scholarly journals Hepatic Encephalopathy: From the Pathogenesis to the New Treatments

2014 ◽  
Vol 2014 ◽  
pp. 1-16 ◽  
Author(s):  
Juan Cordoba
Keyword(s):  
Clinical Trials ◽  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Prospective Studies ◽  
Hepatic Dysfunction ◽  
Short Term ◽  
Multiple Factors ◽  
Short Term Mortality ◽  
Cirrhotic Patients ◽  
New Treatments

Hepatic encephalopathy is a frequent and serious complication of liver cirrhosis; the pathophysiology of this complication is not fully understood although great efforts have been made during the last years. There are few prospective studies on the epidemiology of this complication; however, it is known that it confers with high short-term mortality. Hepatic encephalopathy has been classified into different groups depending on the degree of hepatic dysfunction, the presence of portal-systemic shunts, and the number of episodes. Due to the large clinical spectra of overt EH and the complexity of cirrhotic patients, it is very difficult to perform quality clinical trials for assessing the efficacy of the treatments proposed. The physiopathology, clinical manifestation, and the treatment of HE is a challenge because of the multiple factors that converge and coexist in an episode of overt HE.

scholarly journals A model predicting short-term mortality in patients with advanced liver cirrhosis and concomitant infection

Medicine ◽  
2018 ◽  
Vol 97 (41) ◽  
pp. e12758 ◽  
Author(s):  
Ying Li ◽  
Roongruedee Chaiteerakij ◽  
Jung Hyun Kwon ◽  
Jeong Won Jang ◽  
Hae Lim Lee ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Short Term ◽  
Concomitant Infection ◽  
Advanced Liver Cirrhosis ◽  
Short Term Mortality

scholarly journals Low Serum 25-Hydroxy Vitamin D (25-OHD) and Hepatic Encephalopathy in HCV-Related Liver Cirrhosis

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Mohamed Abd Ellatif Afifi ◽  
Ahmed Mohamed Hussein ◽  
Mahmoud Rizk
Keyword(s):  
Vitamin D ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Wide Spectrum ◽  
The Other ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Cirrhotic Patients ◽  
Low Serum

Background. Patients with liver cirrhosis experience a large variety of metabolic disorders associated with more hepatic decompensation. Hepatic encephalopathy (HE) is a significant complication in liver cirrhosis patients, presenting a wide spectrum of neuropsychological symptoms. A deficiency of 25-hydroxy vitamin D (25-OHD) in the general population is associated with a loss of cognitive function, dementia, and Alzheimer’s disease. Aim of the Study. Our study aims to check the relationship between low serum 25-OHD and HE in patients with HCV-related liver cirrhosis and assess its link with patient mortality. Patients and Methods. This study was observationally carried out on 100 patients with HCV-related liver cirrhosis. The patients were divided into 2 groups: Group A—included 50 HCV-related cirrhotic patients with HE, and Group B—included 50 HCV-related cirrhotic patients without HE. Assessment of disease severity using the end-stage liver disease (MELD) model and Child Turcotte Pugh (CTP) scores were done, and 25-OHD levels were measured. Comparison of vitamin D levels in different etiologies and different CTP categories was made using one-way ANOVA. Pearson’s correlation between the level of vitamin D and other biomarkers was applied. Results. There was a statistically significant Vitamin D level difference between the two groups. A lower level of vitamin D was observed in the HE group where the severe deficiency was 16%, while it was 6% in the other group and the moderate deficiency was 24% in HE group as compared to 10% in the other group. The insufficient vitamin D level represented 46% of the non-HE group while none of the HE group falls in this category. Vitamin D level was statistically higher in Grade 1 HE than in Grade 2 which is higher than in Grades 3 to 4. Vitamin D level was also significantly higher in those who improved from HE as compared to those who died. Conclusion. The lower levels of 25-OHD were associated with the higher incidence of HE in cirrhotic HCV patients. The worsening vitamin D deficiency was associated with increased severity of the liver disease, so vitamin D may be considered a prognostic factor for the severity of liver cirrhosis and high mortality rate in HE patients.

scholarly journals Investigation of Bacteremia due toAeromonasSpecies and Comparison with That due to Enterobacteria in Patients with Liver Cirrhosis

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Toru Shizuma ◽  
Chiharu Tanaka ◽  
Hidezo Mori ◽  
Naoto Fukuyama
Keyword(s):  
Liver Cirrhosis ◽  
Japanese Patients ◽  
Meld Score ◽  
Short Term ◽  
E Coli ◽  
End Stage Liver Disease ◽  
Short Term Mortality ◽  
Clinical Background ◽  
End Stage

