Cases Of Cirrhosis Research Articles

Addition of hyaluronic acid to the FIB-4 liver fibrosis score improves prediction of incident cirrhosis and hepatocellular carcinoma in type 2 diabetes: The Edinburgh Type 2 Diabetes Study.

BackgroundType 2 diabetes (T2D) is associated with increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC) in people with chronic liver diseases, particularly non‐alcoholic fatty liver disease (NAFLD). However, the absolute risk of progression is low. So, it is crucial to accurately identify patients who would benefit most from hepatology referral and intensified management. Current risk‐stratification tools are suboptimal and perform worse in people with diabetes.AimsTo determine whether the addition of complementary biomarker(s) to current NAFLD risk‐stratification tools in people with T2D could improve the identification of people who are at increased risk of developing incident cirrhosis or HCC.MethodsThe Edinburgh Type 2 diabetes Study (ET2DS) is a cohort study of men and women with T2D (n = 1066, age 60–75 at baseline). Cases of cirrhosis and HCC were identified over 11 years of follow‐up. Biomarkers were measured at baseline and year 1 and association with incident disease was assessed using logistic regression.ResultsOf existing risk‐stratification scores tested, the Fibrosis‐4 (FIB‐4) index and the AST:platelet ratio index (APRI) performed best in this cohort. Addition of hyaluronic acid (cut‐point ≥ 50 μ g/L) to FIB‐4 (cut‐point ≥ 1.3) maintained a false negative rate of ≤25% and reduced the number of people incorrectly identified as “high risk” for incident disease by ∼50%.ConclusionsThe addition of hyaluronic acid to FIB‐4 reduced the proportion of people inappropriately identified as “high risk” for development of cirrhosis/HCC in a community population of otherwise asymptomatic people with T2D. These findings require a validation in independent cohorts.

Cost-Effectiveness of 1-Time Universal Screening for Chronic Hepatitis B Infection in Adults in the United States.

An estimated 862 000 to 2.4 million people have chronic hepatitis B infection (CHB). Hepatitis B screening is recommended for pregnant women and populations with increased CHB risk. However, diagnosis rates remain low, with only 33% of people with CHB aware of their infection. This study aimed to assess the cost-effectiveness of universal adult screening for CHB. We used a Markov model to calculate the costs, population health impact, and cost-effectiveness of 1-time universal screening and CHB monitoring and treatment compared with current practice. Sensitivity analysis was performed on model parameters to identify thresholds for cost-saving or cost-effectiveness based on a willingness to pay of $50 000/quality-adjusted life-year. The analysis assumed testing would be performed during routine healthcare visits and that generic tenofovir or entecavir would be dispensed for treatment. Testing costs were based on Medicare reimbursement rates. At an estimated 0.24% prevalence of undiagnosed CHB, universal hepatitis B surface antigen (HBsAg) screening in adults aged 18-69 years is cost-saving compared with current practice if antiviral treatment drug costs remain below $894/year. Compared with current practice, universal screening would avert an additional 7.4 cases of compensated cirrhosis, 3.3 cases of decompensated cirrhosis, 5.5 cases of hepatocellular carcinoma, 1.9 liver transplants, and 10.3 hepatitis B virus-related deaths at a saving of $263 000/100 000 adults screened. Universal HBsAg screening of adults in the US general population for CHB is cost-effective and likely cost-saving compared with current CHB screening recommendations.

STUDY OF CLINICAL PRESENTATION OF HEPATITIS C IN CASES OF ACUTE VIRAL HEPATITIS AND CIRRHOSIS OF LIVER

BACKGROUND: Hepatitis C virus is a major causative agent of liver disease, resulting in acute and chronic infections that can lead to brosis, cirrhosis and hepatocellular carcinoma. Acute hepatitis is usually asymptomatic. The main objective was to study the clinical presentation of Hepatitis C in cases of acute viral hepatitis and cirrhosis of liver. METHOD: The study was carried out for a period of one year from April 2002 to February 2003.The study was carried out in the department of Medicine, Pt. J.N.M. Medical College and associated Dr. B.R.Ambedkar Memorial Hospital, Raipur, Chhattisgarh. 52 cases of acute viral hepatitis and 42 cases of cirrhosis of liver were identied consecutively RESULT: Out of 52 cases, icterus was noted in 98%, hepatomegaly in 80%, splenomegaly in 26% and cervical lymphadenopathy in 3% clinically. Abdominal distension was the commonest complaint reported by 94% of the cases followed by anorexia and atulent dyspepsia in 86% cases. Ascites was the commonest clinical sign, detected in 96% of cases. Next to follow it was the splenomegaly noted in 60% of cases. In decreasing order of frequency were the pallor, icterus, hepatomegaly, veins, gynaecomastia and testicular atrophy, pedal edema and spider naevi accounting for 55%.38%, 31%, 29%, 22%, 18% and 12% of cases. CONCLUSION: Improved prevention and expanded access to viral hepatitis treatments could greatly reduce the burden of these infections. Strategies to enhance HCV assessment are urgently needed

