Rapid and dose-dependent increase of 25(OH)D levels after calcifediolsupplementation in a woman with obesity, chronic liver disease, andosteoporosis

The prevalance of QT prolongation in chronic viral liver disease is high and the risk of complications is increased. We wanted to study the QT interval prolongation at the patients diagnosed with chronic hepatic disease and also to evaluate some of clinical and biochemical variables. We studied a cohort with 126 patients diagnosed with chronic viral hepatic diseases hospitalised to Cardiology Department, to the County Hospital of Craiova, between Octomber 2016 and January 2018. We aimed to determine the occurrence of QT interval prolongation in a large series of patients with chronic hepatic disease of viral etiology. We wanted to evaluated the QT prolongation to clinical and biochemical variables. The QT interval was measured by a standard 12-lead ECG for each patient, with prolongation defined as 460 ms. Multiple clinical and biochemical variables were evaluated including sex, age, areas (rural/urban) the frequency of arrhythmic events (PACs, PVCs, Atrial fibrillation, Bradycardia, Tachycardia), NT proBNP, Hb,uric acid, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST) , cholesterol, triglyceride, etc. The group of patients was composed by 43 woman and 83 men. From 43 women, representing 65.06% (461.56 �42.03) and from 83 men, means 66.67% (461.14 � 45.10) presented interval QT prolongation. Studing the distribution of hepatic etiologies we can see that 34 patients had hepatitis B, 35 patients hepatitis C, 5 patients B and C dual virus infection and 52 patients with chronic liver disease of etiology other than viral. We registered close results about QT interval prolongation on group, sex and origine group of patients. The value of QT interval to our patients was higher compared to other values recorder in other studies, at the patients with chronic hepatic disease, despide the fact we chose a higher value of QT prolongation. The highest value of QT interval was in the group of age between 60 and 69, even if in other studies we notice a prolonged QT interval at patients over 70 years old. The biological and biochemical profile of chronic hepatic disease of the subjects included in our study showed no statistical difference between male and female patients.We found a higher incidence of arrhythmic events, at patients with chronic hepatic disease of viral etiology, especially to premature atrial contraction and atrial fibrillation.We found a couple of correlation between QT interval prolongation and the evolution of chronic hepatic disease of viral etiology. It is very important to develop a strong and complex strategies to prevent and to treat the arrhythmic event presented at the patients diagnosticated with hepatic disease, because of the higher risk of developing life-threatening arrhythmias, includen sudden cardiac death.

The Impact of Liver Disease on Growth and Nutrition

Fat-soluble vitamin deficiency in pediatric patients with chronic liver disease

The liver has multiple regeneration modes, including hepatocellular hypertrophy and self-renewal of hepatocytes. When hepatocyte proliferation is impaired, hepatic progenitor cells may proliferate through ductular reaction (DR), differentiate into hepatocytes, and contribute to fibrosis. However, the three-dimensional spatial relationship between DR and regenerating hepatocytes and dynamic changes in DR associated with fibrosis remain poorly understood. Here, we performed three-dimensional (3D) imaging of cleared 42 liver explants with chronic and acute liver diseases and 4 normal livers to visualize DR. In chronic hepatic liver diseases, such as viral hepatitis, steatohepatitis, autoimmune hepatitis, and cryptogenic cirrhosis, the total length and number of branches of DR showed a significant positive correlation. We studied the spatial relationship between DR and GS-expressing cells using glutamine synthetase (GS) and cytokeratin 19 (CK19) as markers of liver regeneration and DR, respectively. The percentage of CK19-positive cells that co-expressed GS was less than 10% in chronic liver diseases. In contrast, nearly one-third of CK19-positive cells co-expressed GS in acute liver diseases, and chronic cholestatic liver diseases, including primary biliary cholangitis and primary sclerosing cholangitis, showed no co-expression. We also found that DR was longer and had more branching in livers with progressive fibrosis compared to those with regressive fibrosis. Our results suggest that DR displays varying degrees of spatial complexity and contribution to liver regeneration. DR may serve as hepatobiliary junctions that maintain continuity between hepatocytes and bile ducts rather than hepatocyte regeneration in chronic liver diseases.

Venous Thromboembolism with Chronic Liver Disease

Contribution of metabolic factors to alanine aminotransferase activity in persons with other causes of liver disease

Fatigue in Cirrhosis: Is Transplant the Answer?

