Decompensation Of Chronic Liver Disease Research Articles

Comparison of Rifaximin Alone and With Quinolones in the Primary Prevention of Spontaneous Bacterial Peritonitis in Patients With Decompensated Chronic Liver Disease.

Background In cirrhotic patients with ascites, primary prevention of spontaneous bacterial peritonitis (SBP) is a key strategy to lower morbidity and death. Rifaximin and fluoroquinolone used alternately as main prophylaxis are as effective as reported. This study aimed to compare the frequency of occurrence of SBP in patients with decompensated chronic liver disease treated with rifaximin alone and in combination with fluoroquinolone. Methodology A total of 76 patients with hepatitis C virus-related decompensated chronic liver disease and ascites were divided into two groups based on matching age, sex, and Child-Pugh class. Group A (38 patients) received rifaximin 1,100 mg/day in two divided doses with daily fluoroquinolone 400 mg/day, whereas group B (38 patients) received rifaximin 1,100 mg/day alone as a two dosage. The patients were monitored for up to three months. The study's endpoints were SBP, hepatocellular carcinoma, compliance failure, death, or liver transplantation. Results In this comparative study involving 76 patients, the demographic and clinical characteristics were assessed across two treatment groups: rifaximin alone (n = 38) and rifaximin with fluoroquinolone (n = 38). The combination therapy demonstrated a statistically significant reduction in SBP compared to rifaximin alone. Additionally, the overall survival rate was higher in the combination group. These findings suggest potential benefits of the combined approach in managing hepatic encephalopathy-related complications. Conclusions When compared to rifaximin alone for primary SBP prophylaxis, the combination of rifaximin with fluoroquinolone exhibited greater effectiveness with the same safety profile.

Sexual Dimorphism in Decompensated Non Ethanol-related Chronic Liver Disease: A Retrospective Cohort Study

Introduction: Women exhibit a distinct natural history of chronic liver disease compared to men, particularly regarding progression and outcomes. Although liver disease prevalence is generally higher in men, the incidence of non ethanol-related liver disease is increasing among females. Metabolic syndromes and their consequences are less recognised in the female population until they develop end-stage cirrhosis. Limited studies have explored the differences between male and female cirrhosis. The present study aimed to address the knowledge gap in female Decompensated Chronic Liver Disease (DCLD). Aim: To identify the differences in presentation and outcomes between females and males with non ethanol-related cirrhosis. Materials and Methods: The present retrospective cohort study was conducted in the Department of Medical Gastroenterology and Hepatology,Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, involving 27 males and 33 females with non ethanol-related decompensated cirrhosis. A comparison was made between the aetiologies, presenting symptoms, complications, laboratory values, Model for End-stage Liver Disease (MELD) score, and in-hospital mortality during the first decompensation. Data analysis was performed using Statistical Packages for Social Sciences (SPSS) version 24.0 Quantitative variables were expressed as mean and Standard Deviation, while qualitative variables were expressed as frequency and percentage. The association between categorical variables was analysed using the Chi-square test, and the comparison of continuous variables between the two groups was analysed using independent sample t-test. A p-value of <0.05 was considered statistically significant. Results: The mean age of decompensation was 56.5 years for men and 50.9 years for women. The most common aetiology in men was Non Alcoholic Fatty Liver Disease (NAFLD) (63%), while in females, it was NAFLD (45%) and cryptogenic cirrhosis (45%) (p=0.020). Diabetes Mellitus (DM) was more prevalent in males (55.6% versus 33.3%). Variceal bleed was more common in females (66.7% versus 48.1%). Jaundice was more frequently observed in males (44.4% versus 21.2%) (p=0.05). Ascites was more prominent in males (70.4% versus 45.5%) (p=0.05). Hepatic Encephalopathy (HE) was more prevalent in males (22.2% versus 15.2%). Females had a lower MELD scores compared to males (12.4±6.1 versus 15.2±6.4). Mortality was higher in males (22.2% versus 12.1%). Conclusion: Women with Decompensated Chronic Liver Disease tend to decompensate at a younger age compared to males and have a higher risk of Upper Gastrointestinal (UGI) bleeding. NAFLD was the most common aetiology in both groups. Ascites and HE were more commonly observed in men. Females had lower MELD scores, resulting in a longer waiting period on the transplant list compared to males. Mortality was higher in males.

