scholarly journals Melatonin Levels in Serum and Ascitic Fluid of Patients with Hepatic Encephalopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Cezary Chojnacki ◽  
Marek Romanowski ◽  
Katarzyna Winczyk ◽  
Janusz Błasiak ◽  
Jan Chojnacki
Keyword(s):  
Hepatic Encephalopathy ◽  
Ascitic Fluid ◽  
Sleep Disturbances ◽  
Clinical Manifestations ◽  
Serum Levels ◽  
Ammonia Concentration ◽  
Blood Levels ◽  
Radioimmune Assay ◽  
Cirrhotic Patients ◽  
Ascetic Fluid

Cirrhotic patients exhibit disturbed melatonin homeostasis, which may lead to sleep disturbances, but an influence on the hepatic encephalopathy has not been elucidated.Aim. In the present study, the association of melatonin levels in serum and ascitic fluid and ammonia concentration related to the intensity of hepatic encephalopathy (HE) was investigated.Material and Methods. The study included 90 alcoholic patients with hepatic encephalopathy and 30 healthy volunteers (C). Patients were divided in three groups according to 0–4 West-Haven Score: HE1(n=28), HE2(n=30), and HE3(n=32). Melatonin was measured by radioimmune assay.Results. In fasting patients with hepatic encephalopathy we noted higher melatonin serum levels [pg/mL] than in healthy subjects groups: C—11.3 ± 3.9, HE1– 34.3 ± 12.2(P<0.01), HE2—54.8 ± 23.9, and HE3—119.8 ± 96.4(P<0.001). No correlation between melatonin and ammonia levels was found. Melatonin was detected in ascetic fluid in 24 patients of group HE2and 27 patients of group HE2of hepatic encephalopathy.Conclusions. Our results suggest that high blood levels of melatonin in cirrhotic liver patients may account for some of the clinical manifestations of hepatic encephalopathy, for example, daytime sleepiness, fatigue.

scholarly journals Spectrum of bacterial infections and predictors of mortality in adult cirrhotic patients

2019 ◽  
Author(s):  
Chandrashekar Udyavara Kudru ◽  
Vandana Kalwaje Eshwara ◽  
Shivashankara Kaniyoor Nagiri ◽  
Vasudeva Guddattu
Keyword(s):  
Acute Kidney Injury ◽  
Hepatic Encephalopathy ◽  
Ascitic Fluid ◽  
Bacterial Infections ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Multivariate Logistic Regression ◽  
Factors Associated ◽  
Organ Systems ◽  
Cirrhotic Patients

Introduction. Bacterial infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease and account for significant morbidity and mortality in them. Once an infection develops, it induces excessive production of pro-inflammatory cytokines leading to organ failure and death. Aims. This study aims to identify the clinical characteristics and outcome of bacterial infections affecting various organ systems in patients with liver cirrhosis and to determine factors associated with mortality. Materials and methods. A cross sectional study was performed on subjects with cirrhosis having microbiologically proven bacterial infection involving various organ systems, admitted to a tertiary care hospital in southern India. Demographic, clinical data, laboratory parameters and outcome details were noted. Univariate associations and subsequent multivariate logistic regression analysis was performed to determine factors associated with mortality. Results. The study included 158 patients. Chronic alcohol intake was the most common etiology of cirrhosis (66.4%). Community acquired infections occurred more frequently than hospital acquired infections (85.5% vs 14.5%). The common site of isolation of etiological agent was ascitic fluid (38.3%) followed by blood (24.3%), respiratory tract (15.5%) and urinary tract (14.5%). Gram negative bacterial infections were more common (74.3%), Escherichia coli being the most frequent pathogen (38.5%). Mortality was noted in 38 (24%) patients. The factors associated with mortality were the type of infection, Child Pugh category, acute kidney injury, hepatic encephalopathy, urinary tract infection, and creatinine and bilirubin levels. Multivariate logistic regression analysis revealed that type of infection (OR: 0.33, 95% CI: 0.11-1.01), ascitic fluid infection (OR: 2.81, 95% CI: 1.11-7.12), hepatic encephalopathy (OR: 0.17, 95% CI: 0.070-0.422) and acute kidney injury (OR: 0.19, 95% CI: 0.077-0.502) were significantly associated with in-hospital mortality. Conclusion. This study indicates that the type of infection, hepatic encephalopathy, ascitic fluid infection and acute kidney injury are associated with mortality in cirrhotic patients. Early effective treatment and prevention of these complications may help modify the outcome.