Impact of alcohol on the progression of HCV-related liver disease: A systematic review and meta-analysis

Despite a marked reduction in new cases of cirrhosis caused by HCV infection, over 500,000 new cirrhosis cases in this category were estimated globally in 2019. This contribution quantifies the relationship between alcohol use and the progression of liver disease in people with HCV infections. The causal impact of different levels of alcohol use on cirrhosis has previously been established. The quantification of this relationship was undertaken based on a systematic search of the literature and a meta-analysis. We limited our search to longitudinal and case-control studies with biologically verified outcomes. Different sensitivity analyses were conducted to check on key assumptions and on the generalizability of the relationship. Alcohol use has a dose-dependent relationship with incident cirrhosis, which is linear on the log-linear level, and thus exponential on the level of odds ratios or other risk indicators. Each standard drink of 12 grams of pure alcohol per day increases the risk by about 11%. The results were stable regardless of the statistical model used, level of adjustment, quality of the study, or outcome (i.e., cirrhosis, decompensated cirrhosis, liver-related death). Alcohol use has a marked impact on the progression of HCV infections to cirrhosis and more severe liver outcomes. Alcohol consumption has a significant impact on the progression of liver disease in people with HCV infections. Each alcoholic drink per day is associated with an increase in the risk of cirrhosis of 11%.

Etiologies of Liver Cirrhosis and Their Clinical Presentation among Inpatients in Medical City Complex - Baghdad Teaching Hospital

BACKGROUND: Liver cirrhosis is one of common diseases that doctors deal with during working days, so it is important for all doctors to have a basic knowledge about its etiologies, clinical presentations, complications and prognosis.
 
 AIM OF THE STUDY: 1) To detect the most common causes of liver cirrhosis among Iraqi patients. 2) To Find the most common clinical presentations and look for any association between them and a particular etiology. 3) To make recommendations regarding screening for the most common etiology among population and deal with it and treat it early prior to development of liver fibrosis and cirrhosis.
 
 PATIENT & METHODS: A cross-sectional study was conducted from January 2016 to January 2019. 1000 patients were enrolled in the current study and followed at medical wards at Baghdad teaching hospital, taking detailed history from them including history of alcohol intake, drug history, etc... and sending them for complete work up including Abdominal US, virology screening, autoimmune, Wilson, iron study etc... and calculating Child - Pugh score for each patient.
 
 RESULTS: 1) The most common causes of liver cirrhosis are alcoholic liver disease (20%) and HCV (20%) followed by HBV (18%), NAFLD (14%), cryptogenic (14%), AIH (6%), Wilson (4%), PBC (4%). 2) the most common presentation of liver cirrhosis from all causes are ascites (38%) and encephalopathy (38%). followed by bleeding varices (21%), jaundice (11%). 3) HCV was associated significantly with Encephalopathy, NAFLD significantly associated with bleeding varices, Cryptogenic significantly associated with ascites, Wilson disease and PBC significantly associated with jaundice.
 
 CONCLUSIONS: HCV and alcoholism are so common among Iraqi patients with liver cirrhosis, while NAFLD cases are commonly related to diabetes mellitus and obesity. Ascites and encephalopathy are the most common presentation at medical wards from all causes of liver cirrhosis. Most cases of liver cirrhosis due to HCV are within middle and elderly. While Wilson disease should be kept at the top of differential diagnosis of liver cirrhosis among young individuals as it is significantly related to young age group. Cryptogenic cases of liver cirrhosis need aggressive work up and screening for uncommon causes.