Hypocoagulability in Children With Decompensated Chronic Liver Disease and Sepsis: Assessment by Thromboelastography.

To evaluate the coagulation status of children with decompensated chronic liver disease (DCLD) and infection and factors affecting it using thromboelastography (TEG). Coagulation status of children admitted with DCLD and infection was assessed by international normalized ratio (INR), platelet count, and TEG [reaction time (R), kinetic time (K), α-angle (AA), maximum amplitude (MA), coagulation index (CI), and lysis index (LY30)] at admission and at 7-14 days after treatment. CI < -3 represents hypocoagulable state. Clinical profile including systemic inflammatory response syndrome (SIRS), infection severity, bleeding, treatment response, and outcome were noted. Thirty children (21 boys, median (IQR) age 78 [15.7-180] months) were studied prospectively. At admission, 29 (96.7%) had prolonged INR, 24 (80%) had thrombocytopenia, and 17 (56.6%) were hypocoagulable by TEG. Nine of 30 (30%) had normal TEG but deranged INR and platelets. Nineteen (63.3%) cases had SIRS, 11 (36.6%) had severe sepsis, and 8 (26.6%) had bleeding. Hypocoagulable state was common in severe sepsis than sepsis/infection (81.1% versus 42.1%; P = 0.05) and persistent (n = 4) versus recovered SIRS (n = 15, 100% versus 33%; P = 0.03). Bleeders had prolonged R-time (7.8 versus 5.4 min; P = 0.03), smaller MA (30.2 versus 47 mm; P = 0.05), and α-angle (40.4 versus 62.9; P = 0.03) but similar INR and platelets than nonbleeders. Six patients (20%) had poor in-hospital outcomes; R-time ≥8.5 min predicted mortality with high sensitivity (83%) and specificity (100%). Fifth-seven percent of children with DCLD and infection were hypocoagulable by TEG. Severe sepsis and persistent SIRS worsened the coagulation status. TEG identifies bleeders better than INR and platelet count. R-time ≥8.5 min predicts a poor hospital outcome.

Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure-A Review of Current Evidence.

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute and severe decompensation of chronic liver disease (CLD) correlated with multiple organ failure, poor prognosis, and increased mortality. In 40-50% of ACLF cases, the trigger is not recognized; for many of these patients, bacterial translocation associated with systemic inflammation is thought to be the determining factor; in the other 50% of patients, sepsis, alcohol consumption, and reactivation of chronic viral hepatitis are the most frequently described trigger factors. Other conditions considered precipitating factors are less common, including acute alcoholic hepatitis, major surgery, TIPS insertion, or inadequate paracentesis without albumin substitution. Host response is likely the primary factor predicting ACLF severity and prognosis, the host immune response having a particular significance in this syndrome, together with the inflammatory cascade. The management of ACLF includes both the prevention of the precipitating factors that lead to acute liver decompensation and the support of vital functions, the prevention and management of complications, the estimation of prognosis, and the opportunity for liver transplantation.

Hepatic Encephalopathy Confirmed by Magnetic Resonance Imaging in a Patient with Unobvious Cause of Chronic Liver Disease Decompensation

Fifty-four-year old male was admitted to the intensive care unit (ICU) due to impaired consciousness. Past medical history included alcohol dependence, liver cirrhosis, esophageal varices, 2 esophageal varices banding procedures in the past, pathological obesity. Computed tomography (CT) examination of the head performed in the referring hospital was normal. At admission the CT examination of the head was repeated and showed no abnormalities. Urgent esophagogastroduodenoscopy revealed presence of esophageal varices and scarification following previous banding procedures located in the middle and lower part of the esophagus. Gastrointestinal bleeding being the most likely cause of chronic liver decompensation was therefore excluded. Multimodal neurologic diagnostic assessment was negative. Finally magnetic resonance imaging (MRI) of the head was performed. Taking into account clinical picture and the MRI result, the differential diagnosis included chronic liver encephalopathy, exacerbated acquired hepatocerebral degeneration, and acute liver encephalopathy. Due to history of umbilical hernia CT of the abdomen and pelvis was performed and showed intussusception of the ileum, confirming hepatic encephalopathy. In this case report the MRI suggested the diagnosis of hepatic encephalopathy and prompted search for alternative causes of decompensation of chronic liver disease.

