis,we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.METHODS A literature search from the PubMed and Embase databases(inception till June 2024)focused on hyponatremia(primary outcome)and various outcomes such as gastrointestinal bleeding,hepatic encephalopathy,severe infection,post-paracentesis-induced circulatory dysfunction(PICD),ascites reappearance,spontaneous bacterial peritonitis,hepatorenal syndrome,renal impairment,hospital stay,mortality,and safety was performed.The primary analysis pooled studies that compared albumin infusion with control.In the subgroup analysis,comparisons were made within the stratified treatment categories included in the control group.RESULTS Of the 2957 studies retrieved,31 studies(27 randomized controlled trials and 4 observational studies)comprising 6255 patients were included.Albumin use was significant in reducing odds of hyponatremia[odds ratio(OR)=0.67;95%confidence interval(95%CI)=0.53-0.85]and PICD(OR=0.38;95%CI=0.20-0.71),whereas the reduction in severe infection(OR=0.55;95%CI=0.28-1.07)did not reach statistical significance.In the subgroup analysis,albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy(OR=0.54;95%CI=0.27-1.09).For PICD,albumin use was significant compared with other VEs(OR=0.31;95%CI=0.11-0.85)but not with vasoconstrictors(OR=0.63;95%CI=0.21-1.91).In the overall subgroup analysis,a significant reduction was observed in hyponatremia(OR=0.67;95%CI=0.53-0.85)and PICD(OR=0.38;95%CI=0.20-0.71).CONCLUSION Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis,whereas its effect on severe infection remains suggestive but not statistically significant.展开更多
Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related deaths worldwide.The primary risk factor for HCC is cirrhosis.Identifying individuals who are at high risk of developing HCC will have numerou...Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related deaths worldwide.The primary risk factor for HCC is cirrhosis.Identifying individuals who are at high risk of developing HCC will have numerous benefits for patient outcomes,patient quality of life,and the global healthcare system.Artificial intelligence(AI)has the capability to develop systems that emulate human intelligence.Recent studies have highlighted the potential of AI in the management of HCC,and the application of AI appears promising for identifying high-risk groups among patients with cirrhosis who require closer monitoring.Ultimately,the aim of AI in the field of HCC clinical care is to enable earlier diagnosis and consequently improve prognosis.展开更多
BACKGROUND Sarcopaenia is associated with a two-fold higher mortality rate in patients with cirrhosis independent of liver disease severity.Few treatments for cirrhosis related sarcopaenia exist beyond optimal nutriti...BACKGROUND Sarcopaenia is associated with a two-fold higher mortality rate in patients with cirrhosis independent of liver disease severity.Few treatments for cirrhosis related sarcopaenia exist beyond optimal nutritional management.AIM To assess if rifaximin-α,a minimally absorbed antimicrobial used to manage hepatic encephalopathy(HE),may improve sarcopaenia in cirrhosis through its ammonia lowering and anti-inflammatory properties.METHODS This single-centre retrospective cohort study of patients with prior HE compared patients treated with lactulose alone to those on combination therapy with rifaximin-α.The primary outcome was a change in skeletal muscle area(SMA)as measured by computed tomography over two time points.Secondary outcomes included episodes of spontaneous bacterial peritonitis,variceal bleeding,and gastrointestinal Clostridium difficile infection.RESULTS Of the 142 patients included,63 were on rifaximin-α[35%female,median age 57(51,62)],and 79 were on lactulose without rifaximin-α[20%female,median age 55(51,60)].Univariate analysis for SMA found that male sex(P<0.001),hepatocellular carcinoma presence(P=0.024),and greater baseline body mass index(P=0.001)were associated with improvement of SMA.Multivariate analysis that adjusted for baseline SMA was performed and found only use of rifaximin-α(P=0.029)to be associated with improvement of SMA.CONCLUSION This study demonstrates a significant independent association between rifaximin-αtherapy and muscle mass in patients with cirrhosis and HE.Prospective studies of rifaximin-αtherapy examining its impact on sarcopenia are required to assess its potential therapeutic role in this cohort.展开更多
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
BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study...BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.展开更多
Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious...Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious complications,such as portal hypertension,esophagogastric variceal bleeding,and refractory ascites.All these factors have a serious impact on patients’quality of life and prognosis.This article evaluates the current evidence on the management of PVT in cirrhosis and explores the role of direct oral anticoagulants,but data on individualized anticoagulation strategies are limited and lacking for the treatment of PVT in cirrhosis,and it is hoped that it will inform a broad range of clinicians on the treatment of cirrhosis combined with PVT.展开更多
Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in ...Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in the context of end-stage liver disease and concomitant ascites.The most widely accepted explanatory model for HH accumulation is the formation of small diaphragmatic defects(pleuroperitoneal connections)facilitating migration of ascitic fluid from the peritoneal cavity directly to the pleural cavity.Medical management involves sodium restriction and diuretic therapy,with thoracentesis also offering symptomatic relief.In cases of refractory HH,a transjugular intrahepatic portosystemic shunt is considered either as definitive treatment or as a bridge to liver transplantation,which remains the only curative treatment option.HH refractory to medical therapy presents a challenging clinical dilemma,particularly in those who are ineligible for liver transplantation.In this mini-review,we aim to highlight the pathophysiology,clinical presentation,diagnosis and management of HH.Additionally,we discuss and appraise novel therapeutic options and offer future directions.展开更多
Advanced endoscopic methods like endoscopic ultrasound(EUS)have recently been applied for the management of complications related to cirrhosis.This includes novel techniques to measure portal pressure gradients,esopha...Advanced endoscopic methods like endoscopic ultrasound(EUS)have recently been applied for the management of complications related to cirrhosis.This includes novel techniques to measure portal pressure gradients,esophageal,gastric,and ectopic varices management,and EUS-assisted treatment of liver tumors.Management of liver tumors has seen significant changes in recent years,and many minimally invasive procedures have been approved,especially in the management of liver cell carcinoma.These are specialized procedures and are performed only in patients with cirrhosis in specialized centers.There are concerns for complications in patients with cirrhosis due to their increased risk of bleeding and the altered hemostatic milieu.This minireview summarizes the recent evidence on using EUS in the management of cirrhosis-related complications.展开更多
BACKGROUND Shwachman-Diamond syndrome(SDS)is a rare genetic disorder that affects multiple organs,primarily the liver.Most patients are diagnosed during infancy or early childhood.As they grow older,the majority of af...BACKGROUND Shwachman-Diamond syndrome(SDS)is a rare genetic disorder that affects multiple organs,primarily the liver.Most patients are diagnosed during infancy or early childhood.As they grow older,the majority of affected children may experience spontaneous remission,and cases of cirrhosis in adults are rarely reported.CASE SUMMARY A 36-year-old male patient presented with massive ascites.Laboratory tests revealed pancytopenia and a serum-ascites albumin gradient greater than 1.1 g/dL.An abdominal computed tomography scan demonstrated cirrhosis,splenomegaly,pancreatic fat infiltration,and a substantial accumulation of peritoneal fluid.Gastroscopy identified esophageal varices.Liver stiffness measurement indicated a value of 32.7 kPa.Based on the results of auxiliary examinations,common causes of cirrhosis were excluded,and a mutation in the Shwachman-Bodian-Diamond syndrome gene was ultimately identified through whole-exome sequencing.The patient was diagnosed with cirrhosis secondary to SDS.Following the correction of hypoalbuminemia and administration of diuretics,the patient's ascites resolved.CONCLUSION Patients with liver cirrhosis who also exhibit pancreatic fat infiltration and pancytopenia necessitate further exon testing to exclude the possibility of SDS.展开更多
BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to...BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to fungal infections.To date,the incidence of spontaneous fungal peritonitis(SFP)has not been determined in Mexico;this endeavor is of great importance because many patients may be suffering from this condition without receiving targeted treatment,which may increase mortality.AIM To report the incidence of SFP in patients presenting with decompensated LC with ascites.METHODS This was a prospective,single-center,descriptive,observational and crosssectional study where patients presenting with decompensated LC with ascites were evaluated from November 2023 to May 2024 in Mexico City.Fungal cultures of ascites were performed and the samples kept in an incubator for 10 days to 14 days,and molecular tests(the API 20 C AUX test)were used for molecular characterization.RESULTS Of the 48 patients included,54.2%were women,77.1%had a comorbidity,47.9%had LC secondary to metabolic dysfunction,43.8%were classified as Child-Pugh C with a model for end-stage liver disease 3.0 median score of 22,and 10.4%were in secondary prophylaxis for spontaneous bacterial peritonitis(SBP).Only four patients had positive cultures where Candida parapsilosis and Candida albicans were isolated,with two of the four patients being positive for Rhodotorula minuta;an SBP incidence of 8.3%was thus calculated.Chronic kidney disease[P=0.012 and relative risk(RR)=15]and secondary prophylaxis for SBP(P=0.049 with RR=8.6)were statistically significant and associated with a high mortality risk(P=0.001 with RR=33).CONCLUSION The presence of infection of fungal origin in ascites in patients presenting with cirrhosis increases short-and medium-term mortality;therefore,it is recommended that fungal culture tests are performed in those patients who visit the emergency room or experience continuous admission with acute decompensation and no bacteria identified in ascites cultures,and even more so in patients with chronic kidney disease and a history of antibiotic use as prophylaxis for SBP.Further studies are needed for the identification of clinical and biochemical data that can help to define SFP so that its presence may be assessed without the need to wait for a positive fungal culture.Thus,treatment may be initiated early in the hope of having a positive impact on the prognosis in this group of patients.展开更多
BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This resear...BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.展开更多
文摘BACKGROUND Gallstones and gallbladder wall thickening(GBWT)are frequent findings in patients with cirrhosis,reflecting the critical interplay between hepatobiliary dysfunction and portal hypertension.AIM To assess the prevalence of gallstones and asymptomatic GBWT in patients with cirrhosis.METHODS Hospitalized patients with cirrhosis who had undergone abdominal imaging studies during hospitalization were retrospectively analyzed.RESULTS A total of 128 patients were included.The patients had a mean age of 64±12.2 years,were predominantly male(73.4%),and most had decompensated liver cirrhosis(DeCi)(78.1%).Alcohol-associated liver disease(47.7%)and metabolic dysfunction-associated steatohepatitis(16.4%)are the leading causes of cirrhosis.Most patients were classified as Child-Pugh stage B(53.1%),followed by stage C(32%),and stage A(14.8%).A significant percentage of patients had cholelithiasis(39.8%),and DeCi patients were more likely to have gallstones(45%)than compensated patients(21.4%)(P=0.024).Furthermore,a significant number of patients had asymptomatic GBWT(32.8%),and almost half(42.9%)did not have concurrent cholelithiasis.Patients with DeCi were significantly more likely to have GBWT(39%)than those with compensated disease(10.7%)(P=0.005).There was no statistical correlation between cirrhosis etiology and cholelithiasis or Tsankof A et al.Gallstones and GBWT in patients with cirrhosis WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 GBWT.CONCLUSION This study underlines the high prevalence of radiologic gallbladder findings in patients with cirrhosis while simultaneously serving as a reminder to clinicians to refrain from accrediting these findings to a diagnosis of acute cholecystitis in the absence of symptoms.
基金supported by grants from the Clinical Research and Development Program of Zhongnan Hospital of Wuhan University(LCYF 202205)the National Natural Science Foundation of China(82370671)。
文摘To the Editor:Chylothorax is a serious disease characterized by rupture of the thoracic tube and milky exudation from the pleural cavity,which can lead to a variety of pathological symptoms and is life threatening[1].Chylothorax is common after thoracic surgery or trauma.The non-traumatic chylothorax is rare in the clinical practice,and the etiology is complex and often associated with the primary disease[2].Chylothorax is a rare complication of patients with advanced cirrhosis[3],most of which are manifested as dyspnea,cough,chest pain,and the medical treatment effect is relatively poor.We performed orthotopic liver transplantation(OLT)in a patient with advanced cirrhosis combined with massive chylothorax and chyloperitoneum.The 2-year follow-up showed that the patient’s liver function was stable and no recurrence of chylothorax.