Clinical and economic burden of nonalcoholic steatohepatitis in Saudi Arabia, United Arab Emirates and Kuwait

Background and aimsThe Middle East (ME) has a high prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), driven by obesity and type-2 diabetes mellitus (T2DM). Studies in Saudi Arabia (KSA) and United Arab Emirates (UAE) predict an escalating impact of NAFLD/NASH, particularly advanced fibrosis due to NASH (AF-NASH), increasing cases of cirrhosis, liver cancer and death. The scale of this burden in other ME countries is unknown with no reports of NAFLD/NASH healthcare resource utilization (HCRU) or costs. We estimated the clinical and economic burden of NAFLD/NASH in KSA, UAE and Kuwait.MethodsMarkov models populated with country-specific obesity and T2DM prevalence data estimated numbers and progression of NAFLD/NASH patients from 2018 to 2030. Model inputs, assumptions and outputs were collected from literature, national statistics, and expert consensus.ResultsOver 13 years, the KSA model estimated cases increasing as follows: patients with fibrosis F0–3 doubled to 2.5 m, compensated and decompensated cirrhosis and hepatocellular carcinoma trebled to 212,000; liver failure or transplant patients increased four-fold to 4,086 and liver-related death escalated from < 10,000 to > 200,000. Similar trends occurred in UAE and Kuwait. Discounted lifetime costs of NASH standard-care increased totaling USD40.41 bn, 1.59 bn and 6.36 bn in KSA, UAE (Emiratis only) and Kuwait, respectively. NASH-related costs in 2019 comprised, respectively, 5.83%, 5.80% and 7.66% of national healthcare spending.ConclusionsNASH, especially AF-NASH, should be considered a higher priority in ME Public Health policy. Our analyses should inform health policy makers to mitigate the enormity of this escalating regional burden.

Epidemiology and Disease Burden of Non-Alcoholic Steatohepatitis (NASH) in Greater China: A Systematic Review

Background: Non-Alcoholic steatohepatitis (NASH) is a progression of non-alcoholic fatty liver disease, leading to fibrosis, cirrhosis and hepatocellular carcinoma. The increasing burden of NASH has become a major concern of public health in greater China largely contributed by the rapid transition of lifestyle. The study aimed to characterize the epidemiology, disease burden, and treatment of NASH in greater China in order to better inform national disease management and delivery of health services. Methods: We conducted a systematic review searching four English databases (Web of Science, PubMed, Medline, and Cochrane Central) and three Chinese databases (CNKI, Wanfang, and VIP). We identified articles published from database inception to Oct 10, 2020 which reported NASH epidemiology, disease burden, and/or intervention in Chinese adults. The type of studies might include cross-sectional, cohort studies, randomized controlled trials and mathematical models. Exclusion criteria were studies for animal or cellular experiments, about population outside greater China, or with incomplete data. Findings: Of 44,115 articles retrieved, 33 were eligible for inclusion. Overall prevalence of NASH ranged from 2 ·4% to 6·1% in greater China, with a more substantial burden among males, the aged, and those in Hong Kong and Taiwan. Most NASH patients suffered from several comorbidities, including obesity, diabetes, and cardiovascular conditions. For non-obese subjects, PNPLA3 rs738409 G allele and haptoglobin 2-2 genotype drove the fibrosis progression in NASH. Increasingly prevalent cases of cirrhosis and hepatocellular carcinoma caused a higher NASH-related mortality. Compared with normal population, NASH patients experienced markedly poorer quality of life and heavier costs. Clinical trials of medication treatments specific for NASH are still ongoing. Interpretation: This is the first comprehensive overview of NASH among Chinese population that revealed an overwhelming impact of social and healthcare burden associated with the condition. Further high-quality studies are needed to improve the understanding and management of NASH in greater China. Funding: There was no funding source for this study. Declaration of Interests: We declare no competing interests.

Heterozygosity of the Alpha 1-Antitrypsin Pi*Z Allele and Risk of Liver Disease.

