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 Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced i...BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.展开更多
BACKGROUND The hepatic venous pressure gradient serves as a crucial parameter for assessing portal hypertension and predicting clinical decompensation in individuals with cirrhosis.However,owing to its invasive nature...BACKGROUND The hepatic venous pressure gradient serves as a crucial parameter for assessing portal hypertension and predicting clinical decompensation in individuals with cirrhosis.However,owing to its invasive nature,there has been growing interest in identifying noninvasive alternatives.Transient elastography offers a promising approach for measuring liver stiffness and spleen stiffness,which can help estimate the likelihood of decompensation in patients with chronic liver disease.AIM To investigate the predictive ability of the liver stiffness measurement(LSM)and spleen stiffness measurement(SSM)in conjunction with other noninvasive indicators for clinical decompensation in patients suffering from compensatory cirrhosis and portal hypertension.METHODS This study was a retrospective analysis of the clinical data of 200 patients who were diagnosed with viral cirrhosis and who received computed tomography,transient elastography,ultrasound,and endoscopic examinations at The Second Affiliated Hospital of Xi’an Jiaotong University between March 2020 and November 2022.Patient classification was performed in accordance with the Baveno VI consensus.The area under the curve was used to evaluate and compare the predictive accuracy across different patient groups.The diagnostic effectiveness of several models,including the liver stiffness-spleen diameter-platelet ratio,variceal risk index,aspartate aminotransferase-alanine aminotransferase ratio,Baveno Ⅵ criteria,and newly developed models,was assessed.Additionally,decision curve analysis was carried out across a range of threshold probabilities to evaluate the clinical utility of these predictive factors.RESULTS Univariate and multivariate analyses demonstrated that SSM,LSM,and the spleen length diameter(SLD)were linked to clinical decompensation in individuals with viral cirrhosis.On the basis of these findings,a predictive model was developed via logistic regression:Ln[P/(1-P)]=-4.969-0.279×SSM+0.348×LSM+0.272×SLD.The model exhibited strong performance,with an area under the curve of 0.944.At a cutoff value of 0.56,the sensitivity,specificity,positive predictive value,and negative predictive value for predicting clinical decompensation were 85.29%,88.89%,87.89%,and 86.47%,respectively.The newly developed model demonstrated enhanced accuracy in forecasting clinical decompensation among patients suffering from viral cirrhosis when compared to four previously established models.CONCLUSION Noninvasive models utilizing SSM,LSM,and SLD are effective in predicting clinical decompensation among patients with viral cirrhosis,thereby reducing the need for unnecessary hepatic venous pressure gradient testing.展开更多
BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accu...BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accurate identification of AD patients with high risk of development of ACLF and mortality.Soluble triggering receptor expressed on myeloid cells-1(sTREM-1)is released from activated innate immune cells and correlated with various inflammatory processes.AIM To explore the prognostic value of sTREM-1 in patients with AD of cirrhosis.METHODS A multicenter prospective cohort of 442 patients with cirrhosis hospitalized for AD was divided into a study cohort(n=309)and validation cohort(n=133).Demographic and clinical data were collected,and serum sTREM-1 was measured at admission.All enrolled patients were followed-up for at least 1 year.RESULTS In patients with AD and cirrhosis,serum sTREM-1 was an independent prognosis predictor for 1-year survival and correlated with liver,coagulation,cerebral and kidney failure.A new prognostic model of AD(P-AD)incorporating sTREM-1,blood urea nitrogen(BUN),total bilirubin(TBil),international normalized ratio(INR)and hepatic encephalopathy grades was established and performed better than the model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-consortium(CLIF-C)ACLF and CLIF-C AD scores.Additionally,sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d follow-up.The ACLF risk score incorporating serum sTREM-1,BUN,INR,TBil and aspartate aminotransferase levels was established and significantly superior to MELD,MELD-Na,CLIF-C ACLF,CLIF-C AD and P-AD in predicting risk of ACLF development.CONCLUSION Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.展开更多
Acute decompensation in cirrhotic patients signifies the onset of clinically evident events due to portal hypertension.The transition from compensated to decom-pensated cirrhosis involves hemodynamic changes leading t...Acute decompensation in cirrhotic patients signifies the onset of clinically evident events due to portal hypertension.The transition from compensated to decom-pensated cirrhosis involves hemodynamic changes leading to multiorgan dysfun-ction,managed predominantly in outpatient settings with regular monitoring.The mortality risk is elevated in decompensated patients.Therefore,diligent outpatient management should focus on regular medical follow-ups,medication adjustments,patient education,addressing emergent issues and evaluation for liver transplantation.The ultimate goal is to improve quality of life,prevent di-sease progression,reduce complications,and assess possible recompensation.This guide provides valuable recommendations for medical experts managing de-compensated cirrhotic patients post-hospitalization.展开更多
AIM:To examine the clinical features and analyze prognostic factors in a prospective study of primary biliary cirrhosis(PBC) patients.METHODS:From 1995 to 2010,PBC patients without hepatic decompensation seen at the P...AIM:To examine the clinical features and analyze prognostic factors in a prospective study of primary biliary cirrhosis(PBC) patients.METHODS:From 1995 to 2010,PBC patients without hepatic decompensation seen at the Peking Union Medical College Hospital were enrolled.Clinical signs and manifestations(pruritus,persistent fatigue,jaundice and pain in the right hypochondrium),laboratory parameters(auto-antibodies for autoimmune hepatic disease,biliary and hepatic enzymes,immunoglobulin,bilirubin,and albumin) and imaging findings were recorded at entry and at specific time points during follow-up.Cox regression and Kaplan-Meier analyses,respectively,assessed the risk factors for hepatic decompensation and survival.RESULTS:Two hundred and sixty-two PBC patients were enrolled with a median follow-up of 75.2 mo(range,21-201 mo).The 240 patients were aged 51.5 ± 10.2 years at diagnosis and 91.6% were female.Two hundred and forty-five(93.5%) were seropositive for anti-mitochondrial antibodies.At presentation,170 patients(64.9%) were symptomatic,while 96 patients(36.6%) had extra-hepatic autoimmune disease.During the follow-up period,62(23.7%) patients developed hepatic decompensation of whom four underwent liver transplantation and 17 died.The cumulative survival rate and median survival time were 83.9% and 181.7 mo,respectively.Cox regression analysis revealed that an incomplete ursodeoxycholic acid(UDCA) response or inconsistent treatment [P < 0.001;hazard risk(HR) 95%CI = 2.423-7.541],anti-centromere antibodies(ACA) positivity(P < 0.001;HR 95%CI = 2.516-7.137),alanine aminotransferase ratio(AAR) elevations(P < 0.001;HR 95%CI = 1.357-2.678),and histological advanced liver disease(P = 0.006;HR 95%CI = 1.481-10.847) were predictors of hepatic decompensation.The clinical features and survival of PBC in China are consistent with those described in Western countries.CONCLUSION:Incomplete UDCA response or inconsistent treatment,ACA positivity,AAR elevations,and advanced histological stage are predictors of decompensation.展开更多