基金Supported by National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.
文摘BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.
文摘Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.
文摘The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of restoring the structure and function of the liver,reducing the portal pressure with a positive effect on complications associated with portal hypertension and decreasing the risk of developing hepatocellular carcinoma after elimination of the etiological factor.To create a unified understanding the recompensation of decompensated LC,at the Baveno VII consensus workshop were developed criteria confirming it.At the moment,the efficacy of etiological therapy in achieving established criteria for recompensation has been evaluated only in patients with alcohol-related,as well as hepatitis B virus-related and hepatitis C virus-related decompensated LC.The purpose of the review is to provide up–to-date information on the role of etiological therapy in achieving recompensation of decompensated LC according to Baveno VII criteria.So far,only the first steps have been taken in studying this problem.To further understand it,research is needed to identify pathophysiological mechanisms,modifying factors,predictors,and potential noninvasive biomarkers of recompensation of decompensated LC.
文摘In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population.Building upon their final observation regarding the importance of understanding this association,we will delve into the topic of infections in patients with liver cirrhosis.These patients exhibit intrinsic characteristics that make them particularly susceptible to infections,both bacterial and fungal.This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations,including the development of acute-on-chronic liver failure,which markedly worsens prognosis and mortality.Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections,multidrug-resistant organisms,and atypical clinical presentations.Delayed or inadequate management can lead to unfavorable outcomes,further complicating the course of their underlying liver disease.The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections.Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality.By raising awareness among clinicians about the complexity of these cases,we hope to contribute to optimizing the care of this high-risk population.
基金Supported by the Foundation of Health Commission of Hubei Province,No.WJ2019H053Natural Science Foundation of Hubei Province,No.2023AFB169+1 种基金Foundation of Health Commission of Hubei Province,No.ZY2021Q019Open Fund Hubei Provincial Clinical Research Center for Umbilical Cord Blood Hematopoietic Stem Cells,Taihe Hospital,No.2024SCOF008.
文摘BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.
文摘We commend Worland et al for their work associating rifaximin-αuse with imp-roved muscle mass in individuals with liver cirrhosis.This observation adds momentum to the evolving gut-liver-muscle axis hypothesis.However,the retro-spective design and lack of functional outcomes invite caution in interpretation.Mechanistically,rifaximin may exert benefit beyond ammonia reduction through modulation of systemic inflammation,tumor necrosis factor alpha suppression,and restoration of myocyte integrity.Additionally,concerns about long-term anti-microbial resistance must be acknowledged.Overall,this study represents a valuable first step,but its implications require validation in future,prospective,mechanistically informed clinical trials.
基金Supported by National Natural Science Foundation of China,No.82070604 and No.82270618the Shanghai Municipal Key Clinical Specialty,China,No.shslczdzk01103。
文摘BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders(VEs),and vasoactive agents are used to manage patients with cirrhosis.Despite numerous clinical trials,a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited.This study provides the current and comprehensive synthesis of evidence,offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.AIM To systematically update available data on therapies of liver cirrhosis,we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.METHODS A literature search from the PubMed and Embase databases(inception till June 2024)focused on hyponatremia(primary outcome)and various outcomes such as gastrointestinal bleeding,hepatic encephalopathy,severe infection,post-paracentesis-induced circulatory dysfunction(PICD),ascites reappearance,spontaneous bacterial peritonitis,hepatorenal syndrome,renal impairment,hospital stay,mortality,and safety was performed.The primary analysis pooled studies that compared albumin infusion with control.In the subgroup analysis,comparisons were made within the stratified treatment categories included in the control group.RESULTS Of the 2957 studies retrieved,31 studies(27 randomized controlled trials and 4 observational studies)comprising 6255 patients were included.Albumin use was significant in reducing odds of hyponatremia[odds ratio(OR)=0.67;95%confidence interval(95%CI)=0.53-0.85]and PICD(OR=0.38;95%CI=0.20-0.71),whereas the reduction in severe infection(OR=0.55;95%CI=0.28-1.07)did not reach statistical significance.In the subgroup analysis,albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy(OR=0.54;95%CI=0.27-1.09).For PICD,albumin use was significant compared with other VEs(OR=0.31;95%CI=0.11-0.85)but not with vasoconstrictors(OR=0.63;95%CI=0.21-1.91).In the overall subgroup analysis,a significant reduction was observed in hyponatremia(OR=0.67;95%CI=0.53-0.85)and PICD(OR=0.38;95%CI=0.20-0.71).CONCLUSION Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis,whereas its effect on severe infection remains suggestive but not statistically significant.