The serpin family A member 1 (SERPINA1) Z allele is present in approximately one in 25 individuals of European ancestry. Z allele homozygosity (Pi*ZZ) is the most common cause of alpha 1‐antitrypsin deficiency and is a proven risk factor for cirrhosis. We examined whether heterozygous Z allele (Pi*Z) carriers in United Kingdom (UK) Biobank, a population‐based cohort, are at increased risk of liver disease. We replicated findings in Massachusetts General Brigham Biobank, a hospital‐based cohort. We also examined variants associated with liver disease and assessed for gene–gene and gene–environment interactions. In UK Biobank, we identified 1,493 cases of cirrhosis, 12,603 Z allele heterozygotes, and 129 Z allele homozygotes among 312,671 unrelated white British participants. Heterozygous carriage of the Z allele was associated with cirrhosis compared to noncarriage (odds ratio [OR], 1.53; P = 1.1×10−04); homozygosity of the Z allele also increased the risk of cirrhosis (OR, 11.8; P = 1.8 × 10−09). The OR for cirrhosis of the Z allele was comparable to that of well‐established genetic variants, including patatin‐like phospholipase domain containing 3 (PNPLA3) I148M (OR, 1.48; P = 1.1 × 10−22) and transmembrane 6 superfamily member 2 (TM6SF2) E167K (OR, 1.34; P = 2.6 × 10−06). In heterozygotes compared to noncarriers, the Z allele was associated with higher alanine aminotransferase (ALT; P = = 4.6 × 10−46), aspartate aminotransferase (AST; P = 2.2 × 10−27), alkaline phosphatase (P = 3.3 × 10−43), gamma‐glutamyltransferase (P = 1.2 × 10−05), and total bilirubin (P = 6.4 × 10−06); Z allele homozygotes had even greater elevations in liver biochemistries. Body mass index (BMI) amplified the association of the Z allele for ALT (P interaction = 0.021) and AST (P interaction = 0.0040), suggesting a gene–environment interaction. Finally, we demonstrated genetic interactions between variants in PNPLA3, TM6SF2, and hydroxysteroid 17‐beta dehydrogenase 13 (HSD17B13); there was no evidence of epistasis between the Z allele and these variants. Conclusion: SERPINA1 Z allele heterozygosity is an important risk factor for liver disease; this risk is amplified by increasing BMI.

Epidemiological evolution of chronic hepatitis, liver cirrhosis and liver cancer in the Republic of Moldova

Introduction. The burden of liver diseases is a major health issue, being underestimated both at the national and international level. In the Republic of Moldova, there are over 70 thousand patients with chronic hepatitis and over 10 thousand people suffering from liver cirrhosis. 70% of patients with cirrhosis develop liver cancer. Over 2,000 patients die annually from complications caused by liver cirrhosis, and over 400 patients die due to primary liver cancer.&#x0D; Material and methods. The statistical analysis of 2000-2019 reports, presented by the Agency for Public Health, as well as of 3666 patient medical records retrieved from „Timofei Mosneaga” Republican Hospital, „Toma Ciorba” Clinical Hospital and “Sfinta Treime” Clinical Hospital was carried out.&#x0D; Results. 89290 cases of chronic hepatitis, liver cirrhosis and liver cancer have been officially registered. Most of them exhibited a viral etiology. The death rate was mostly recorded in patients aged 70-79. The mean age of patients with chronic hepatitis was 57.74±11.22, liver cirrhosis - 56.21±10.17, and liver cancer- 59.05±10.94. The risk factors included unprotected sex, use of sharp objects, scissors and syringes, noncompliance with dietary regimens, alcohol and tobacco use, etc. Close relatives were also investigated for the presence of viral markers in only 38.81% of cases of chronic hepatitis and in 24.37% patients with liver cirrhosis&#x0D; Conclusions. The study of common epidemiological evolution of chronic hepatitis, liver cirrhosis and primary liver cancer in the population, while considering the patient’s close relationship, might reduce both morbidity and medical and socio-economic impact.

The Association Between Chronic Hepatitis B, Chronic Hepatitis C, Sustained Liver Damage, and Features of Increased Cardiovascular Risk

It is thought that chronic liver disease affects a person's risk of cardiovascular disease (CVD) development. The aim of this study was to assess the effect of Chronic Hepatitis B (HBV) infection, Chronic Hepatitis C (HCV) infection, and liver damage on cardiovascular risk and selected vascular parameters contributing to CVD risk. This case-control study included a group of 114 patients composed of 34 patients with HBV, 35 patients with HCV, and 45 patients as the control group. Cardiovascular risk was assessed by analyzing classic risk factors, and the SCORE system. The following arterial properties were analyzed using applanation tonometry with SphygmoCor Vx technology: central systolic blood pressure (cSBP), central pulse pressure, augmentation pressure, augmentation index, and carotid-femoral pulse wave velocity (PWV). Asymmetric dimethyloarginine (ADMA) blood levels were analyzed using ELISA as a marker of vascular function. In a univariable analysis we found no significant differences between the hepatitis B, hepatitis C, and control groups in terms of PWV (respectively: median 7.2 [Q25-Q75 6.4-8.5], 7.3 [6.9-8.7], 7.8 [6.5-8.9]), cSBP (115 [109-126], 118 [107-123], 116 [107-129]), ADMA (0.52 [0.47-0.60], 0.53 [0.45-0.62], 0.58 [0.51-0.63]), SCORE (0 [0-1], 0 [0-2], 0 [0-2]). No significant differences in cardiovascular variables were observed between cirrhotic and non-cirrhotic patients. A multivariable analysis confirmed the above findings. (PWV, p=0 . 29; cSBP, p=0.26; ADMA, p=0.19). We concluded that chronic hepatitis B or C was not independently associated with an adverse cardiovascular risk profile nor with an unfavorable pattern of vascular parameters contributing to CVD risk in our study population, even in the case of liver cirrhosis. The same was true for blood ADMA levels.