Annual Burden and Costs of Hospitalization for High-Need, High-Cost Patients With Chronic Gastrointestinal and Liver Diseases

Coffee and Tea Consumption Are Associated With a Lower Incidence of Chronic Liver Disease in the United States

Few data have been published regarding the epidemiology and outcome of infective endocarditis (IE) in patients with chronic hepatic disease (CHD). A retrospective analysis of the Studio Endocarditi Italiano (SEI) database was performed to evaluate the epidemiology and outcome of CHD+ patients compared with CHD- patients. The diagnosis of IE was defined in accordance with the modified Duke criteria. Echocardiography, diagnosis, and treatment procedures were in accordance with current clinical practice. Among the 1722 observed episodes of IE, 300 (17.4 %) occurred in CHD+ patients. The cause of CHD mainly consisted of chronic viral infection. Staphylococcus aureus was the most common bacterial species in CHD+ patients; the frequency of other bacterial species (S. epidermidis, streptococci, and enterococci) were comparable among the two groups. The percentage of patients undergoing surgery for IE was 38.9 in CHD+ patients versus 43.7 in CHD- patients (p = 0.06). Complications were more common among CHD+ patients (77 % versus 65.3 %, p < 0.001); embolization (43.3 % versus 26.1 %, p < 0.001) and congestive heart failure (42 % versus 34.1 %, p = 0.01) were more frequent among CHD+ patients. Mortality was comparable (12.5 % in CHD- and 15 % in CHD+ patients). At multivariable analysis, factors associated with hospital-associated mortality were having an infection sustained by S. aureus, a prosthetic valve, diabetes and a neoplasia, and CHD. Being an intravenous drug user (IVDU) was a protective factor and was associated with a reduced death risk. CHD is a factor worsening the prognosis in patients with IE, in particular in patients for whom cardiac surgery was required.

Hepcidin: clinical utility as a diagnostic tool and therapeutic target

Hepatic hydroxylation of bile acids and chronic liver diseases: do transporters play a mechanistic role?

Chronic liver diseases are very common worldwide and represent a major healthcare issue (GBD 2013 Mortality and Causes of Death Collaborators, 2015). Chronic liver diseases are characterized by inflammation of the liver, which may be secondary to distinct etiological factors, including hepatitis C or B infection, increased alcohol consumption, or non-alcoholic fatty liver disease (NAFLD). This article is protected by copyright. All rights reserved.

Nutritional aspects of chronic liver disease and liver transplantation in children.

Disclosure: X. Sun: None. B. Leder: None. T.V. Ly: None. E. Franco-Garcia: None. M.B. Bolster: Grant Recipient; Self; Rheumatology Research Foundation Clinician Scholar Educator Award; Genentech, Cumberland, Inc, Corbus, Mitsubishi. Other; Self; Honoraria: The Merck Manual, American Board of Internal Medicine, Practice Update. W. Fan: None. Context: A Fracture Liaison Service (FLS) provides an important mechanism to address vitamin D deficiency (VDD) which is commonly found in patients hospitalized with a fragility fracture. Objectives: To study the prevalence of VDD and its associated clinical outcomes among patients hospitalized for osteoporotic fracture. To explore inpatient strategies of vitamin D repletion in the immediate post fracture setting. Design, Setting and Patients: An observational study of patients admitted to the Massachusetts General Hospital (MGH) with fractures between January 2016 to October 2023 who were cared by the FLS. Exposures and Intervention: A vitamin D repletion regimen consisting of ergocalciferol 50,000 international units (IU) oral daily for a number of days followed by maintenance cholecalciferol of 1000-1500 IU daily was studied in a subset of patients with VDD. Main Outcomes and Measures: Prevalence of VDD among MGH FLS patients. Efficacy of inpatient daily ergocalciferol administration to raise serum 25OHD. Results: Of the 2,951 consecutive patients, 724 (24.53%) were vitamin D deficient as defined by serum 25OHD level of ≤19ng/ml. Men (252 of 897, or 28.09%) were more likely than women (472 of 2,054, or 22.98%) to have VDD (p = 0.003). VDD was seen 41.79% (117 of 280), 24.41% (332 of 1,360) and 20.98% (275 out 1,311) of patients of ≤59, 60-79, and ≥80 years old, respectively (p &amp;lt; 0.00001).Of the 1,303 patients with hip fragility fractures, 327 (25.09%) had VDD. Patients with VDD, despite being younger (78.55±11.75 vs. 80.28±10.47, p=0.018), had longer average length-of-stay (aLOS) than those without VDD did (8.37±7.35 vs. 7.23±4.78 days, p=0.009). Re-admission and non-union rates up to two years following the index hip fracture were not different between the two groups.Among 32 patients, without known malabsorption or liver cirrhosis, who had 25OHD levels available before and after ergocalciferol treatment, each dose of ergocalciferol, on average, raised serum 25OHD by 3.62±2.35 (m±sd) ng/ml. Daily ergocalciferol administration did not change serum calcium and creatinine levels.Patients with chronic liver disease (CLD), who had higher prevalence of VDD (64 of 156 patients, or 41.04%), showed impaired per-dose-of-ergocalciferol 25OHD response (0.87±0.92. n=10) ng/ml. Conclusions and Relevance: Nearly 25% of patients hospitalized for osteoporotic fractures, cared for by MGH FLS, had VDD. Male sex, younger age, and CLD were associated with a higher prevalence of VDD. VDD was associated with, on average, one extra day of hospital stay among patients admitted for hip fracture. Daily ergocalciferol, with each dose of 50,000 IU raising serum 25OHD level by 3-4 ng/ml, followed by maintenance dose of cholecalciferol of 1000 to 1500 IU is potentially a practical way to quickly replete vitamin D among patients with VDD hospitalized for fracture. Presentation: 6/3/2024