Liver cirrhosis (LC) is a critical stage of chronic liver disease, including that caused by hepatitis C virus (HCV). In the absence of antiviral therapy, 67%-91% of patients with HCV-related LC patients die of liver-r...Liver cirrhosis (LC) is a critical stage of chronic liver disease, including that caused by hepatitis C virus (HCV). In the absence of antiviral therapy, 67%-91% of patients with HCV-related LC patients die of liver-related causes, including hepatocellular carcinoma (HCC) and liver failure. Among the therapeutic strategies used to prevent liver-related complications in these patients is standard therapy with pegylated interferon and ribavirin, which induces a sustained virological response (SVR) in 25% of HCV genotype 1-infected patients and in 69% of patients infected with genotypes 2 and 3. SVR in patients with HCV-related LC has been associated with reduced rates of hepatic decompensation, HCC, and mortality. More recently developed direct-acting antiviral agents have shown excellent antiviral efficacy, with preliminary data demonstrating that an interferon-free regimen that includes these direct-acting antiviral agents achieved SVR in more than 50% of patients with HCV genotype 1 LC. Branched-chain amino acid supplementation, improvement of insulin resistance, and the use of β-blockers for portal hypertension may also reduce liver-related complications. Here, we review advances in antiviral and adjunctive therapies for improved outcomes in patients with HCV-associated LC.展开更多
To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.METHODSThis is a prospective cohort study designed to assess the prognostic performance of t...To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.METHODSThis is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium(CLIF-C)acute decompensation score(CLIF-C AD)and CLIF-C acute-on-chronic liver failure score(CLIF-C ACLF),regarding 28-d and 90-d mortality,as well as to compare them to other prognostic models,such as Model for End-Stage Liver Disease(MELD),MELD Sodium(MELD-Na),Child-Pugh(CP)score,and the CLIF-C Organ Failure score(CLIF-C OF).All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil.Prognostic performances were evaluated by means of the receiver operating characteristic(ROC)curves,area under the curves(AUC)and 95%CI.RESULTSOne hundred and thirteen cirrhotic patients were included.At admission,18 patients had acute-on-chronic liver failure(ACLF)and 95 individuals had acute decompensation(AD)without ACLF,of which 24 eventually developed ACLF during the course of hospitalization(AD evolving to ACLF group).The AD group had significantly lower 28-d(9.0%)and 90-d(18.3%)mortality as compared to the AD evolving to ACLF group and to the ACLF group(both P<0.001).On the other hand,28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group(P=0.542 and P=0.708,respectively).Among patients with ACLF,at 28 d from the diagnosis,CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line,with an AUC(95%CI)of 0.71(95%CI:0.54-0.88,P=0.021).Among patients with AD,all prognostic scores performed significantly better than the reference line regarding 28-d mortality,presenting with similar AUCs:CLIF-C AD score 0.75(95%CI:0.63-0.88),CP score 0.72(95%CI:0.59-0.85),MELD score 0.75(95%CI:0.61-0.90),MELD-Na score 0.76(95%CI:0.61-0.90),and CLIF-C OF score 0.74(95%CI:0.60-0.88).The same occurred concerning AUCs for 90-d mortality:CLIF-C AD score 0.70(95%CI:0.57-0.82),CP score 0.73(95%CI:0.62-0.84),MELD score 0.71(95%CI:0.59-0.83),MELD-Na score 0.73(95%CI:0.62-0.84),and CLIF-C OF score 0.65(95%CI:0.52-0.78).CONCLUSIONThis study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF.CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF,but it was not superior to other well-established prognostic scores.展开更多
BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has ...BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.AIM To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.METHODS One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than 9.Baseline clinical and laboratory variables and decompensation events were collected.The ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic encephalopathy.RESULTS Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]mo.Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P<0.001).The odds ratio for decompensation in patients of the high-risk group was 23.33(95%CI:3.88-140.12,P=0.001).CONCLUSION The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.Those cirrhotic patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.展开更多
BACKGROUND Autoimmune liver disease(AILD)has been considered a relatively uncommon disease in China,epidemiological data for AILD in patients with cirrhosis and acute decompensation(AD)is sparse.AIM To investigate the...BACKGROUND Autoimmune liver disease(AILD)has been considered a relatively uncommon disease in China,epidemiological data for AILD in patients with cirrhosis and acute decompensation(AD)is sparse.AIM To investigate the prevalence,outcome and risk factors for AILD in cirrhotic patients complicated with AD in China.METHODS We collected data from patients with cirrhosis and AD from two prospective,multicenter cohorts in hepatitis B virus endemic areas.Patients were regularly followed up at the end of 28-d,90-d and 365-d,or until death or liver transplantation(LT).The primary outcome in this study was 90-d LTfree mortality.Acute-on-chronic liver failure(ACLF)was assessed on admission and during 28-d hospitalization,according to the diagnostic criteria of the European Association for the Study of the Liver(EASL).Risk factors for death were analyzed with logistic regression model.RESULTS In patients with cirrhosis and AD,the overall prevalence of AILD was 9.3%(242/2597).Prevalence of ACLF was significantly lower in AILD cases(14%)than those with all etiology groups with cirrhosis and AD(22.8%)(P<0.001).Among 242 enrolled AILD patients,the prevalence rates of primary biliary cirrhosis(PBC),autoimmune hepatitis(AIH)and PBC-AIH overlap syndrome(PBC/AIH)were 50.8%,28.5%and 12.0%,respectively.In ACLF patients,the proportions of PBC,AIH and PBC/AIH were 41.2%,29.4% and 20.6%.28-d and 90-d mortality were 43.8% and 80.0% in AILD-related ACLF.The etiology of AILD had no significant impact on 28-d,90-d or 365-d LTfree mortality in patients with cirrhosis and AD in both univariate and multivariate analysis.Total bilirubin(TB),hepatic encephalopathy(HE)and blood urea nitrogen(BUN)were independent risk factors for 90-d LT-free mortality in multivariate analysis.The development of ACLF during hospitalization only independently correlated to TB and international normalized ratio.CONCLUSION AILD was not rare in hospitalized patients with cirrhosis and AD in China,among which PBC was the most common etiology.90-d LT-free mortality were independently associated with TB,HE and BUN.展开更多