Urine neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury and prognosis in decompensated chronic liver disease: A prospective study.

Acute kidney injury (AKI) heralds deterioration in patients with decompensated chronic liver disease (DCLD). Serum creatinine (sCr), a component of the model for end-stage liver disease-sodium (MELD-Na) prognostic score, has limitations in patients with DCLD. We evaluated the prognostic role of urine neutrophil gelatinase-associated lipocalin (NGAL) in DCLD and its ability to sub-type AKI. Total 147consecutive patients hospitalized between June 2018 andJune 2020 for complications of DCLD were evaluated. Urine NGAL was estimated and demographic, clinical and biochemical parameters recorded at baseline. Participants were followed up till theend of study period or mortality, whichever came earlier. Primary outcomes included all-cause mortality and time to death after index hospitalization. Secondary outcomes included thepresence and type of AKI, need for intensive care unit (ICU) stay, length of ICU/hospital stay, in-hospital mortality, development of new-onset/recurrent AKI and recurrent hospitalization after index admission. Urine NGAL was highest in acute tubular necrosis (ATN), lowest in pre-renal azotemia (PRA) and intermediate in hepatorenal syndrome (HRS-AKI). Urine NGAL (p = 0.0208) was superior to sCr (p = 0.0388) and inferior to fractionated excretion of sodium (FENa) (p = 0.0013) in stratifying AKI. A cut-off of 203.9ng/mL discriminated between HRS and PRA with sensitivity 77.8% and specificity 68.7%. Urine NGAL correlated with MELD-Na score, need for ICU stay, in-hospital mortality and mortality at three and sixmonths. Two-year survival was significantly lower in patients with urine NGAL > 205ng/mL. Addition of log-urine-NGAL score did not improve predictive performance of MELD-Na. Urine NGAL could identify AKI sub-types and correlated with short-term clinical outcomes, including mortality.

Hepatogenous Diabetes; an Overlooked Entity and its Implications in Course Of Decompensated Chronic Liver Disease: An Interim Analysis

Hepatogenous Diabetes; an Overlooked Entity and its Implications in Course Of Decompensated Chronic Liver Disease: An Interim Analysis

Assessment of Serum Biochemical Changes in Hepatic Encephalopathy

Objective: To analyze the association of various biochemical changes with different grades of hepatic encephalopathy among patients of hepatitis C-related decompensated liver disease presenting at Pak Emirates Military Hospital. Rawalpindi, Pakistan.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Medicine and Gastroenterology Department of Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Mar 2020 to Feb 2021.&#x0D; Methodology: This study was conducted on 100 patients with hepatitis C-related decompensated liver. A consultant medical specialist or gastroenterologist graded hepatic encephalopathy according to the West Haven criteria. Serum urea, creatinine, albumin and international normalized ratio were performed in all the patients at the time of grading of encephalopathy and derangement in the level of these parameters was analyzed with Grades of encephalopathy.&#x0D; Results: Out of 100 patients, in the final analysis, 66 were males, and 44 were females. The commonest aetiology of hepatic encephalopathy was Infection (33%) followed by Constipation (29%). 15 patients had Grade-1 encephalopathy, 43 had Grade-2, 26 had Grade-3 while 16 had Grade-4 encephalopathy. Deranged serum creatinine, international normalized ratio and albumin levels were significantly associated with a higher grade of hepatic encephalopathy (p-value&lt;0.05) in our study participants.&#x0D; Conclusion: Biochemical markers studied in patients with hepatic encephalopathy secondary to hepatitis C-related decompensated chronic liver disease were deranged. In addition, creatinine, albumin and International normalized ratio were found to be more deranged in higher grades of encephalopathy.

