Periodontal diseases are prevalent among the general population and are associated with several systemic conditions,such as chronic kidney disease and type 2 diabetes mellitus.Chronic liver disease and cirrhosis have ...Periodontal diseases are prevalent among the general population and are associated with several systemic conditions,such as chronic kidney disease and type 2 diabetes mellitus.Chronic liver disease and cirrhosis have also been linked with periodontal disease,an association with complex underlying mechanisms,and with potential prognostic implications.Multiple factors can explain this relevant association,including nutritional factors,alcohol consumption,disruption of the oral-gut-liver axis and associated dysbiosis.Additionally,patients with liver disease have been observed to exhibit poorer oral hygiene practices compared with the general population,potentially predisposing them to the development of periodontal disease.Therefore,it is recommended that all patients with liver disease undergo screening and subsequent treatment for periodontal disease.Treatment of periodontal disease in patients with cirrhosis may help reduce liver-derived inflammatory damage,with recent research indicating a potential benefit in terms of reduced mortality.However,further studies on periodontal disease treatment in patients with liver disease are still warranted to determine optimal management strategies.This narrative review describes current concepts on the association between periodontal disease and chronic liver disease.展开更多
Background Severe alcohol-associated hepatitis(sAH)is a life-threatening condition with high mortality,where corticosteroid use is the only treatment that has shown short-term benefits.Pentoxifylline,an anti-tumour ne...Background Severe alcohol-associated hepatitis(sAH)is a life-threatening condition with high mortality,where corticosteroid use is the only treatment that has shown short-term benefits.Pentoxifylline,an anti-tumour necrosis factor-alpha agent,has been proposed for its potential to improve outcomes,especially in patients with acute kidney injury(AKI).We aimed to evaluate the impact of pentoxifylline on mortality in patients with sAH and AKI in a well-characterised global cohort.Methods We conducted a retrospective,registry-based study including patients meeting the National Institute on Alcohol Abuse and Alcoholism clinical criteria for sAH and AKI.Mortality was the primary endpoint,with liver transplantation as a competing risk.Statistical analysis included Cox regression and Kaplan-Meier survival estimates.Results We included 525 patients from 20 centres across eight countries.The median age was 48 years,with 26.1%females,and 76.9%had a history of cirrhosis.Multivariable Cox regression models showed that pentoxifylline use was not associated with survival(HR 1.20,95%CI 0.85 to 1.69,p=0.291).Factors associated with mortality included age(HR 1.23,95%CI 1.10 to 1.36,p<0.001),Model for End-Stage Liver Disease score at admission(HR 1.06,95%CI 1.04 to 1.08,p<0.001)and renal replacement therapy use(HR 1.39,95%CI 1.05 to 1.84,p=0.019).The main causes of death were multiple organ failure(42%),infections(10%),oesophageal varices bleeding(7%)and renal failure(6%).Conclusion Pentoxifylline showed no significant benefit on mortality in patients with sAH and AKI.Further studies are needed to refine treatment strategies for this high-risk group.展开更多
基金support from the Chilean government through the Fondo Nacional de Desarrollo Científico y Tecnológico(FONDECYT 1241450).
文摘Periodontal diseases are prevalent among the general population and are associated with several systemic conditions,such as chronic kidney disease and type 2 diabetes mellitus.Chronic liver disease and cirrhosis have also been linked with periodontal disease,an association with complex underlying mechanisms,and with potential prognostic implications.Multiple factors can explain this relevant association,including nutritional factors,alcohol consumption,disruption of the oral-gut-liver axis and associated dysbiosis.Additionally,patients with liver disease have been observed to exhibit poorer oral hygiene practices compared with the general population,potentially predisposing them to the development of periodontal disease.Therefore,it is recommended that all patients with liver disease undergo screening and subsequent treatment for periodontal disease.Treatment of periodontal disease in patients with cirrhosis may help reduce liver-derived inflammatory damage,with recent research indicating a potential benefit in terms of reduced mortality.However,further studies on periodontal disease treatment in patients with liver disease are still warranted to determine optimal management strategies.This narrative review describes current concepts on the association between periodontal disease and chronic liver disease.
基金support from the Chilean government through the Fondo Nacional de Desarrollo Científico y Tecnológico(FONDECYT 1241450).
文摘Background Severe alcohol-associated hepatitis(sAH)is a life-threatening condition with high mortality,where corticosteroid use is the only treatment that has shown short-term benefits.Pentoxifylline,an anti-tumour necrosis factor-alpha agent,has been proposed for its potential to improve outcomes,especially in patients with acute kidney injury(AKI).We aimed to evaluate the impact of pentoxifylline on mortality in patients with sAH and AKI in a well-characterised global cohort.Methods We conducted a retrospective,registry-based study including patients meeting the National Institute on Alcohol Abuse and Alcoholism clinical criteria for sAH and AKI.Mortality was the primary endpoint,with liver transplantation as a competing risk.Statistical analysis included Cox regression and Kaplan-Meier survival estimates.Results We included 525 patients from 20 centres across eight countries.The median age was 48 years,with 26.1%females,and 76.9%had a history of cirrhosis.Multivariable Cox regression models showed that pentoxifylline use was not associated with survival(HR 1.20,95%CI 0.85 to 1.69,p=0.291).Factors associated with mortality included age(HR 1.23,95%CI 1.10 to 1.36,p<0.001),Model for End-Stage Liver Disease score at admission(HR 1.06,95%CI 1.04 to 1.08,p<0.001)and renal replacement therapy use(HR 1.39,95%CI 1.05 to 1.84,p=0.019).The main causes of death were multiple organ failure(42%),infections(10%),oesophageal varices bleeding(7%)and renal failure(6%).Conclusion Pentoxifylline showed no significant benefit on mortality in patients with sAH and AKI.Further studies are needed to refine treatment strategies for this high-risk group.