The formation of liver cirrhosis(LC) is an unfavorable event in the natural history of chronic liver diseases and with the development of portal hypertension and/or impaired liver function can cause a fatal outcome. D...The formation of liver cirrhosis(LC) is an unfavorable event in the natural history of chronic liver diseases and with the development of portal hypertension and/or impaired liver function can cause a fatal outcome. Decompensation of LC is considered the most important stratification variable for the risk of death. It is currently postulated that decompensation of LC occurs through an acute(including acute-on-chronic liver failure) and non-acute pathway. Acute decompensation of LC is accompanied by the development of life-threatening complications, characterized by an unfavorable prognosis and high mortality.Progress in understanding the underlying molecular mechanisms has led to the search for new interventions, drugs, and biological substances that can affect key links in the pathogenesis of acute decompensation in LC, for example the impaired gut-liver axis and associated systemic inflammation. Given that particular alterations in the composition and function of gut microbiota play a crucial role here, the study of the therapeutic possibilities of its modulation has emerged as one of the top concerns in modern hepatology. This review summarized the investigations that describe the theoretical foundations and therapeutic potential of gut microbiota modulation in acute decompensation of LC. Despite the encouraging preliminary data, the majority of the suggested strategies have only been tested in animal models or in preliminary clinical trials;additional multicenter randomized controlled trials must demonstrate their efficacy in larger patient populations.展开更多
AIM: To determine the safety profile of new hepatitis C virus (HCV) treatments in liver transplant (LT) recipients with recurrent HCV infection.METHODS: Forty-two patients were identified with recurrent HCV infection ...AIM: To determine the safety profile of new hepatitis C virus (HCV) treatments in liver transplant (LT) recipients with recurrent HCV infection.METHODS: Forty-two patients were identified with recurrent HCV infection that underwent LT at least 12 mo prior to initiating treatment with a Sofosbuvir-based regimen during December 2013-June 2014. Cases were patients who experienced hepatic decompensation and/or serious adverse events (SAE) during or within one month of completing treatment. Controls had no evidence of hepatic decompensation and/or SAE. HIV-infected patients were excluded. Cumulative incidence of decompensation/SAE was calculated using the Kaplan Meier method. Exact logistic regression analysis was used to identify factors associated with the composite outcome.RESULTS: Median age of the 42 patients was 60 years [Interquartile Range (IQR): 56-65 years], 33% (14/42) were female, 21% (9/42) were Hispanic, and 9% (4/42) were Black. The median time from transplant to treatment initiation was 5.4 years (IQR: 2.1-8.8 years). Thirteen patients experienced one or more episodes of hepatic decompensation and/or SAE. Anemia requiring transfusion, the most common event, occurred in 62% (8/13) patients, while 54% (7/13) decompensated. The cumulative incidence of hepatic decompensation/SAE was 31% (95%CI: 16%-41%). Risk factors for decompensation/SAE included lower pre-treatment hemoglobin (OR = 0.61 per g/dL, 95%CI: 0.40-0.88, P < 0.01), estimated glomerular filtration rate (OR = 0.95 per mL/min per 1.73 m<sup>2</sup>, 95%CI: 0.90-0.99, P = 0.01), and higher baseline serum total bilirubin (OR = 2.43 per mg/dL, 95%CI: 1.17-8.65, P < 0.01). The sustained virological response rate for the cohort of 42 patients was 45%, while it was 31% for cases.CONCLUSION: Sofosbuvir/ribavirin will continue to be used in the post-transplant population, including those with HCV genotypes 2 and 3. Management of anemia remains an important clinical challenge.展开更多
Cirrhosis is a leading cause of morbidity and mortality,impacting more than 120 million people worldwide.Although geographic differences exist,etiologic factors such as alcohol use disorder,chronic viral hepatitis inf...Cirrhosis is a leading cause of morbidity and mortality,impacting more than 120 million people worldwide.Although geographic differences exist,etiologic factors such as alcohol use disorder,chronic viral hepatitis infections,and non-alcoholic fatty liver disease are prevalent in nearly every region.Historically,significant effort has been devoted to modifying these risks to prevent disease progression.Nevertheless,more than 11%of patients with compensated cirrhosis experience hepatic decompensation each year.This transition signifies the most important prognostic factor in the natural history of the disease,corresponding to a decline in median survival to below 2 years.Over the past decade,the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized,and non-selective beta-blockers have emerged as the most effective option to date.However,a critical therapeutic gap still exists,and additional therapies have been proposed,including statins,rifaximin,and sodium-glucose cotransporter-2 inhibitors.Based on the results of innovative retrospective analyses and small-scale prospective trials,these pharmacotherapies represent promising options,but further studies,including randomized controlled trials,are necessary before they can be incorporated into clinical use.This report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis.展开更多