Background. The role ofAeromonasspecies (sp.) in bacteremia in Japanese patients with liver cirrhosis is poorly understood.Aim. To establish the importance ofAeromonassp. as a cause of bacteremia in patients with liver cirrhosis.Methods. Clinical and serological features and short-term prognosis were retrospectively investigated and compared in Japanese patients with bacteremia due toAeromonassp. () and due to enterobacteria (E. coli, Klebsiellasp., andEnterobactersp.) ().Results. There were no significant differences in patients’ clinical background, renal dysfunction, or short-term mortality rate between the two groups. However, in theAeromonasgroup, the model for end-stage liver disease (MELD) score and Child-Pugh score were significantly higher than in the enterobacteria group.Conclusion. These results indicate that the severity of liver dysfunction inAeromonas-induced bacteremia is greater than that in enterobacteria-induced bacteremia in Japanese patients with liver cirrhosis.

Elevated Soluble Tumour Necrosis Factor Receptor Serum Concentrations and Short-Term Mortality in Liver Cirrhosis without Acute Infections

Digestion ◽  
2000 ◽  
Vol 62 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Christoph Reichel ◽  
Thomas Sudhop ◽  
Barbara Braun ◽  
Karl-Anton Kreuzer ◽  
Corinna Hahn ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Tumour Necrosis Factor Receptor ◽  
Serum Concentrations ◽  
Short Term ◽  
Acute Infections ◽  
Short Term Mortality ◽  
Necrosis Factor

scholarly journals The impact of PNPLA3 and TM6SF2 in cirrhosis related complications

2021 ◽  
Author(s):  
Haruki Uojima ◽  
Xue Shao ◽  
Taeang Arai ◽  
Yuji ogawa ◽  
Toru Setsu ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Odds Ratio ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Fibrosis Progression ◽  
Cirrhotic Patients ◽  
The Impact

Patatin-like phospholipase domain-containing 3 (PNPLA3) and transmembrane 6-superfamily member 2 (TM6SF2) polymorphisms have major impact for fibrosis due to steatohepatitis. However, there are scant data about correlations between cirrhosis-related complications and the polymorphisms of these genes. Therefore, we aimed to determine the role of the PNPLA3 and TM6SF2 polymorphisms in fibrosis progression for patients with liver cirrhosis. A multicenter study was performed at six hospitals in Japan enrolling 400 patients with liver cirrhosis caused by virus (n = 157), alcohol (n = 104), nonalcoholic fatty liver disease (NAFLD) (n = 106), or autoimmune disease (n = 33). These cirrhotic patients included those with complications of variceal bleeding, hepatic ascites, and/or hepatic encephalopathy and those without. To assess the role of the PNPLA3 and TM6SF2 polymorphisms in patients with cirrhosis related complications, we calculated the odds ratio and relative risk for the rs738409 and rs58542926 polymorphisms. We also accessed whether or not the interaction between these two polymorphisms contributed to cirrhosis related complications. As a result, the odds ratio for complications in the NAFLD group significantly increased in the presence of the rs738409 GG genotype when the CC genotype was used as the reference. There were no significant risks between complications and the presence of the rs738409 G allele in the virus or alcohol groups. There were no significant risks of complications in the frequency of the rs58542926 T polymorphism regardless of the etiology of liver cirrhosis. The interaction between the trs738409 and rs58542926 polymorphisms had the highest odds ratio of 2.415 for complications in the rs738409 GG + rs58542926 (CT+TT) group when rs738409 (CC+CG) + TM6SF2 CC was used as the reference in the NAFLD group.

scholarly journals Baseline Neutrophil-to-Lymphocyte Ratio Is Independently Associated With 90-Day Transplant-Free Mortality in Patients With Cirrhosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jing Liu ◽  
Hai Li ◽  
Jie Xia ◽  
Xianbo Wang ◽  
Yan Huang ◽  
...  
Keyword(s):  
Cubic Splines ◽  
Neutrophil To Lymphocyte Ratio ◽  
Short Term ◽  
Infection Group ◽  
Lymphocyte Ratio ◽  
Increased Risk ◽  
Unit Increase ◽  
Short Term Mortality ◽  
Cirrhotic Patients ◽  
Restricted Cubic Splines

