scholarly journals Right Heart Remodeling in Patients with End-Stage Alcoholic Liver Cirrhosis: Speckle Tracking Point of View

2019 ◽  
Vol 8 (9) ◽  
pp. 1285 ◽  
Author(s):  
Kun Zhang ◽  
Alexander Braun ◽  
Francisca von Koeckritz ◽  
Rosa B. Schmuck ◽  
Eva M. Teegen ◽  
...  

Background: Data regarding cardiac remodeling in patients with alcoholic liver cirrhosis are scarce. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis. Methods: This retrospective cross-sectional investigation included 67 end-stage cirrhotic patients, who were referred for evaluation for liver transplantation and 36 healthy controls. All participants underwent echocardiographic examination including strain analysis, which was performed offline. Results: RV basal diameter and RV thickness were significantly higher in patients with cirrhosis. Conventional parameters of the RV systolic function were similar between the observed groups. Global, endocardial, and epicardial RV longitudinal strains were significantly lower in patients with cirrhosis. Active RA function was significantly higher in cirrhotic patients than in controls. The RA reservoir and conduit strains were significantly lower in cirrhotic patients, while there was no difference in the RA contractile strain. Early diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Transaminases and bilirubin correlated negatively with RV global longitudinal strain and RV-free wall strain in patients with end-stage liver cirrhosis. The Model for End-stage Liver Disease (MELD) score, predictor of 3-month mortality, correlated with parameters of RV structure and systolic function, and RA active function in patients with end-stage liver cirrhosis. Conclusions: RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Liver enzymes, bilirubin, and the MELD score correlated with RV and RA remodeling.

Author(s):  
Ahmed Abdelrahman Mohamed Baz ◽  
Rana Magdy Mohamed ◽  
Khaled Helmy El-kaffas

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.


2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Si-Hai Chen ◽  
Qin-Si Wan ◽  
Ting Wang ◽  
Kun-He Zhang

Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.


2009 ◽  
Vol 66 (9) ◽  
pp. 724-728 ◽  
Author(s):  
Daniela Benedeto-Stojanov ◽  
Aleksandar Nagorni ◽  
Goran Bjelakovic ◽  
Dragan Stojanov ◽  
Bojan Mladenovic ◽  
...  

Background/Aim. Esophageal variceal bleeding is one of the most frequent and gravest complications of liver cirrhosis, directly life-threatening. By monitoring certain clinical and laboratory hepatocellular insufficiency parameters (Child-Pugh score), it is possible to determine prognosis in patients who are bleeding and evaluate further therapy. Recently, the Model for the End-Stage Liver Disease (MELD) has been proposed as a tool to predict mortality risk in cirrhotic patients. The aim of the study was to evaluate survival prognosis of cirrhotic patients by the MELD and Child-Pugh scores and to analyze the MELD score prognostic value in patients with both liver cirrhosis and variceal bleeding. Methods. We retrospectively evaluated the survival rate of a group of 100 cirrhotic patients of a median age of 57 years. The Child-Pugh score was calculated and the MELD score was computed according to the original formula for each patient. We also analyzed clinical and laboratory hepatocellular insufficiency parameters in order to examine their connection with a 15-month survival. The MELD values were correlated with the Child-Pugh scores. The Student's t-test was used for statistical analysis. Results. Twenty-two patients died within 15-months follow-up. Age and gender did not affect survival rate. The Child- Pugh and MELD scores, as well as ascites and encephalopathy significantly differed between the patients who survived and those who died (p < 0.0001). The International Normalized Ratio (INR) values, serum creatinine and bilirubin were significantly higher, and albumin significantly lower in the patients who died (p < 0.0001). The MELD score was significantly higher in the group of patients who died due to esophageal variceal bleeding (p < 0.0001). Conclusion. In cirrhotic patients the MELD score is an excellent survival predictor at least as well as the Child-Pugh score. Increase in the MELD score is associated with decrease in residual liver function. In the group of patients with liver cirrhosis and esophageal variceal bleeding, the MELD score identifies those with a higher intrahospital mortality risk.