Background:To describe and discuss four cases of corneal endothelial decompensation secondary to chronic hypotony after glaucoma surgery.Methods:A retrospective case review was undertaken for four4 patients over a 20-...Background:To describe and discuss four cases of corneal endothelial decompensation secondary to chronic hypotony after glaucoma surgery.Methods:A retrospective case review was undertaken for four4 patients over a 20-year period from a single glaucoma surgeon.These data were collected from the clinical records of each subject included in the study:(I)patient demographic characteristics;(II)past ocular history and indication for surgery;(III)ocular vitals;(IV)complications from glaucoma surgery;(V)corneal exam and pathology and the indication for corneal transplant;(VI)surgical interventions during the period of follow-up.Results:Four patients sustained chronic hypotony(range,3-18 years)after glaucoma surgery.In most of these eyes during relative hypotony,long thin vertical folds were often noted in the superficial cornea(possibly involving Bowman’s layer and the epithelium),leading to fluorescein pooling.They subsequently developed marked corneal pathologies including stromal edema,diminished endothelial density,microcyst formation,corneal erosion,Descemet folds,superficial punctate keratitis and bullous keratopathy.Three of them received Descemet stripping automated endothelial keratoplasty(DSAEK)and regained functional vision.Conclusions:This case series demonstrates a unique clinical entity in which corneal endothelial demise developed in the context of chronic hypotony.The mechanism underlying this entity,which we term“chronic hypotony corneal endotheliopathy(CHCE)”,remains unclear.We hypothesize that it can be due to a combination of tectonic instability and energy disturbance of the cornea.In clinical practice,it is important to monitor endothelial cell count in patients with persistent hypotony,especially those who had procedures such as glaucoma surgery that can precipitate endothelial injury.展开更多
AIM To determine whether ribavirin(RBV) concentrations differ according to cirrhosis stage among cirrhotic patients treated with interferon-free regimens. METHODS We included patients with hepatitis C virus and cirrho...AIM To determine whether ribavirin(RBV) concentrations differ according to cirrhosis stage among cirrhotic patients treated with interferon-free regimens. METHODS We included patients with hepatitis C virus and cirrhosis [Child-Pugh(CP) A or B], Glomerular Filtration Rate ≥ 60 mL/min, who started therapy with DAAs and weightbased RBV between October 2014 and February 2016. RBV plasma levels were assessed during the treatment. We focused our analysis on the first 8 wk of therapy. RESULTS We studied 68 patients: 54 with compensated(CP-B) and 14 with decompensated(CP-A) cirrhosis. Patients withdecompensated cirrhosis displayed significantly higher RBV concentrations than those with compensated cirrhosis at week 1, 2, 4 and 8(P < 0.035). RBV levels were positively correlated with Hb loss over the treatment(P < 0.04). Majority(71%) of CP-B patients required a RBV dosage reduction during the treatment. After adjustment for confounders, Child-Pugh class remained significantly associated(95%CI: 35, 348, P = 0.017) to RBV levels, independently from baseline per-Kg RBV dosage. CONCLUSION Liver decompensation might affect RBV clearance leading to an overexposure and increased related toxicities in decompensated cirrhosis. Our findings underscore the importance of an early ribavirin therapeutic drug monitoring and suggest that an initial lower RBV dose, rather than weight-based, might be considered in those with advanced liver disease(CP-B) treated with directacting antivirals.展开更多
Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetu...Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.展开更多
Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,an...Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,and hepatic encephalopathy.This narrative review explores the pathophysiology of PH in cirrhosis,evaluates diagnostic methods for identifying clinically significant PH(CSPH),and discusses guideline-driven strategies to prevent initial and further decompensation.While HVPG remains the gold standard for diagnosing CSPH,non-invasive tools such as liver stiffness measurement and spleen stiffness measurement are increasingly used for initial risk stratification.The combined use of these tools reduces the proportion of patients in the diagnostic"grey zone".Endoscopic ultrasound-guided portal pressure gradient is an emerging diagnostic tool that requires further validation.Non-selective beta-blockers are the cornerstone of primary prophylaxis for decompensation,and their combination with endoscopic variceal ligation is the first-line therapy for secondary prophylaxis of recurrent esophageal variceal bleeding.Statins show promise in reducing PH and preventing decompensation while further studies are still needed.This review also discusses the indications for preemptive transjugular intrahepatic portosystemic shunt and its role in managing refractory ascites and variceal bleeding.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
Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an...Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt.Over time,TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension.From the outset,this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery.Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy,in fact this method is applicable to many patients with severe liver disease not suitable for it.TIPSS has been studied for the management of variceal bleeding,ascites,hepatic hydrothorax,hepatorenal syndrome,and other types of cirrhosis.However,some drawbacks of the TIPSS,such as shunt stenosis and hepatic encephalopathy,have also been reported in the literature.On the basis of the available evidence and the new epidemiological findings regarding liver disease,the following question may be posed:What is the place of TIPSS in current clinical practice?展开更多
Intraocular ointment is conventionally placed on the eye to prevent infection after cataract surgery.The purpose of this study is to report a case and conduct a systematic review of a rare occurrence of the entry of i...Intraocular ointment is conventionally placed on the eye to prevent infection after cataract surgery.The purpose of this study is to report a case and conduct a systematic review of a rare occurrence of the entry of intraocular ointment after cataract surgery.PubMed,Scopus,Embase,CNKI,WANFANG data,China Science and Technology Journal Database and Chinese Medical Journal Full-text Database were systematically searched from their commencement to 30 th October 2023,and 19 literatures were screened out and 31 cases of intraocular ointment after surgery were collected.Among the 31 patients,the age of presentation ranged from 55 to 87 years with a median of 73,males accounted for 45.2%and females accounted for 32.3%.The length of the incision was generally 3.2 mm.Most of the patients detected ointment within 3 days post-operation and presented without complications(45.2%).The most common ocular manifestations were corneal edema,glaucoma and uveitis.Early postoperative follow-up is very important.Presence of anterior chamber ointment is a rare complication after cataract surgery,but it can lead to severe vision loss if not detected and treated on time.When patients complain of foreign body sensation in the in the eye after cataract surgery,ophthalmologists need to take a kin interest and examine the eye for early detection of ointment for appropriate intervention and prevent further complications.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BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.