Background: Patients with cirrhosis have an increased risk of short-term mortality, however, few studies quantify the association between neutrophil-to-lymphocyte ratio (NLR) and 90-day transplant-free mortality in cirrhotic patients.Methods: We prospectively analyzed 3,970 patients with chronic liver diseases from two multicenter cohorts in China (January 2015 to December 2016 and July 2018 to January 2019). Restricted cubic splines (RCS) were used to analyze the relation of NLR and all-causes 90-day transplant-free mortality in cirrhosis.Results: A total of 2,583 cirrhotic patients were enrolled in our study. Restricted cubic splines showed that the odds ratio (OR) of all causes 90-day transplant-free mortality started to increase rapidly until around NLR 6.5, and then was relatively flat (p for non-linearity <0.001). The risk of 90-day transplant-free mortality in cirrhotic patients with NLR < 6.5 increased with an increment of 23% for every unit increase in NLR (p < 0.001). The patients with NLR < 4.5 had the highest risk (OR: 2.34, 95% CI 1.66–3.28). In multivariable-adjusted stratified analyses, the increase in the incidence of 90-day transplant-free mortality with NLR increasing was consistent (OR >1.0) across all major prespecified subgroups, including infection group (OR: 1.04, 95% CI 1.00–1.09) and non-infection (OR: 1.06, 95% CI 1.02–1.11) group. The trends for NLR and numbers of patients with organ failure varied synchronously and were significantly increased with time from day 7 to day 28.Conclusions: We found a non-linear association between baseline NLR and the adjusted probability of 90-day transplant-free mortality. A certain range of NLR is closely associated with poor short-term prognosis in patients with cirrhosis.

scholarly journals HEPATIC ENCEPHALOPATHY

2018 ◽  
Vol 25 (12) ◽  
pp. 1857-1862
Author(s):  
Ashok Kumar Lohano ◽  
Shamsuddin Shaikh ◽  
Nazia Arain
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Serum Sodium Level ◽  
Cross Sectional Study ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Cross Sectional ◽  
Medicine Department ◽  
Grade Ii ◽  
Cirrhotic Patients

Objectives: To determine the prevalence and relation to severity of hyponatremia in liver cirrhotic patients associated with hepatic encephalopathy. Study Design: Cross sectional study. Place and Duration of Study: Medicine Department of Peoples University of Medical and Health Sciences Nawabshah from 26th October 2016 to 25th April 2017. Material and Methods: All patients of either gender with 15 to 70 years associated liver cirrhosis, were included in the study. Diagnosis of liver cirrhosis was confirmed by laboratory and ultrasonographic findings. Exclusion criteria were patients outside of patient range, patients with hepatocellular carcinoma, or anotherco morbid. Sodium levels were measured by 2cc bloodsample by blood from cubital vein preferably. Encephalopathy was evaluated via West Haven classification. All the data were entered into SPSS 20 version and were analyzed by using the same software. Results: A total of 369 patients met the inclusion criteria. Among them were 129 males and 240 females. The overall mean age of study subjects was 57.07±9.23 years. The overall mean duration of hepatic encephalopathy was 2.53±0.733 days. The overall mean serum sodium level for study subjects was 129.59±7.11 mEq/L. Most of the study subjects, 83.5% had HCV, 12.7% patients were HBV positive whereas 3% were positive for HBV as well as HCV. 26 patients had grade 1 encephalopathy, 30 patients had grade II encephalopathies, 258 patients had grade III encephalopathies, and 55 patients had grade IV encephalopathy. In our study, 73.2% study subjects were observed with hyponatremia. Out of 270 study subjects found with hyponatremia, 25.2% had mild hyponatremia, 44.8% had moderate hyponatremia, and 30% had severe hyponatremia. The results showed that there was a significant association of hyponatremia with viral markers (p=0.030), duration of hepatic encephalopathy (p=0.102) and grades of hepatic encephalopathy (p=0.746). Conclusion: We concluded hyponatremia is frequently found in patients with cirrhosis liver. Significant correlation of hyponatremia with the severity of hepatic encephalopathy.

Clinical course and short-term mortality of cirrhotic patients with infections other than spontaneous bacterial peritonitis

2016 ◽  
Vol 37 (3) ◽  
pp. 385-395 ◽  
Author(s):  
Javier Fernández ◽  
Juan Acevedo ◽  
Verónica Prado ◽  
Mario Mercado ◽  
Miriam Castro ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Clinical Course ◽  
Short Term ◽  
Bacterial Peritonitis ◽  
Short Term Mortality ◽  
Cirrhotic Patients
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