The role of alcohol use in the aetiology and progression of liver disease: A narrative review and a quantification.

Issues.Alcohol use has been shown to impact on various forms of liver disease, not restricted to alcoholic liver disease.Approach.We developed a conceptual framework based on a narrative review of the literature to identify causal associations between alcohol use and various forms of liver disease including the complex interactions of alcohol with other major risk factors. Based on this framework, we estimate the identified relations for 2017 for the USA.Key Findings.The following pathways were identified and modelled for the USA for the year 2017. Alcohol use caused 35 200 (95% uncertainty interval 32 800–37 800) incident cases of alcoholic liver cirrhosis. There were 1700 (uncertainty interval 1100–2500) acute hepatitis B and C virus (HBV and HCV) infections attributable to heavy-drinking occasions, and 14 000 (uncertainty interval 5900–19 500) chronic HBV and 1700 (uncertainty interval 700–2400) chronic HCV infections due to heavy alcohol use interfering with spontaneous clearance. Alcohol use and its interactions with other risk factors (HBV, HCV, obesity) led to 54 500 (uncertainty interval 50 900–58 400) new cases of liver cirrhosis. In addition, alcohol use caused 6600 (uncertainty interval 4200–9300) liver cancer deaths and 40 700 (uncertainty interval 36 600–44 600) liver cirrhosis deaths.Implications.Alcohol use causes a substantial number of incident cases and deaths from chronic liver disease, often in interaction with other risk factors.Conclusion.This additional disease burden is not reflected in the current alcoholic liver disease categories. Clinical work and prevention policies need to take this into consideration.

Serum Metabolomic Analysis of Chronic Drug-Induced Liver Injury With or Without Cirrhosis.

Background: Chronic drug-induced liver injury (DILI) occurs in up to 20% of all DILI patients. It presents a chronic pattern with persistent or relapsed episodes and may even progress to cirrhosis. However, its underlying development mechanism is poorly understood.Aims: To find serum metabolite signatures of chronic DILI with or without cirrhosis, and to elucidate the underlying mechanism.Methods: Untargeted metabolomics coupled with pattern recognition approaches were used to profile and extract metabolite signatures from 83 chronic DILI patients, including 58 non-cirrhosis (NC) cases, 14 compensated cirrhosis (CC) cases, and 11 decompensated cirrhosis (DC) cases.Results: Of the 269 annotated metabolites associated with chronic DILI, metabolic fingerprints associated with cirrhosis (including 30 metabolites) and decompensation (including 25 metabolites), were identified. There was a significantly positive correlation between cirrhosis-associated fingerprint (eigenmetabolite) and the aspartate aminotransferase-to-platelet ratio index (APRI) (r = 0.315, P = 0.003). The efficacy of cirrhosis-associated eigenmetabolite coupled with APRI to identify cirrhosis from non-cirrhosis patients was significantly better than APRI alone [area under the curve (AUC) value 0.914 vs. 0.573]. The decompensation-associated fingerprint (eigenmetabolite) can effectively identify the compensation and decompensation periods (AUC value 0.954). The results of the metabolic fingerprint pathway analysis suggest that the blocked tricarboxylic acid cycle (TCA cycle) and intermediary metabolism, excessive accumulation of bile acids, and perturbed amino acid metabolism are potential mechanisms in the occurrence and development of chronic DILI-associated cirrhosis.Conclusions: The metabolomic fingerprints characterize different stages of chronic DILI progression and deepen the understanding of the metabolic reprogramming mechanism of chronic DILI progression to cirrhosis.