scholarly journals Hepatic encephalopathy: issues relevant to clinical practice

2021 ◽  
pp. 104-108
Author(s):  
M. V. Maevskaya
Keyword(s):  
Liver Cirrhosis ◽  
Clinical Practice ◽  
Hepatic Encephalopathy ◽  
Clinical Signs ◽  
Ammonia Concentration ◽  
High Concentration ◽  
Expert Opinions ◽  
Diagnostic Role ◽  
Cirrhotic Patients

Hepatic encephalopathy (HE) remains one of the most serious complications of liver cirrhosis. Its clinical spectrum sometimes creates difficulties in the optimal diagnosis at the patient’s bedside and treatment. To present new data on the field of clinical management of cirrhotic patients with hepatic encephalopathy. The role of ammonia in the diagnosis of HE is still under discussion. In clinical practice, in patients with suspected overt HE, normal ammonia concentration can be used to exclude this diagnosis. In contrast, a high concentration of ammonia in the absence of clinical signs of HE should not serve as a criterion for this diagnosis and as a guide for treatment. A separate issue for discussion is the covert HE. The simplest and most affordable test for screening for covert HE and evaluating the effectiveness of therapy is the animal naming test, which can be done on bedside by physician or caregivers. Patients with covert HE need treatment that is similar in approach to overt HE. The diagnosis of overt HE and the methods of its therapy are well known. According to Russian recommendations, depending on the disease course in a certain patient, lactulose, rifaximin, L-ornithine L-aspartate can be used as first-line drugs, which is applicable to the treatment of both overt and latent PE. The main issues on the management of HE in liver cirrhosis relate to the diagnostic role of ammonia, optimal diagnosis and treatment strategy for covert HE, therapy of choice for both overt and latent HE. There are expert opinions and consensus documents on all these issues. Treatment of overt and latent PE is carried out according to the same principles. Drugs of choice: lactulose, rifaximin and L-Ornithine L-Aspartate.

scholarly journals Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

2015 ◽  
Vol 28 (4) ◽  
pp. 480 ◽  
Author(s):  
Mara Barbosa ◽  
Carla Marinho ◽  
Paula Mota ◽  
José Cotter
Keyword(s):  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Venous Blood ◽  
Minimal Hepatic Encephalopathy ◽  
Ammonia Concentration ◽  
Meld Score ◽  
Published Data ◽  
Cross Sectional ◽  
Cirrhotic Patients ◽  
The Mean

<p><strong>Introduction: </strong>Minimal hepatic encephalopathy refers to a mild neurocognitive impairment not detectable by clinical examination that can be present in cirrhotic patients.<br /><strong>Aim:</strong> To determine the prevalence of minimal hepatic encephalopathy in a secondary healthcare center in Northern Portugal.<br /><strong>Material and Methods:</strong> A cross-sectional study was conducted. Cirrhotic outpatients were included. Exclusion criteria: overt hepatic encephalopathy, illiteracy, active alcohol consumption, psychotropic drug use and therapy with lactulose. The presence of minimal hepatic encephalopathy was defined as a value ≤ -4 on the Psychometric Hepatic Encephalopathy Score, calculated according to the Portuguese norms. Variables analyzed: etiology and severity of liver disease and venous blood ammonia concentration. p values &lt;<br />0.05 were considered significant.<br /><strong>Results: </strong>From the 102 patients who were evaluated, 41 were included: 31 males, mean age 57 ± 10 years, mean education 5 ± 2 years, 31 in Child-Pugh class A, mean MELD score 6 ± 3. Minimal hepatic encephalopathy was diagnosed in 14 (34%) patients. The presence of minimal hepatic encephalopathy was unrelated to severity of liver disease. Despite being more elevated, the mean venous ammonia concentration in minimal hepatic encephalopathy patients was not statistically different from the mean venous ammonia concentration in non-minimal hepatic encephalopathy patients (48.5 ± 13.3 vs. 45.6 ± 15.6 μmol/L, p = 0.555).<br /><strong>Discussion:</strong> The prevalence of minimal hepatic encephalopathy reported is in accordance with the international published data.<br /><strong>Conclusion:</strong> Minimal hepatic encephalopathy is a frequent condition that is present early in the course of cirrhosis, even in compensated cirrhotic patients. Therefore, this hidden entity should be actively pursued and managed properly.</p>

scholarly journals Diagnostic value of serum procalcitonin level in the diagnosis of the spontaneous bacterial peritonitis