S1190 Therapeutic Effect of Granulocyte Colony-Stimulating Factor Therapy for Acute-on-Chronic Liver Failure: A Meta-Analysis of Randomized Controlled Trials

Introduction: Acute-on-chronic liver failure (ACLF) is a condition characterized by acute decompensation of chronic liver disease, accompanied by the failure of one or more extra-hepatic organs and high short-term mortality. Currently, liver transplantation is the only definitive treatment for ACLF but it is not beneficial to all patients due to limited donors, expensive procedure and high risk of adverse effects, so granulocyte stimulating factor (G-CSF) is considered as an alternative treatment. However, its therapeutic effectiveness is still debaTable, so we aimed to conduct a meta-analysis to evaluate the clinical efficacy of G-CSF In patients with ACLF. Methods: MEDLINE and SCOPUS were queried from inception till June 2022 for randomized controlled trials (RCTs), without any restriction. RCTs evaluating effects of G-CSF on survival rates and occurrence of infection in patients with ACLF were incorporated. The results were reported using a random-effects meta-analysis and the Mantel-Haenszel risk ratio (RR).The Subgroup analysis was done to investigate the influence of study-level factors such as study setting, population and etiology on the outcomes of interest. Results: Thirteen studies (n = 13) were included in our meta-analysis. The total number of participants in our study was 913, and the median study duration was 3 months. Our pooled analysis demonstrates that G-CSF therapy significantly improved survival rates (RR 1.52; 95% CI 1.23 to 1.88; p = 0.0001; Figure) in patients with ACLD. In our subgroup analysis, G-CSF was found to be associated with an improved survival rate in patients with viral hepatitis (RR 1.47; 95% CI 1.27 to 1.69; p < 0.00001). In contrast, results for patients with alcoholic hepatitis were insignificant (RR 1.66; 95% CI 0.88 to 3.16; p< 0.12). Pooled analysis also showed that G-CSF therapy significantly reduces the occurrence rate of infection more than SMT (RR 0.58; 95% CI 0.39 to 0.86; p= 0.006). In the subgroup analysis for viral hepatitis patients, G-CSF therapy was also significantly beneficial in reducing the occurrence rate of infection (RR 0.56; 95% CI 0.35 to 0.89; p=0.01), but in patients with alcoholic hepatitis, results were insignificant (RR 0.55; 95% CI 0.31 to 0.99; p=0.05). Conclusion: Our findings indicate that G-CSF therapy is beneficial in improving survival rates and reducing the risk of infection in patients with ACLF. Hence, it can be used as an alternative treatment for patients with ACLF.Figure 1.: Survival rates in patients with alcoholic hepatitis and viral hepatitis

Paediatric Acute-on-Chronic Liver Failure: A Review of Current Evidence in Children

Acute-on-chronic liver failure (ACLF) is a syndrome that describes acute decompensation of chronic liver disease with differing definitions worldwide, but is universally associated with high short-term mortality. This is becoming increasingly recognised as a unique entity that affects both adults and children. This narrative review summarises the current available evidence from paediatric studies on definition, incidence, pathophysiology, and outcome, with reference to data on ACLF from adult literature. Paediatric data remain scarce, and study groups have used differing inclusion criteria that have limited generalisability of data. There is a crucial need for a consensus definition for paediatric ACLF so that future collaborative research may provide better understanding on the epidemiology, pathophysiology, risk factors, and outcome of this clinical entity.

Non-hepatotropic viral hepatitis and its causative pathogens: The ongoing need for monitoring in children with severe acute hepatitis of unknown etiology.

Non-hepatotropic viral hepatitis and its causative pathogens: The ongoing need for monitoring in children with severe acute hepatitis of unknown etiology.