Ретроспективний аналіз летальних випадків від цирозу печінки за 20 річний період

Patients with a liver cirrhosis are at high risk for a number of complications that significantly reduce their life expectancy. The purpose of the study was to conduct a retrospective analysis of fatal cases of liver cirrhosis during the 20-year period. Material and methods. In the pathologoanatomic department of the V. T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine». A retrospective analysis of the medical records for the period 2001-2020 (20 years) was performed in order to study the lethal cases of liver cirrhosis during the 20-year period. To analyze the dynamics of the number of deaths from liver cirrhosis we used dynamic series indicators. To compare two independent groups, we used Student's t-test for signs with Gaussian distribution and Mann-Whitney U-test for signs with non-normal distribution. Results and discussion. Over 20 years, the dynamics of the number of deaths changed unevenly. The analysis of the efficiency indicator, which was calculated against the previous level (2001), showed a decrease in the indicator for the 20-year period only in 2002 and 2004, namely by 79.8 and 81.5% respectively. In other years there was only an increase in the indicator as compared with the previous level. In the years 2001-2010 371 patients died, their average age was 52.2±13.7 years. Most of them were males: 263 cases (70.9%) with an average age of 49.9±13.1. The number of dead women was 108 (29.1%) with an average age of 57.9±13.7 years. According to their age structure, most of the patients were 41-60 years old: 50.1% of males (137 cases) and 45.4% of females (49 cases). From 2011 to 2020 years 378 patients died, their average age was 54.9±12.9 years. Most of them were males: 284 cases (75.1%), average age - 53.5±12.3 years. The number of deceased women were 94 cases (24.9%), average age - 58.9±13.9 years. According to the age structure, most of the patients were 41-60 years old: 78.4% of males (152 cases), 24.9% of females (37 cases). Conclusion. When comparing the two semiannual periods 2001-2010 and 2011-2020, we found that in 2011-2020 there was a significant increase in the number of deaths from liver cirrhosis at ages 41-60 years from 50.1% to 78.39%, (p &lt;0.05) and in both cases men predominated. Among causes of death, depending on complications, bleeding from varicose esophageal and gastric veins was found to be the most important (66.0% and 53.2%, respectively), but this indicator decreased in 2011-2020 (p &lt;0.05). Bleeding occurred more frequently in men than in women (p &lt;0.05). In 2001-2010, the mean age of women was significantly higher than that of men (58.5±7.1 and 49.5±6.4 years, respectively), (p &lt;0.05), and in contrast, in 2011-2020, the mean age of men was significantly higher than that of women (59.1±6.6 and 52.3±6.9 years, respectively), (p &lt;0.05)

English

BACKGROUND The increased propensity for acute kidney injury (AKI) in patients with cirrhosis stems from haemodynamic abnormalities typical for patients with cirrhosis and ascites. 15 which is due to development of portal hypertension and portosystemic collaterals with splanchnic and systemic vasodilatation, resulting in decrease in effective arterial blood volume with increase in renin angiotensin-aldosterone system (RAAS), sympathetic nervous system and non-osmotic release of antidiuretic hormone causing sodium retention, increased intravascular volume, and a hyperdynamic circulatory state, 16 complemented with increased production of nitric oxide which is considered the main cause of vasodilatation in cirrhosis. Mechanism of renal dysfunction in cirrhosis includes portal hypertension &amp; its accompanying haemodynamic abnormalities15 leading to increased synthesis of endogenous vasodilatory compounds such as nitric oxide leading to vasodilatation in splanchnic &amp; systemic arterial systems ultimately leading to activation of reninangiotensinogen–aldosterone system causing compensatory renal vasoconstriction &amp; hypo-perfusion resulting into renal failure. We wanted to study the clinical profile of patients with AKI who presented to a tertiary care hospital in Bangalore. METHODS Ninety-four patients of either gender admitted in the department of gastroenterology at a tertiary care hospital with age &gt; 18 years with either diagnosed or newly diagnosed case of cirrhosis of liver (including both compensated &amp; decompensated cases) admitted with acute kidney injury diagnosed according to International Club of Ascites Classification were enrolled in this study. The sample size was based on number of eligible patients admitted to tertiary care hospital during the study period. Details of the study were explained to them and consent was taken either from the patient or their attender. RESULTS Most patients were in the age group &gt; 60 yrs. with 32 male patients (45.07 %) in the age group of 40 - 60 years &amp; 13 female patients (56.52 %) in the age group of &gt; 60 yrs. 78.7 % of patients developed AKI before hospital admission i.e., at community level; whereas 21.3 % of patients developed AKI after hospital admission i.e., they had normal creatinine level on admission. CONCLUSIONS Pre renal AKI was the most common cause of AKI followed by hepatorenal syndrome &amp; acute tubular necrosis (ATN) comprising 52.1 %, 28.7 % &amp; 19.1 % respectively. KEYWORDS AKI, Cirrhosis, ATN

Platelet count can predict the grade of esophageal varices in cirrhotic patients: a cross-sectional study.