基金Supported by Xi’an Science and Technology Plan,No.23YXYJ0172.
文摘BACKGROUND The hepatic venous pressure gradient serves as a crucial parameter for assessing portal hypertension and predicting clinical decompensation in individuals with cirrhosis.However,owing to its invasive nature,there has been growing interest in identifying noninvasive alternatives.Transient elastography offers a promising approach for measuring liver stiffness and spleen stiffness,which can help estimate the likelihood of decompensation in patients with chronic liver disease.AIM To investigate the predictive ability of the liver stiffness measurement(LSM)and spleen stiffness measurement(SSM)in conjunction with other noninvasive indicators for clinical decompensation in patients suffering from compensatory cirrhosis and portal hypertension.METHODS This study was a retrospective analysis of the clinical data of 200 patients who were diagnosed with viral cirrhosis and who received computed tomography,transient elastography,ultrasound,and endoscopic examinations at The Second Affiliated Hospital of Xi’an Jiaotong University between March 2020 and November 2022.Patient classification was performed in accordance with the Baveno VI consensus.The area under the curve was used to evaluate and compare the predictive accuracy across different patient groups.The diagnostic effectiveness of several models,including the liver stiffness-spleen diameter-platelet ratio,variceal risk index,aspartate aminotransferase-alanine aminotransferase ratio,Baveno Ⅵ criteria,and newly developed models,was assessed.Additionally,decision curve analysis was carried out across a range of threshold probabilities to evaluate the clinical utility of these predictive factors.RESULTS Univariate and multivariate analyses demonstrated that SSM,LSM,and the spleen length diameter(SLD)were linked to clinical decompensation in individuals with viral cirrhosis.On the basis of these findings,a predictive model was developed via logistic regression:Ln[P/(1-P)]=-4.969-0.279×SSM+0.348×LSM+0.272×SLD.The model exhibited strong performance,with an area under the curve of 0.944.At a cutoff value of 0.56,the sensitivity,specificity,positive predictive value,and negative predictive value for predicting clinical decompensation were 85.29%,88.89%,87.89%,and 86.47%,respectively.The newly developed model demonstrated enhanced accuracy in forecasting clinical decompensation among patients suffering from viral cirrhosis when compared to four previously established models.CONCLUSION Noninvasive models utilizing SSM,LSM,and SLD are effective in predicting clinical decompensation among patients with viral cirrhosis,thereby reducing the need for unnecessary hepatic venous pressure gradient testing.
基金National Natural Science Foundation of China,No.81970550,No.82070613 and No.82370638Natural Science Foundation of Hunan Province,China,No.2021JJ31067 and No.2021JJ41048+1 种基金Hunan innovative province construction project,No.2023JJ10095Innovative Talented Project of Hunan province,China,No.2022RC1212.
文摘BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accurate identification of AD patients with high risk of development of ACLF and mortality.Soluble triggering receptor expressed on myeloid cells-1(sTREM-1)is released from activated innate immune cells and correlated with various inflammatory processes.AIM To explore the prognostic value of sTREM-1 in patients with AD of cirrhosis.METHODS A multicenter prospective cohort of 442 patients with cirrhosis hospitalized for AD was divided into a study cohort(n=309)and validation cohort(n=133).Demographic and clinical data were collected,and serum sTREM-1 was measured at admission.All enrolled patients were followed-up for at least 1 year.RESULTS In patients with AD and cirrhosis,serum sTREM-1 was an independent prognosis predictor for 1-year survival and correlated with liver,coagulation,cerebral and kidney failure.A new prognostic model of AD(P-AD)incorporating sTREM-1,blood urea nitrogen(BUN),total bilirubin(TBil),international normalized ratio(INR)and hepatic encephalopathy grades was established and performed better than the model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-consortium(CLIF-C)ACLF and CLIF-C AD scores.Additionally,sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d follow-up.The ACLF risk score incorporating serum sTREM-1,BUN,INR,TBil and aspartate aminotransferase levels was established and significantly superior to MELD,MELD-Na,CLIF-C ACLF,CLIF-C AD and P-AD in predicting risk of ACLF development.CONCLUSION Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.
文摘Acute decompensation in cirrhotic patients signifies the onset of clinically evident events due to portal hypertension.The transition from compensated to decom-pensated cirrhosis involves hemodynamic changes leading to multiorgan dysfun-ction,managed predominantly in outpatient settings with regular monitoring.The mortality risk is elevated in decompensated patients.Therefore,diligent outpatient management should focus on regular medical follow-ups,medication adjustments,patient education,addressing emergent issues and evaluation for liver transplantation.The ultimate goal is to improve quality of life,prevent di-sease progression,reduce complications,and assess possible recompensation.This guide provides valuable recommendations for medical experts managing de-compensated cirrhotic patients post-hospitalization.
