scholarly journals Hematological Indices in Portal Hypertension: Cirrhosis versus Noncirrhotic Portal Hypertension

2018 ◽  
Vol 7 (8) ◽  
pp. 196 ◽  
Author(s):  
Abdurrahman Sahin ◽  
Hakan Artas ◽  
Nurettin Tunc ◽  
Mehmet Yalniz ◽  
Ibrahim Bahcecioglu
Keyword(s):  
Portal Hypertension ◽  
Retrospective Study ◽  
Radiological Findings ◽  
Hematological Indices ◽  
Noncirrhotic Portal Hypertension ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Hematological Abnormalities ◽  
End Stage ◽  
Cirrhotic Group

Portal hypertension (PHT) leads to several alterations on hematological indices (HI). The aim of the study is to investigate the differences in HI between cirrhotic subjects and subjects who have noncirrhotic PHT (NCPHT). This retrospective study included 328 patients with PHT (239 cirrhosis and 89 NCPHT). Demographic and clinical features, endoscopic and radiological findings, and HI including neutrophil to lymphocyte ratio (NLR) at the time of PHT diagnosis were recorded. Severity of cirrhosis was assessed according to the Child–Turcotte–Pugh (CTP) classification and Model for End-Stage Liver Disease (MELD) scores. Hematological abnormalities were found in 92.5% of cirrhotic patients and in 55.1% of patients with NCPHT (p < 0.001). While thrombocytopenia was the most common HI in patients with cirrhosis, anemia was the most prevalent HI in NCPHT group. In the cirrhotic group, the NLR was the only parameter to differentiate each CTP group from two others. The NLR value increased with the severity of cirrhosis (2.28 ± 0.14 in CTP-A, 2.85 ± 0.19 in CTP-B and 3.26 ± 0.37 in CTP-C). The AUROC of NLR was 0.692 for differentiating compensated cirrhotic patients from decompensated. Hematological abnormalities are more prevalent and more severe in cirrhotic patients compared to patients with NCPHT. NLR may be used to assess the severity of cirrhosis.

Groin Herniorrhaphy in Patients with Cirrhosis and after Liver Transplantation

2009 ◽  
Vol 75 (10) ◽  
pp. 962-965
Author(s):  
Elise H. Lawson ◽  
Elizabeth Benjamin ◽  
Ronald W. Busuttil ◽  
Jonathan R. Hiatt
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
International Normalized Ratio ◽  
Wound Complications ◽  
End Stage Liver Disease ◽  
Proper Patient Selection ◽  
Cirrhotic Patients ◽  
End Stage ◽  
Cirrhotic Group

We report on 43 groin herniorrhaphy operations, 18 in 18 patients with documented cirrhosis and 25 in 24 patients after liver transplantation (LT), over a 10-year period at UCLA. Average follow up was 33 months. Most patients were males (84%) with reducible inguinal hernias (70%). Child's class of cirrhotic patients was B in 66 per cent and A and C in 17 per cent each; 7 patients (39%) went on to LT. Compared with post-LT patients, patients with cirrhosis had significantly lower platelets and significantly higher bilirubin, international normalized ratio, and Model for End-stage Liver Disease scores. Mesh was used in 33 per cent of the cirrhotic group and 48 per cent of the LT group. There were four minor wound complications but no deaths, major complications, infections, or ascitic leaks in either group. Two hernias recurred in the cirrhosis group (11%) and none after LT. We conclude that with proper patient selection, groin herniorrhaphy with or without mesh is a safe and durable procedure in patients with cirrhosis and after LT. This is the first large series of groin herniorrhaphy after LT.

scholarly journals An Unexpected Hepatic Hydrothorax After a Successful Kasai Portoenterostomy: A Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Giulia Ranucci ◽  
Fabiola Di Dato ◽  
Daniela Liccardo ◽  
Marco Spada ◽  
Giuseppe Maggiore ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Bile Flow ◽  
Rare Complication ◽  
Kasai Portoenterostomy ◽  
Hepatic Hydrothorax ◽  
Pediatric Case ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Hepatic hydrothorax (HH) represents a rare complication of portal hypertension among adult cirrhotic patients. Here, we describe a pediatric case of HH, observed in a biliary atresia infant. The child presented with recurrent right-sided pleural effusion, after a successful Kasai portoenterostomy with restoration of bile flow and without overt signs of hepatic failure. Recurrence of HH led the patient to liver transplant despite a low pediatric end-stage liver disease value. Although rare, HH can also occur in children and should be suspected in patients with portal hypertension and respiratory distress. HH may be an indication for liver transplantation.