Background: Bleeding from esophageal varices is a life-threatening complication in cirrhosis. Screening endoscopy is recommended in cirrhotic patients to identify patients at risk of variceal hemorrhage, but this is an invasive procedure and has limitations. Therefore, thrombocytopenia has been proposed to predict the existence and grade of esophageal varices. The aim of the current study was to determine a correlation between platelet count and grades of esophageal varices in patients with liver cirrhosis. Methods: This cross-sectional study was conducted at the POF Hospital, Wah Cantt from 1 st October, 2017 to 30 th May, 2018. Newly diagnosed cases of cirrhosis having varices of any grade on endoscopy were included. Endoscopic findings of patients were standardized using Paquet grading system. On the basis of platelet count, patients were divided into four subgroups. Platelet count groups were correlated with grading of esophageal varices using Spearman rank correlations. Chi Square test was used to see association between the platelet count and grade of esophageal varices. Results: 110 patients were included in the study, 55.5% (n=61) were male. Mean age of the patients was 59.89±9.01 years. Platelet count was <50,000/uL in 35.5% patients, 50,000-99,000/uL in 26.4%, 100,000-150000 in 12.7%, and >150,000/uL in 25.5% patients. Grade I esophageal varices were found in 23.6% of patients, whereas grade II, III and IV were found in 24.5%, 33.6% and 18.2% of patients, respectively. Mean platelet count was 213884.62/mm 3 in patients with grade I varices, whereas it was 119518.52/mm 3, 58386.49/mm 3 and 21600.00/mm 3 in patients with grade II, III and IV varices, respectively (p=<0.0001). A significant negative correlation between platelet count and grades of esophageal varices was found (p<0.001). Conclusion: Platelet count can predict the grade of esophageal varices in cirrhotic patients. There is significant negative correlation between platelet count and grades of esophageal varices.

Relation of Serum Uric Acid Concentrations with Etiology and Severity in Patients with Cirrhosis of Liver

Hyperuricaemia is now an established factor to cause oxidative stress, insulin resistance and systemic inflammation. So it is likely that hyperuricemia might be involved in hepatic necroinflammation and destruction which are the common underlying pathophysiology of cirrhosis. On the other hand, as uric acid is the end product of cellular degradation, increased hepatocyte destruction due to any etiology increases the level of serum uric acid which might further aggravate hepatic necroinflammation, cirrhosis and complications. The aim of this study is to assess serum uric acid concentrations in patients of cirrhosis of liver and its relation with cirrhosis of different etiology, disease severity and liver enzymes. This cross sectional observational study was carried out in the Department of Gastroenterology, Banghabandhu Sheikh Mujib Medical University, Bangladesh during the period of September 2015 to October 2016. A total of 220 diagnosed cases of cirrhosis of liver due to any cause from inpatient and outpatient Department of Gastroenterology were enrolled as the study population. Serum uric acid level was measured in each patient and its relationship with different etiology of cirrhosis, severity of cirrhosis and liver enzymes were assessed. The mean age was found to be 47.8 ± 14.6 years and male: female ratio was 1.9:1. Majority patients (52.3%) belonged to Child-Turcotte-Pugh Class C. The mean (±SD) value of serum uric acid was 6.19 (±3.25mg/dl) and hyperuricemia (&gt;7 mg/dl) was detected in 27.73% patients. Among all etiologies of cirrhosis, the higher mean (±SD) level of serum uric acid was found in Non-alcoholic Fatty Liver Disease (19.54 ±2.20 mg/dl). There was positive correlation of serum uric acid with liver enzymes. Mean serum uric acid level increased gradually as the cirrhotic patients progressed to higher CTP classes and there was positive correlation of serum uric acid with liver enzymes. It requires further large scale multicenter studies with increased sample size &amp; prolong follow-up to establish serum uric acid as a risk factor of cirrhosis of liver.&#x0D; Bangladesh Med J. 2021 January; 50(1) : 46-51

Modeling dysbiosis of human NASH in mice: Loss of gut microbiome diversity and overgrowth of Erysipelotrichales.