2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Mona A. Amin ◽  
Marwa E. El-Shahat ◽  
Nouman El-Garem ◽  
Ahmed Soliman ◽  
Eman Obaia

Serum cholinesterase levels are closely correlated with the severity of liver disease. The aim of the paper was to assess the value of serum cholinesterase in evaluating liver reserve function in cirrhotic patients. 90 patients with liver cirrhosis and thirty healthy control group were included. Liver cirrhosis patients were classified according to child score into three equal groups: Child A liver cirrhosis, Child B liver cirrhosis and Child C liver cirrhosis. Patients were subjected to clinical evaluation, laboratory analysis, abdominal U/S. Measuring serum cholinesterase, and Calculation of both Child and model of end stage liver disease (MELD) scores. The level of serum cholinesterase was higher in control group than the three groups of liver cirrhosis with median (IQR) 17,410 (12,111-21,774), 7528 (5200-9856), 6021 (4500-7542), 3828.5 (1541-6060), respectively P<0.001). And the level of serum cholinesterase was higher in Child A more than Child B and Child C and the level of serum cholinesterase was higher in Child B more than Child C with very strong negative correlation between serum Cholinesterase level and Child score (r=-0.9, P<0.001). Also strong negative correlation between serum Cholinesterase level and MELD score (r=- 0.85, P=0.001), and positive correlation with prothrombin concentration (r=0.554, P=0.009), and serum albumin levels (r=0.582, P=0.0002). Serum cholinesterase is a good biomarker of cirrhosis. Since it distinguishes decompensated from compensated cirrhosis well, low levels in cirrhosis may serve as a useful prognostic marker of advanced liver disease.


2021 ◽  
pp. 56-62
Author(s):  
N. R. Matkovska ◽  
N. H. Virstiuk ◽  
I. O. Kostitska

Abstract. In Ukraine, among the causes of death because of digestive tract diseases, alcoholic liver disease (ALD) has the second place. Due to the significant prevalence of obesity and the growing incidence of ALD, methods are being sought to prevent the progression of the pathological process in the liver, the occurrence of complications and to improve the quality of life of such patients. The aim of the study: to examine the effect of complex treatment with ademethionine, arginine glutamate and rosuvastatin on changes in lipid and carbohydrate metabolism in patients with alcoholic liver cirrhosis (ALC) in combination with obesity. Methods. The study included 156 patients diagnosed with ALC in combination with obesity, including 18 women and 138 men aged (45.3±8.9) years and a median duration of disease (5.1±2.8) years. Patients were divided into subgroups depending on the stage of Child-Pugh decompensation and depending on the applied treatment. Results. At the stage of decompensation, lipid metabolism and leptin levels were low, which indicates the depletion of body fat depots as the disease progresses. It may be due to the progression of the liver dysfunction, as it is actively involved in regulating the formation, destruction and accumulation of fats. Changes in carbohydrate metabolism in patients with ALC in combination with obesity were characterized by a significant increase in IRI, HOMA-IR index and a decrease in the QUICKI index, indicating the presence of insulin resistance (p<0.05). In determining the adipocytokine values, it was found that in decompensated liver function, the leptin rates decreased and the levels of adiponectin increased. Higher leptin content in the stage of compensation and subcompensation is also associated with increased secretion of adipose tissue. At the stage of decompensation, fat depots are depleted, so leptin levels are reduced. This decrease is directly related to the Child-Pugh and MELD scores. Adiponectin levels were decreased in the stage of compensation and increased with the progression of the disease and correlated with disease severity and the MELD score. It is thought that an increased adiponectin level indicates the level of anti-inflammatory reaction in response to hepatocyte damage. Significant deterioration in carbohydrate metabolism, adiponectin and leptin in patients receiving basic treatment was accompanied by deterioration of their condition and increased the risk of 3-month mortality. After the course of treatment in patients of group receiving ademethionine, arginine, glutamate and rosuvastatin at the stage of compensation and subcompensation, the rates of lipid, carbohydrate metabolism, adiponectin and leptin significantly improved and differed from those in patients receiving basic treatment and combination of basic treatment, ademethionine and arginine glutamate (p<0.05). At the stage of decompensation in the scheme with the inclusion of rosuvastatin it was possible to normalize the levels of HDL cholesterol, VLDL cholesterol, atherogenic coefficient and leptin, reduce the levels of adiponectin, IRI, HOMA-IR, HbA1c and increase the QUICKI index, which was accompanied by a decrease in Child-Pugh severity score and 3 month mortality MELD score. Conclusions. In patients with ALC in combination with obesity, the inclusion in the treatment of ademethionine, arginine glutamate and rosuvastatin helps to improve the course of the disease according to the lipid and carbohydrate metabolism, Child-Pugh and MELD scores.


2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenzhen Zhang ◽  
Guomin Xie ◽  
Li Liang ◽  
Hui Liu ◽  
Jing Pan ◽  
...  

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.