基金Supported by National Science Technology Pillar Program in the 11th Five-Year Plan,No. 2008BAI59B03Research Special Fund for the Public Welfare Industry of Health,No.201202004
文摘AIM:To examine the clinical features and analyze prognostic factors in a prospective study of primary biliary cirrhosis(PBC) patients.METHODS:From 1995 to 2010,PBC patients without hepatic decompensation seen at the Peking Union Medical College Hospital were enrolled.Clinical signs and manifestations(pruritus,persistent fatigue,jaundice and pain in the right hypochondrium),laboratory parameters(auto-antibodies for autoimmune hepatic disease,biliary and hepatic enzymes,immunoglobulin,bilirubin,and albumin) and imaging findings were recorded at entry and at specific time points during follow-up.Cox regression and Kaplan-Meier analyses,respectively,assessed the risk factors for hepatic decompensation and survival.RESULTS:Two hundred and sixty-two PBC patients were enrolled with a median follow-up of 75.2 mo(range,21-201 mo).The 240 patients were aged 51.5 ± 10.2 years at diagnosis and 91.6% were female.Two hundred and forty-five(93.5%) were seropositive for anti-mitochondrial antibodies.At presentation,170 patients(64.9%) were symptomatic,while 96 patients(36.6%) had extra-hepatic autoimmune disease.During the follow-up period,62(23.7%) patients developed hepatic decompensation of whom four underwent liver transplantation and 17 died.The cumulative survival rate and median survival time were 83.9% and 181.7 mo,respectively.Cox regression analysis revealed that an incomplete ursodeoxycholic acid(UDCA) response or inconsistent treatment [P < 0.001;hazard risk(HR) 95%CI = 2.423-7.541],anti-centromere antibodies(ACA) positivity(P < 0.001;HR 95%CI = 2.516-7.137),alanine aminotransferase ratio(AAR) elevations(P < 0.001;HR 95%CI = 1.357-2.678),and histological advanced liver disease(P = 0.006;HR 95%CI = 1.481-10.847) were predictors of hepatic decompensation.The clinical features and survival of PBC in China are consistent with those described in Western countries.CONCLUSION:Incomplete UDCA response or inconsistent treatment,ACA positivity,AAR elevations,and advanced histological stage are predictors of decompensation.
文摘Liver cirrhosis (LC) is a critical stage of chronic liver disease, including that caused by hepatitis C virus (HCV). In the absence of antiviral therapy, 67%-91% of patients with HCV-related LC patients die of liver-related causes, including hepatocellular carcinoma (HCC) and liver failure. Among the therapeutic strategies used to prevent liver-related complications in these patients is standard therapy with pegylated interferon and ribavirin, which induces a sustained virological response (SVR) in 25% of HCV genotype 1-infected patients and in 69% of patients infected with genotypes 2 and 3. SVR in patients with HCV-related LC has been associated with reduced rates of hepatic decompensation, HCC, and mortality. More recently developed direct-acting antiviral agents have shown excellent antiviral efficacy, with preliminary data demonstrating that an interferon-free regimen that includes these direct-acting antiviral agents achieved SVR in more than 50% of patients with HCV genotype 1 LC. Branched-chain amino acid supplementation, improvement of insulin resistance, and the use of β-blockers for portal hypertension may also reduce liver-related complications. Here, we review advances in antiviral and adjunctive therapies for improved outcomes in patients with HCV-associated LC.
文摘To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.METHODSThis is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium(CLIF-C)acute decompensation score(CLIF-C AD)and CLIF-C acute-on-chronic liver failure score(CLIF-C ACLF),regarding 28-d and 90-d mortality,as well as to compare them to other prognostic models,such as Model for End-Stage Liver Disease(MELD),MELD Sodium(MELD-Na),Child-Pugh(CP)score,and the CLIF-C Organ Failure score(CLIF-C OF).All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil.Prognostic performances were evaluated by means of the receiver operating characteristic(ROC)curves,area under the curves(AUC)and 95%CI.RESULTSOne hundred and thirteen cirrhotic patients were included.At admission,18 patients had acute-on-chronic liver failure(ACLF)and 95 individuals had acute decompensation(AD)without ACLF,of which 24 eventually developed ACLF during the course of hospitalization(AD evolving to ACLF group).The AD group had significantly lower 28-d(9.0%)and 90-d(18.3%)mortality as compared to the AD evolving to ACLF group and to the ACLF group(both P<0.001).On the other hand,28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group(P=0.542 and P=0.708,respectively).Among patients with ACLF,at 28 d from the diagnosis,CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line,with an AUC(95%CI)of 0.71(95%CI:0.54-0.88,P=0.021).Among patients with AD,all prognostic scores performed significantly better than the reference line regarding 28-d mortality,presenting with similar AUCs:CLIF-C AD score 0.75(95%CI:0.63-0.88),CP score 0.72(95%CI:0.59-0.85),MELD score 0.75(95%CI:0.61-0.90),MELD-Na score 0.76(95%CI:0.61-0.90),and CLIF-C OF score 0.74(95%CI:0.60-0.88).The same occurred concerning AUCs for 90-d mortality:CLIF-C AD score 0.70(95%CI:0.57-0.82),CP score 0.73(95%CI:0.62-0.84),MELD score 0.71(95%CI:0.59-0.83),MELD-Na score 0.73(95%CI:0.62-0.84),and CLIF-C OF score 0.65(95%CI:0.52-0.78).CONCLUSIONThis study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF.CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF,but it was not superior to other well-established prognostic scores.
文摘BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.AIM To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.METHODS One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than 9.Baseline clinical and laboratory variables and decompensation events were collected.The ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic encephalopathy.RESULTS Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]mo.Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P<0.001).The odds ratio for decompensation in patients of the high-risk group was 23.33(95%CI:3.88-140.12,P=0.001).CONCLUSION The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.Those cirrhotic patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.
基金Supported by Shanghai Hospital Development Commission,No.SHDC2020CR1037Bthe National Key R&D Program of China,No.2017YFC0908100+7 种基金the National Science and Technology Major Project,No.2018ZX10302206,2018ZX10723203 and 2017ZX10202202Shanghai Municipal Education Commission-Guofeng Clinical Medicine Grant,No.20152213the National Natural Science Foundation of China,No.82170629,81930061,81900579,81970550,82070613,82070650,and 81972265Chongqing Natural Science Foundation,No.CSTC2019jcyj-zdxmX0004Beijing Municipal Science&Technology Commission,No.Z191100006619033Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program,No.2017BT01S131the Foundation for Innovative Research Groups of Hubei Provincial Natural Science Foundation,No.2018CFA031Guangdong Basic and Applied Basic Research Foundation,No.2020A1515010052.