文摘Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related deaths worldwide.The primary risk factor for HCC is cirrhosis.Identifying individuals who are at high risk of developing HCC will have numerous benefits for patient outcomes,patient quality of life,and the global healthcare system.Artificial intelligence(AI)has the capability to develop systems that emulate human intelligence.Recent studies have highlighted the potential of AI in the management of HCC,and the application of AI appears promising for identifying high-risk groups among patients with cirrhosis who require closer monitoring.Ultimately,the aim of AI in the field of HCC clinical care is to enable earlier diagnosis and consequently improve prognosis.
文摘BACKGROUND Sarcopaenia is associated with a two-fold higher mortality rate in patients with cirrhosis independent of liver disease severity.Few treatments for cirrhosis related sarcopaenia exist beyond optimal nutritional management.AIM To assess if rifaximin-α,a minimally absorbed antimicrobial used to manage hepatic encephalopathy(HE),may improve sarcopaenia in cirrhosis through its ammonia lowering and anti-inflammatory properties.METHODS This single-centre retrospective cohort study of patients with prior HE compared patients treated with lactulose alone to those on combination therapy with rifaximin-α.The primary outcome was a change in skeletal muscle area(SMA)as measured by computed tomography over two time points.Secondary outcomes included episodes of spontaneous bacterial peritonitis,variceal bleeding,and gastrointestinal Clostridium difficile infection.RESULTS Of the 142 patients included,63 were on rifaximin-α[35%female,median age 57(51,62)],and 79 were on lactulose without rifaximin-α[20%female,median age 55(51,60)].Univariate analysis for SMA found that male sex(P<0.001),hepatocellular carcinoma presence(P=0.024),and greater baseline body mass index(P=0.001)were associated with improvement of SMA.Multivariate analysis that adjusted for baseline SMA was performed and found only use of rifaximin-α(P=0.029)to be associated with improvement of SMA.CONCLUSION This study demonstrates a significant independent association between rifaximin-αtherapy and muscle mass in patients with cirrhosis and HE.Prospective studies of rifaximin-αtherapy examining its impact on sarcopenia are required to assess its potential therapeutic role in this cohort.
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BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.
基金Supported by the Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_2067Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province,No.CXPJJH123009-079.
文摘Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious complications,such as portal hypertension,esophagogastric variceal bleeding,and refractory ascites.All these factors have a serious impact on patients’quality of life and prognosis.This article evaluates the current evidence on the management of PVT in cirrhosis and explores the role of direct oral anticoagulants,but data on individualized anticoagulation strategies are limited and lacking for the treatment of PVT in cirrhosis,and it is hoped that it will inform a broad range of clinicians on the treatment of cirrhosis combined with PVT.
文摘Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in the context of end-stage liver disease and concomitant ascites.The most widely accepted explanatory model for HH accumulation is the formation of small diaphragmatic defects(pleuroperitoneal connections)facilitating migration of ascitic fluid from the peritoneal cavity directly to the pleural cavity.Medical management involves sodium restriction and diuretic therapy,with thoracentesis also offering symptomatic relief.In cases of refractory HH,a transjugular intrahepatic portosystemic shunt is considered either as definitive treatment or as a bridge to liver transplantation,which remains the only curative treatment option.HH refractory to medical therapy presents a challenging clinical dilemma,particularly in those who are ineligible for liver transplantation.In this mini-review,we aim to highlight the pathophysiology,clinical presentation,diagnosis and management of HH.Additionally,we discuss and appraise novel therapeutic options and offer future directions.