2016 ◽  
Vol 4 (16) ◽  
pp. 45
Author(s):  
Supannee Rassameehiran ◽  
Tinsay Woreta

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.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tomasz Dziodzio ◽  
Robert Öllinger ◽  
Wenzel Schöning ◽  
Antonia Rothkäppel ◽  
Radoslav Nikolov ◽  
...  

Abstract Background MELD score and MELD score derivates are used to objectify and grade the risk of liver-related death in patients with liver cirrhosis. We recently proposed a new predictive model that combines serum creatinine levels and maximum liver function capacity (LiMAx®), namely the CreLiMAx risk score. In this validation study we have aimed to reproduce its diagnostic accuracy in patients with end-stage liver disease. Methods Liver function of 113 patients with liver cirrhosis was prospectively investigated. Primary end-point of the study was liver-related death within 12 months of follow-up. Results Alcoholic liver disease was the main cause of liver disease (n = 51; 45%). Within 12 months of follow-up 11 patients (9.7%) underwent liver transplantation and 17 (15.1%) died (13 deaths were related to liver disease, two not). Measures of diagnostic accuracy were comparable for MELD, MELD-Na and the CreLiMAx risk score as to power in predicting short and medium-term mortality risk in the overall cohort: AUROCS for liver related risk of death were for MELD [6 months 0.89 (95% CI 0.80–0.98) p < 0.001; 12 months 0.89 (95% CI 0.81–0.96) p < 0.001]; MELD-Na [6 months 0.93 (95% CI 0.85–1.00) p < 0.001 and 12 months 0.89 (95% CI 0.80–0.98) p < 0.001]; CPS 6 months 0.91 (95% CI 0.85–0.97) p < 0.01 and 12 months 0.88 (95% CI 0.80–0.96) p < 0.001] and CreLiMAx score [6 months 0.80 (95% CI 0.67–0.96) p < 0.01 and 12 months 0.79 (95% CI 0.64–0.94) p = 0.001]. In a subgroup analysis of patients with Child-Pugh Class B cirrhosis, the CreLiMAx risk score remained the only parameter significantly differing in non-survivors and survivors. Furthermore, in these patients the proposed score had a good predictive performance. Conclusion The CreLiMAx risk score appears to be a competitive and valid tool for estimating not only short- but also medium-term survival of patients with end-stage liver disease. Particularly in patients with Child-Pugh Class B cirrhosis the new score showed a good ability to identify patients not at risk of death.


2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Chi-Chieh Hung ◽  
Yin-Chou Hsu ◽  
Kuo-Hsuan Lin

Patients with liver cirrhosis and bacteremia have substantially higher risk of mortality and morbidity. Our study aimed to investigate scoring systems that can predict the mortality risk in patients with cirrhosis and bacteremia. A single-center, retrospective cohort study was performed among adult patients who visited the emergency department from January 2015 to December 2018. All patients diagnosed with liver cirrhosis and bacteremia were enrolled and divided into survivor and nonsurvivor groups for comparison based on their 30-day in-hospital mortality event. The Pitt bacteremia score (PBS), model for end-stage liver disease (MELD) score, Child–Pugh score, and quick sequential Organ Failure Assessment (qSOFA) score were calculated and compared using the area under the receiver operating characteristic (AUROC) curves. A total of 127 patients (survivor: 86; nonsurvivor: 41) were eligible for this study. Compared with the nonsurvivor group, patients in the survivor group had significantly lower MELD score (22 ± 7 vs. 29 ± 5, p < 0.001 ), lower proportion of high qSOFA (score ≥ 2) (23.3% vs. 51.2%, p < 0.01 ), and high PBS (score ≥ 4) (7.0% vs. 34.1%, p < 0.001 ) category. There was also a significantly different distribution in Child–Pugh classification between the two groups p < 0.01 . The survivor group had significantly lower proportion of acute-on-chronic liver failure (27.9% vs. 68.3%, p < 0.001 ) and fewer number of organ failures p < 0.001 . In comparison of the discriminative ability in mortality risk prediction, PBS (AUROC = 0.83, 95% CI = 0.75–0.90, p < 0.001 ) and MELD scores (AUROC = 0.78, 95% CI = 0.70–0.86, p < 0.001 ) revealed a better predictive ability than Child–Pugh (AUROC = 0.69, 95% CI = 0.59–0.70, p < 0.01 ) and qSOFA scores (AUROC = 0.65, 95% CI = 0.54–0.75, p < 0.01 ). PBS and MELD scores both demonstrated a superior ability of predicting mortality risk in cirrhotic patients with bacteremia.


2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Toru Shizuma ◽  
Chiharu Tanaka ◽  
Hidezo Mori ◽  
Naoto Fukuyama

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.


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