scholarly journals Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Ahmed Abdelrahman Mohamed Baz ◽  
Rana Magdy Mohamed ◽  
Khaled Helmy El-kaffas
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Meld Score ◽  
Hepatic Decompensation ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Us Findings ◽  
End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

scholarly journals RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenzhen Zhang ◽  
Guomin Xie ◽  
Li Liang ◽  
Hui Liu ◽  
Jing Pan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Poor Prognosis ◽  
Alcoholic Cirrhosis ◽  
Normal Liver ◽  
Neutrophil Infiltration ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

scholarly journals The use of MELD scores in critically ill cirrhotic patients

2016 ◽  
Vol 4 (16) ◽  
pp. 45
Author(s):  
Supannee Rassameehiran ◽  
Tinsay Woreta
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Critically Ill ◽  
Meld Score ◽  
Chronic Liver Failure ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

The Model for End-Stage Liver Disease (MELD) was originally created to predict survival following transjugular intrahepatic portosystemic shunt and was subsequently found to accurately predict mortality in patients with end-stage liver disease. It has been used in the United States for liver allocation since 2002, and implementation of the MELD score resulted in a reduction in total number of deaths on the waitlist and a reduction in waiting time. Critically ill cirrhotic patients have an in-hospital mortality greater than 50%. Although the MELD score was also found to be an accurate predictor of in-ICU mortality and in-hospital mortality after ICU admission in critically ill cirrhotic patients, the Sequential Organ Failure Assessment (SOFA) score appears to perform better in many studies. The Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score was later developed by using specific cut-points for each organ failure score system in CLIF patients to predict mortality in patients with ACLF. Neither the MELD nor SOFA score independently predicts post-liver transplantation mortality in cirrhotic patients with extrahepatic organ failure and should not be use as a delisting criterion for these patients. More data are needed to determine the accuracy of the CLIF-C ACLF score in predicting post-liver transplantation outcomes. Prospective evaluation of critically ill cirrhotic patients is needed to optimize liver organ allocation.

scholarly journals Predictive power of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score for mortality in cirrhotic patients

2018 ◽  
Vol 4 (4) ◽  
pp. 240-246 ◽  
Author(s):  
Damian Piotrowski ◽  
Anna Sączewska-Piotrowska ◽  
Jerzy Jaroszewicz ◽  
Anna Boroń-Kaczmarska
Keyword(s):  
Liver Disease ◽  
Predictive Power ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

scholarly journals Development of a national Department of Veterans Affairs mortality risk prediction model among patients with cirrhosis

2019 ◽  
Vol 6 (1) ◽  
pp. e000342 ◽  
Author(s):  
Jejo David Koola ◽  
Samuel Ho ◽  
Guanhua Chen ◽  
Amy M Perkins ◽  
Aize Cao ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Prediction Models ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
End Stage Liver Disease ◽  
Risk Patients ◽  
Cirrhotic Patients ◽  
End Stage

ObjectiveCirrhotic patients are at high hospitalisation risk with subsequent high mortality. Current risk prediction models have varied performances with methodological room for improvement. We used current analytical techniques using automatically extractable variables from the electronic health record (EHR) to develop and validate a posthospitalisation mortality risk score for cirrhotic patients and compared performance with the model for end-stage liver disease (MELD), model for end-stage liver disease with sodium (MELD-Na), and the CLIF Consortium Acute Decompensation (CLIF-C AD) models.DesignWe analysed a retrospective cohort of 73 976 patients comprising 247 650 hospitalisations between 2006 and 2013 at any of 123 Department of Veterans Affairs hospitals. Using 45 predictor variables, we built a time-dependent Cox proportional hazards model with all-cause mortality as the outcome. We compared performance to the three extant models and reported discrimination and calibration using bootstrapping. Furthermore, we analysed differential utility using the net reclassification index (NRI).ResultsThe C-statistic for the final model was 0.863, representing a significant improvement over the MELD, MELD-Na, and the CLIF-C AD, which had C-statistics of 0.655, 0.675, and 0.679, respectively. Multiple risk factors were significant in our model, including variables reflecting disease severity and haemodynamic compromise. The NRI showed a 24% improvement in predicting survival of low-risk patients and a 30% improvement in predicting death of high-risk patients.ConclusionWe developed a more accurate mortality risk prediction score using variables automatically extractable from an EHR that may be used to risk stratify patients with cirrhosis for targeted postdischarge management.

A national retrospective study of paediatric end-stage liver disease as a predictor of change to second-line therapy in children with autoimmune hepatitis

2017 ◽  
Vol 37 (10) ◽  
pp. 1562-1570 ◽  
Author(s):  
Andréanne N. Zizzo ◽  
Carolina Jimenez-Rivera ◽  
Joseph Kim ◽  
Richard A. Schreiber ◽  
Simon C. Ling ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Liver Disease ◽  
Autoimmune Hepatitis ◽  
Second Line ◽  
Second Line Therapy ◽  
End Stage Liver Disease ◽  
Line Therapy ◽  
End Stage
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