2020 ◽  
Vol 6 (2) ◽  
pp. e19-e19
Author(s):  
Rasoul Estakhri ◽  
Lachin Bartari ◽  
Morteza Ghojazadeh
Keyword(s):  
Ascitic Fluid ◽  
Sensitivity And Specificity ◽  
Spontaneous Bacterial Peritonitis ◽  
White Blood Cells ◽  
Serum Levels ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Introduction: Spontaneous bacterial peritonitis (SBP) is an infectious ascitic fluid with an unknown intraabdominal source. Rapid diagnosis of infection can improve prognosis in cirrhotic patients. Objectives: We aim to determine the diagnostic value of serum procalcitonin (PCT) and C-reactive protein (CRP) in SBP. Patients and Methods: In this cross-sectional study, we included 120 cirrhotic patients with possible diagnosis of SBP asities. Serum and ascitic fluid samples were taken from the patient before initiating antibiotics. The ascitic fluid parameters, serum levels of CRP, PCT and white blood cells were measured and the diagnostic value of the CRP and PCT were evaluated. Results: Of 120 patients, 59.16% had confirmed SBP. PCT with a cutoff of 0.8 ng/mL and CRP with cutoff of 10.5 mg/L had a sensitivity of 90.91% and 86.11% and specificity of 91.5% and 81.25% respectively in diagnosing of SBP. Considering PCT above 0.8 ng/mL and CRP above 10.5 mg/L both, they had the sensitivity and specificity of 96.87% and 83.92% in detecting SBP in cirrhotic patients. Conclusion: Serum PCT and CRP levels could predict SBP in cirrhotic patients while PCT had the most sensitivity and specificity. Considering both parameters, the sensitivity will increase, but the specificity is decreasing. Both PCT and CRP levels could be used as a less invasive method compared to ascites fluid analysis in diagnosing SBP.

Serum Zinc Levels in Cirrhotic Patients Attending General and Specialty Hospitals, Yangon

2019 ◽  
Vol 31 (3) ◽  
pp. 251-256
Keyword(s):  
Clinical Practice ◽  
Hepatic Encephalopathy ◽  
Zinc Deficiency ◽  
Serum Zinc ◽  
Zinc Level ◽  
The Body ◽  
Serum Zinc Level ◽  
Cross Sectional ◽  
Cirrhotic Patients ◽  
Cirrhosis Of Liver

Cirrhosis of liver is one of the common medical problem in daily clinical practice and one of the leading causes of morbidity and mortality. Zinc is an essential trace elements for human and plays in many biological roles in the body. Among them, zinc deficiency is thought to be involved in metabolism of ammonia and causes hyperammonia that worsen hepatic encephalopathy. This study aimed to find out the severity of cirrhosis of liver was by Child Turcotte Pugh score and to investigate the associations between serum zinc level and severity of cirrhosis. A hospital-based cross-sectional descriptive study was performed on 78 patients with different underlying causes of cirrhosis of liver at the Medical Units of Yangon General Hospital and Yangon Specialty Hospital. Among the study population, Child grade A was found to be 28.21%, Child grade B was 30.77% and Child grade C was 41.03%. Regarding result of serum zinc level, 62.8% were low level, 28.2% were within normal level and 8.9% were high level. Mean value of serum zinc level in grade A was 0.68 mg/l, grade B was 0.54 mg/l and grade C was 0.48 mg/l (p=0.00). It was found out that there was a high prevalence of zinc deficiency in severe cirrhotic patients. The zinc level was significantly lowest among patients with Child-Pugh C as compare to those with Child-Pugh B and C. Severity of zinc deficiency should be requested for supplementation therapy in cirrhotic patients as to prevent complications such as hepatic encephalopathy, hepatocellular carcinoma and liver failure. Screening for zinc deficiency may need in these patients with more advanced cirrhosis because it seems to be a marker of advanced liver disease and it can be deducted that awareness of serum zinc level among cirrhotic patients is very important in clinical practice.