文摘BACKGROUND Autoimmune liver disease(AILD)has been considered a relatively uncommon disease in China,epidemiological data for AILD in patients with cirrhosis and acute decompensation(AD)is sparse.AIM To investigate the prevalence,outcome and risk factors for AILD in cirrhotic patients complicated with AD in China.METHODS We collected data from patients with cirrhosis and AD from two prospective,multicenter cohorts in hepatitis B virus endemic areas.Patients were regularly followed up at the end of 28-d,90-d and 365-d,or until death or liver transplantation(LT).The primary outcome in this study was 90-d LTfree mortality.Acute-on-chronic liver failure(ACLF)was assessed on admission and during 28-d hospitalization,according to the diagnostic criteria of the European Association for the Study of the Liver(EASL).Risk factors for death were analyzed with logistic regression model.RESULTS In patients with cirrhosis and AD,the overall prevalence of AILD was 9.3%(242/2597).Prevalence of ACLF was significantly lower in AILD cases(14%)than those with all etiology groups with cirrhosis and AD(22.8%)(P<0.001).Among 242 enrolled AILD patients,the prevalence rates of primary biliary cirrhosis(PBC),autoimmune hepatitis(AIH)and PBC-AIH overlap syndrome(PBC/AIH)were 50.8%,28.5%and 12.0%,respectively.In ACLF patients,the proportions of PBC,AIH and PBC/AIH were 41.2%,29.4% and 20.6%.28-d and 90-d mortality were 43.8% and 80.0% in AILD-related ACLF.The etiology of AILD had no significant impact on 28-d,90-d or 365-d LTfree mortality in patients with cirrhosis and AD in both univariate and multivariate analysis.Total bilirubin(TB),hepatic encephalopathy(HE)and blood urea nitrogen(BUN)were independent risk factors for 90-d LT-free mortality in multivariate analysis.The development of ACLF during hospitalization only independently correlated to TB and international normalized ratio.CONCLUSION AILD was not rare in hospitalized patients with cirrhosis and AD in China,among which PBC was the most common etiology.90-d LT-free mortality were independently associated with TB,HE and BUN.
文摘The formation of liver cirrhosis(LC) is an unfavorable event in the natural history of chronic liver diseases and with the development of portal hypertension and/or impaired liver function can cause a fatal outcome. Decompensation of LC is considered the most important stratification variable for the risk of death. It is currently postulated that decompensation of LC occurs through an acute(including acute-on-chronic liver failure) and non-acute pathway. Acute decompensation of LC is accompanied by the development of life-threatening complications, characterized by an unfavorable prognosis and high mortality.Progress in understanding the underlying molecular mechanisms has led to the search for new interventions, drugs, and biological substances that can affect key links in the pathogenesis of acute decompensation in LC, for example the impaired gut-liver axis and associated systemic inflammation. Given that particular alterations in the composition and function of gut microbiota play a crucial role here, the study of the therapeutic possibilities of its modulation has emerged as one of the top concerns in modern hepatology. This review summarized the investigations that describe the theoretical foundations and therapeutic potential of gut microbiota modulation in acute decompensation of LC. Despite the encouraging preliminary data, the majority of the suggested strategies have only been tested in animal models or in preliminary clinical trials;additional multicenter randomized controlled trials must demonstrate their efficacy in larger patient populations.
基金Supported by National Institutes of Health,No.DA031095 and No.DK090317
文摘AIM: To determine the safety profile of new hepatitis C virus (HCV) treatments in liver transplant (LT) recipients with recurrent HCV infection.METHODS: Forty-two patients were identified with recurrent HCV infection that underwent LT at least 12 mo prior to initiating treatment with a Sofosbuvir-based regimen during December 2013-June 2014. Cases were patients who experienced hepatic decompensation and/or serious adverse events (SAE) during or within one month of completing treatment. Controls had no evidence of hepatic decompensation and/or SAE. HIV-infected patients were excluded. Cumulative incidence of decompensation/SAE was calculated using the Kaplan Meier method. Exact logistic regression analysis was used to identify factors associated with the composite outcome.RESULTS: Median age of the 42 patients was 60 years [Interquartile Range (IQR): 56-65 years], 33% (14/42) were female, 21% (9/42) were Hispanic, and 9% (4/42) were Black. The median time from transplant to treatment initiation was 5.4 years (IQR: 2.1-8.8 years). Thirteen patients experienced one or more episodes of hepatic decompensation and/or SAE. Anemia requiring transfusion, the most common event, occurred in 62% (8/13) patients, while 54% (7/13) decompensated. The cumulative incidence of hepatic decompensation/SAE was 31% (95%CI: 16%-41%). Risk factors for decompensation/SAE included lower pre-treatment hemoglobin (OR = 0.61 per g/dL, 95%CI: 0.40-0.88, P < 0.01), estimated glomerular filtration rate (OR = 0.95 per mL/min per 1.73 m<sup>2</sup>, 95%CI: 0.90-0.99, P = 0.01), and higher baseline serum total bilirubin (OR = 2.43 per mg/dL, 95%CI: 1.17-8.65, P < 0.01). The sustained virological response rate for the cohort of 42 patients was 45%, while it was 31% for cases.CONCLUSION: Sofosbuvir/ribavirin will continue to be used in the post-transplant population, including those with HCV genotypes 2 and 3. Management of anemia remains an important clinical challenge.
文摘Cirrhosis is a leading cause of morbidity and mortality,impacting more than 120 million people worldwide.Although geographic differences exist,etiologic factors such as alcohol use disorder,chronic viral hepatitis infections,and non-alcoholic fatty liver disease are prevalent in nearly every region.Historically,significant effort has been devoted to modifying these risks to prevent disease progression.Nevertheless,more than 11%of patients with compensated cirrhosis experience hepatic decompensation each year.This transition signifies the most important prognostic factor in the natural history of the disease,corresponding to a decline in median survival to below 2 years.Over the past decade,the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized,and non-selective beta-blockers have emerged as the most effective option to date.However,a critical therapeutic gap still exists,and additional therapies have been proposed,including statins,rifaximin,and sodium-glucose cotransporter-2 inhibitors.Based on the results of innovative retrospective analyses and small-scale prospective trials,these pharmacotherapies represent promising options,but further studies,including randomized controlled trials,are necessary before they can be incorporated into clinical use.This report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis.