文摘Advanced endoscopic methods like endoscopic ultrasound(EUS)have recently been applied for the management of complications related to cirrhosis.This includes novel techniques to measure portal pressure gradients,esophageal,gastric,and ectopic varices management,and EUS-assisted treatment of liver tumors.Management of liver tumors has seen significant changes in recent years,and many minimally invasive procedures have been approved,especially in the management of liver cell carcinoma.These are specialized procedures and are performed only in patients with cirrhosis in specialized centers.There are concerns for complications in patients with cirrhosis due to their increased risk of bleeding and the altered hemostatic milieu.This minireview summarizes the recent evidence on using EUS in the management of cirrhosis-related complications.
文摘BACKGROUND Shwachman-Diamond syndrome(SDS)is a rare genetic disorder that affects multiple organs,primarily the liver.Most patients are diagnosed during infancy or early childhood.As they grow older,the majority of affected children may experience spontaneous remission,and cases of cirrhosis in adults are rarely reported.CASE SUMMARY A 36-year-old male patient presented with massive ascites.Laboratory tests revealed pancytopenia and a serum-ascites albumin gradient greater than 1.1 g/dL.An abdominal computed tomography scan demonstrated cirrhosis,splenomegaly,pancreatic fat infiltration,and a substantial accumulation of peritoneal fluid.Gastroscopy identified esophageal varices.Liver stiffness measurement indicated a value of 32.7 kPa.Based on the results of auxiliary examinations,common causes of cirrhosis were excluded,and a mutation in the Shwachman-Bodian-Diamond syndrome gene was ultimately identified through whole-exome sequencing.The patient was diagnosed with cirrhosis secondary to SDS.Following the correction of hypoalbuminemia and administration of diuretics,the patient's ascites resolved.CONCLUSION Patients with liver cirrhosis who also exhibit pancreatic fat infiltration and pancytopenia necessitate further exon testing to exclude the possibility of SDS.
文摘BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to fungal infections.To date,the incidence of spontaneous fungal peritonitis(SFP)has not been determined in Mexico;this endeavor is of great importance because many patients may be suffering from this condition without receiving targeted treatment,which may increase mortality.AIM To report the incidence of SFP in patients presenting with decompensated LC with ascites.METHODS This was a prospective,single-center,descriptive,observational and crosssectional study where patients presenting with decompensated LC with ascites were evaluated from November 2023 to May 2024 in Mexico City.Fungal cultures of ascites were performed and the samples kept in an incubator for 10 days to 14 days,and molecular tests(the API 20 C AUX test)were used for molecular characterization.RESULTS Of the 48 patients included,54.2%were women,77.1%had a comorbidity,47.9%had LC secondary to metabolic dysfunction,43.8%were classified as Child-Pugh C with a model for end-stage liver disease 3.0 median score of 22,and 10.4%were in secondary prophylaxis for spontaneous bacterial peritonitis(SBP).Only four patients had positive cultures where Candida parapsilosis and Candida albicans were isolated,with two of the four patients being positive for Rhodotorula minuta;an SBP incidence of 8.3%was thus calculated.Chronic kidney disease[P=0.012 and relative risk(RR)=15]and secondary prophylaxis for SBP(P=0.049 with RR=8.6)were statistically significant and associated with a high mortality risk(P=0.001 with RR=33).CONCLUSION The presence of infection of fungal origin in ascites in patients presenting with cirrhosis increases short-and medium-term mortality;therefore,it is recommended that fungal culture tests are performed in those patients who visit the emergency room or experience continuous admission with acute decompensation and no bacteria identified in ascites cultures,and even more so in patients with chronic kidney disease and a history of antibiotic use as prophylaxis for SBP.Further studies are needed for the identification of clinical and biochemical data that can help to define SFP so that its presence may be assessed without the need to wait for a positive fungal culture.Thus,treatment may be initiated early in the hope of having a positive impact on the prognosis in this group of patients.
文摘BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.