scholarly journals Reassessing the Role of the Active TGF-β1 as a Biomarker in Systemic Sclerosis: Association of Serum Levels with Clinical Manifestations

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Andréa Tavares Dantas ◽  
Sayonara Maria Calado Gonçalves ◽  
Anderson Rodrigues de Almeida ◽  
Rafaela Silva Guimarães Gonçalves ◽  
Maria Clara Pinheiro Duarte Sampaio ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Clinical Manifestations ◽  
Serum Levels ◽  
Vascular Involvement ◽  
Digital Ulcers ◽  
Serum Samples ◽  
Peripheral Blood Mononuclear ◽  
Pbmc Culture ◽  
Significant Difference ◽  
Skin Biopsies

Objective. To determine active TGF-β1 (aTGF-β1) levels in serum, skin, and peripheral blood mononuclear cell (PBMC) culture supernatants and to understand their associations with clinical parameters in systemic sclerosis (SSc) patients.Methods. We evaluated serum samples from 56 SSc patients and 24 healthy controls (HC). In 20 SSc patients, we quantified spontaneous or anti-CD3/CD28 stimulated production of aTGF-β1 by PBMC. The aTGF-β1 levels were measured by ELISA. Skin biopsies were obtained from 13 SSc patients and six HC, and TGFB1 expression was analyzed by RT-PCR.Results. TGF-β1 serum levels were significantly higher in SSc patients than in HC (p< 0.0001). Patients with increased TGF-β1 serum levels were more likely to have diffuse subset (p= 0.02), digital ulcers (p= 0.02), lung fibrosis (p< 0.0001), positive antitopoisomerase I (p= 0.03), and higher modified Rodnan score (p= 0.046). Most of our culture supernatant samples had undetectable levels of TGF-β1. No significant difference in TGFB1 expression was observed in the SSc skin compared with HC skin.Conclusion. Raised active TGF-β1 serum levels and their association with clinical manifestations in scleroderma patients suggest that this cytokine could be a marker of fibrotic and vascular involvement in SSc.

Changes in growth rate and thyroid- and sex-hormones blood levels in rats under sub-chronic lithium treatment

2006 ◽  
Vol 25 (5) ◽  
pp. 243-250 ◽  
Author(s):  
M S Allagui ◽  
N Hfaiedh ◽  
C Vincent ◽  
F Guermazi ◽  
J-C Murat ◽  
...  
Keyword(s):  
Growth Rate ◽  
Lithium Treatment ◽  
Lithium Carbonate ◽  
Serum Levels ◽  
Antagonistic Effect ◽  
Blood Levels ◽  
Vaginal Mucosa ◽  
Dependent Manner ◽  
Serum Concentrations ◽  
Dose Dependent

Lithium therapy, mainly used in curing some psychiatric diseases, is responsible for numerous undesirable side effects. The present study is a contribution to the understanding of the pathophysiological mechanisms underlying lithium toxicity. Male and female mature rats were divided into three batches and fed commercial pellets: one batch was the control and the second and third batches were given 2 g (Li1) and 4 g (Li2) of lithium carbonate/kg of food/day, respectively. After 7, 14, 21 and 28 days, serum levels of free tri-iodothyronine (FT3), thyroxine (FT4), testosterone and estradiol were measured. Attention was also paid to growth rate and a histological examination of testes or vaginal mucosa was carried out. In treated rats, a dose-dependent loss of appetite and a decrease in growth rate were observed, together with symptoms of polydypsia, polyuria and diarrhea. Lithium serum concentrations increased from 0.44 mM (day 7) to 1.34 mM (day 28) in Li1 rats and from 0.66 to 1.45 mM (day 14) in Li2 rats. Li2 treatment induced a high mortality after 14 days, reaching 50-60% in female and male animals. From these data, the LD50 (14 days Li2 chronic treatment) was calculated to be about 0.3 g/day per kilogram of animal, leading to Li serum concentrations of about 1.4 mM. A significant decrease of FT3 and FT4 was observed in treated rats. This effect appeared immediately for the highest dose and was more pronounced for FT3, resulting in an increase of the FT4/FT3 ratio. In males, testosterone decreased and spermatogenesis was stopped. Conversely, in females, estradiol increased in a dose-dependent manner as the animals were blocked in the diestrus phase at day 28. This finding supports a possible antagonistic effect of lithium on the estradiol receptors.

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