Non-alcoholic steatohepatitis (NASH) is a severe form of non-alcoholic fatty liver disease (NAFLD) that is responsible for a growing fraction of cirrhosis and liver cancer cases worldwide. Changes in the gut microbiome have been implicated in NASH pathogenesis, but the lack of suitable murine models has been a barrier to progress. We have therefore characterized the microbiome in a well-validated murine NASH model to establish its value in modeling human disease. The composition of intestinal microbiota was monitored in mice on a 12- or 24-week NASH protocol consisting of high fat, high sugar Western Diet (WD) plus once weekly i.p injection of low-dose CCl4. Additional mice were subjected to WD-only or CCl4-only conditions to assess the independent effect of these variables on the microbiome. There was substantial remodeling of the intestinal microbiome in NASH mice, characterized by declines in both species diversity and bacterial abundance. Based on changes to beta diversity, microbiota from NASH mice clustered separately from controls in principal coordinate analyses. A comparison between WD-only and CCl4-only controls with the NASH model identified WD as the primary driver of early changes to the microbiome, resulting in loss of diversity within the 1st week. A NASH signature emerged progressively at weeks 6 and 12, including, most notably, a reproducible bloom of the Firmicute order Erysipelotrichales. We have established a valuable model to study the role of gut microbes in NASH, enabling us to identify a new NASH gut microbiome signature.

Study of association between chronic liver disease and thyroid function tests at a tertiary hospital

Background: Among the various functions of liver, one function is synthesis of carrier proteins and metabolism of hormones and liver diseases, have been shown to be associated with various endocrinal disturbances. Aim of the study was to evaluate the spectrum of chronic liver disease and association between thyroid profile and severity of liver damage at a tertiary hospital. Material and Methods: Present study was single-center, hospital based, case-control study, conducted in 88 cases of liver cirrhosis/ chronic liver disease and 88 age/sex matched healthy controls (randomly selected from relatives attending OPD with patients) were studied. Thyroid function tests were done and compared among cases and controls. Results: In present study 88 cases of liver cirrhosis/ chronic liver disease and 88 healthy controls were studied. Mean age and gender were comparable in cases and controls and difference was not statistically significant. Most of cases had alcoholic liver cirrhosis (80.7 %), rest had non-alcoholic liver cirrhosis (12.5%) and chronic viral hepatitis (6.8%). As per Child-Pugh Score, most cases were from Child-Pugh B (42%), followed by Child-Pugh C (31.8%) and Child-Pugh A (26.1%). In present study free T3, free T4 and TSH were compared between cases and controls, abnormal values were noted in cases and statistically significant difference was noted. Serum thyroid profile abnormalities were noted as per advancement in Child-Pugh Score Classes and difference was statistically significant for free T3 and free T4. Conclusion: Thyroid function test abnormalities in circulating thyroid hormone concentrations were noted in patients liver cirrhosis as compared to healthy subjects and severe abnormalities were associated with advanced Child Pugh score.

中西医结合治疗原发性胆汁性肝硬化合并炎症性肠病1例

中西医结合治疗原发性胆汁性肝硬化合并炎症性肠病1例

Four cases of alcoholic liver cirrhosis in alcohol-dependent patients treated with nalmefene

Traditionally, abstinence has been regarded as the only appropriate goal in the treatment of alcohol dependence in Japan. Recently, harm reduction by reducing alcohol consumption, which has been used as a treatment approach in Europe, has gained recognition in Japan. The 2018 guideline for the treatment of alcohol dependence in Japan recommends abstinence as the primary goal, but reduction of alcohol consumption is described as an appropriate treatment goal in some patients. Nalmefene is an opioid modulator that is used to reduce alcohol consumption in patients with alcohol dependence. Here, we report the clinical course of alcoholic liver cirrhosis in alcohol-dependent patients who were treated with nalmefene for three months. Their alcohol consumption was reduced, which led to an improvement in liver function. Nalmefene provides a clinical benefit, constitutes a potential pharmacological treatment paradigm in terms of the treatment goal and dosing regimen, and addresses an unmet medical need in patients with alcohol dependence who need to reduce their alcohol consumption.