文摘Background:To describe and discuss four cases of corneal endothelial decompensation secondary to chronic hypotony after glaucoma surgery.Methods:A retrospective case review was undertaken for four4 patients over a 20-year period from a single glaucoma surgeon.These data were collected from the clinical records of each subject included in the study:(I)patient demographic characteristics;(II)past ocular history and indication for surgery;(III)ocular vitals;(IV)complications from glaucoma surgery;(V)corneal exam and pathology and the indication for corneal transplant;(VI)surgical interventions during the period of follow-up.Results:Four patients sustained chronic hypotony(range,3-18 years)after glaucoma surgery.In most of these eyes during relative hypotony,long thin vertical folds were often noted in the superficial cornea(possibly involving Bowman’s layer and the epithelium),leading to fluorescein pooling.They subsequently developed marked corneal pathologies including stromal edema,diminished endothelial density,microcyst formation,corneal erosion,Descemet folds,superficial punctate keratitis and bullous keratopathy.Three of them received Descemet stripping automated endothelial keratoplasty(DSAEK)and regained functional vision.Conclusions:This case series demonstrates a unique clinical entity in which corneal endothelial demise developed in the context of chronic hypotony.The mechanism underlying this entity,which we term“chronic hypotony corneal endotheliopathy(CHCE)”,remains unclear.We hypothesize that it can be due to a combination of tectonic instability and energy disturbance of the cornea.In clinical practice,it is important to monitor endothelial cell count in patients with persistent hypotony,especially those who had procedures such as glaucoma surgery that can precipitate endothelial injury.
文摘AIM To determine whether ribavirin(RBV) concentrations differ according to cirrhosis stage among cirrhotic patients treated with interferon-free regimens. METHODS We included patients with hepatitis C virus and cirrhosis [Child-Pugh(CP) A or B], Glomerular Filtration Rate ≥ 60 mL/min, who started therapy with DAAs and weightbased RBV between October 2014 and February 2016. RBV plasma levels were assessed during the treatment. We focused our analysis on the first 8 wk of therapy. RESULTS We studied 68 patients: 54 with compensated(CP-B) and 14 with decompensated(CP-A) cirrhosis. Patients withdecompensated cirrhosis displayed significantly higher RBV concentrations than those with compensated cirrhosis at week 1, 2, 4 and 8(P < 0.035). RBV levels were positively correlated with Hb loss over the treatment(P < 0.04). Majority(71%) of CP-B patients required a RBV dosage reduction during the treatment. After adjustment for confounders, Child-Pugh class remained significantly associated(95%CI: 35, 348, P = 0.017) to RBV levels, independently from baseline per-Kg RBV dosage. CONCLUSION Liver decompensation might affect RBV clearance leading to an overexposure and increased related toxicities in decompensated cirrhosis. Our findings underscore the importance of an early ribavirin therapeutic drug monitoring and suggest that an initial lower RBV dose, rather than weight-based, might be considered in those with advanced liver disease(CP-B) treated with directacting antivirals.
基金supported by the National Key R&D Program of China (grant no.2019YFC1005105).
文摘Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.
基金Supported by Quebec Health Research Fund Clinician Research Scholars Junior 1,No.350546.
文摘Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,and hepatic encephalopathy.This narrative review explores the pathophysiology of PH in cirrhosis,evaluates diagnostic methods for identifying clinically significant PH(CSPH),and discusses guideline-driven strategies to prevent initial and further decompensation.While HVPG remains the gold standard for diagnosing CSPH,non-invasive tools such as liver stiffness measurement and spleen stiffness measurement are increasingly used for initial risk stratification.The combined use of these tools reduces the proportion of patients in the diagnostic"grey zone".Endoscopic ultrasound-guided portal pressure gradient is an emerging diagnostic tool that requires further validation.Non-selective beta-blockers are the cornerstone of primary prophylaxis for decompensation,and their combination with endoscopic variceal ligation is the first-line therapy for secondary prophylaxis of recurrent esophageal variceal bleeding.Statins show promise in reducing PH and preventing decompensation while further studies are still needed.This review also discusses the indications for preemptive transjugular intrahepatic portosystemic shunt and its role in managing refractory ascites and variceal bleeding.
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Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt.Over time,TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension.From the outset,this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery.Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy,in fact this method is applicable to many patients with severe liver disease not suitable for it.TIPSS has been studied for the management of variceal bleeding,ascites,hepatic hydrothorax,hepatorenal syndrome,and other types of cirrhosis.However,some drawbacks of the TIPSS,such as shunt stenosis and hepatic encephalopathy,have also been reported in the literature.On the basis of the available evidence and the new epidemiological findings regarding liver disease,the following question may be posed:What is the place of TIPSS in current clinical practice?
文摘Intraocular ointment is conventionally placed on the eye to prevent infection after cataract surgery.The purpose of this study is to report a case and conduct a systematic review of a rare occurrence of the entry of intraocular ointment after cataract surgery.PubMed,Scopus,Embase,CNKI,WANFANG data,China Science and Technology Journal Database and Chinese Medical Journal Full-text Database were systematically searched from their commencement to 30 th October 2023,and 19 literatures were screened out and 31 cases of intraocular ointment after surgery were collected.Among the 31 patients,the age of presentation ranged from 55 to 87 years with a median of 73,males accounted for 45.2%and females accounted for 32.3%.The length of the incision was generally 3.2 mm.Most of the patients detected ointment within 3 days post-operation and presented without complications(45.2%).The most common ocular manifestations were corneal edema,glaucoma and uveitis.Early postoperative follow-up is very important.Presence of anterior chamber ointment is a rare complication after cataract surgery,but it can lead to severe vision loss if not detected and treated on time.When patients complain of foreign body sensation in the in the eye after cataract surgery,ophthalmologists need to take a kin interest and examine the eye for early detection of ointment for appropriate intervention and prevent further complications.