The Burden of Gastrointestinal, Hepatobiliary and Pancreas Related Diseases and Their Causes at Tertiary Care Hospital in Karachi

Objective: To determine the burden of gastrointestinal, hepatobiliary and pancreas-related disease, frequencies and their presentations.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Gastroenterology Department, Liaquat National Hospital, Karachi from Oct 2020 to Jul 2021&#x0D; Methodology: Patients aged ≥18 years, having diagnosis related to gastrointestinal, hepatobiliary and pancreas were included in the study. Demographic features, reasons for admission, and length of stay were recorded.&#x0D; Results: A total of 2183 patients were enrolled. Nearly half of the patients were ≥60 years. 43% of patients were presented with abdominal pain. The most frequent diagnosis includes decompensated chronic liver disease followed by upper gastrointestinal bleed. The proportion of female patients was significantly higher for gastritis (p=0.009) and acute cholecystitis (p=0.036), while males with Hepatitis-B (p=0.019) and liver abscesses (p=0.018) were significant. Admissions through emergency were higher for gastrointestinal bleeding and decompensated chronic liver disease (p&lt;0.001) in monitoring setup (p=0.034), ward admission via OPD were significant for upper gastrointestinal malignancy (p=0.011) and hepatocellular carcinoma (p=0.038). Extended length of stay and expiry was significant among acute liver failure (p=0.047) and gastric outlet obstruction (p=0.030).&#x0D; Conclusion: Notably, highly evitable diseases are still a foremost reason of clinical importance, lack of awareness and low cure rate, especially in rural areas progress to high fatality as most patients do not seek medical assistance until significant manifestation. This appeals to more effective measures, including eradicating the potentially life-threatening disease.

Triggers for de-compensation of Chronic Liver Disease in South of Lahore

Background: Cirrhosis is a leading cause of mortality and morbidity across the world with cases number estimated to be as high as 1.5 Billion. Pakistan is one of the countries where the burden of disease is significantly high. Aim: To understand potential causative factors contributing towards decompensation of liver disease and report it for the benefit of other units providing service to similar population. Study design: Prospective observational study Methods: Common complications of portal hypertension resulting from chronic liver disease include development of ascites, encephalopathy, GI bleeding and hepato-renal syndrome. Decompensation of cirrhosis can be transient with full recovery (re-compensation), or it can be chronic. During an event of acute decompensation, clinicians strive to treat the underlying trigger which may have resulted in decompensation alongside the supportive treatment. Several of such potential factors have been reported in the literature. New infection, dehydration, consumption of alcohol and new medications are a few to mention. Many a times the cause of decompensation remains unclear. Results: The patients with established cirrhosis can develop such complications of the disease resulting in what is known as decompensation at any point during disease. It is imperative for a liver unit to know the relevant causes of hepatic decompensation in its own patients so that the treatment is based on the evidence from local population; the data which is scarce. Conclusion: Non-compliance with medical advice was the commonest factor as opposed to the available data most of which reports infection as the commonest factor, although infection was the second most common factor, and the commonest concomitant factor in this subset of patients. Cause of decompensation remains unidentified in over one fourth of cases. Keywords: Decompensation, trigger, chronic liver disease

Status 1B designation does not adequately prioritize children with acute-on-chronic liver failure for liver transplantation.

Acute-on-chronic liver failure (ACLF) is an acute decompensation of chronic liver disease leading to multiorgan failure and mortality. The objective of this study was to evaluate characteristics and outcomes of children with ACLF who are at the highest priority for liver transplantation (LT) on the United Network for Organ Sharing (UNOS) database-listed as status 1B. The characteristics and outcomes of 478 children with ACLF listed as status 1B on the UNOS LT waiting list from 2007-2019 were compared with children with similar or higher priority listing for transplant: 929 with acute liver failure (ALF) listed as status 1A and 808 with metabolic diseases and malignancies listed as status 1B (termed "non-ACLF"). Children with ACLF had comparable rates of cumulative organ failures compared with ALF (45% vs. 44%; p>0.99) listings, but higher than non-ACLF (45% vs. 1%; p<0.001). ACLF had the lowest LT rate (79%, 84%, 95%; p<0.001), highest pre-LT mortality (20%, 11%, 1%; p<0.001), and longest waitlist time (57, 3, 56days; p<0.001), and none recovered without LT (0%, 4%, 1%; p<0.001). In survival analyses, ACLF was associated with an increased adjusted hazard ratio (HR) for post-LT mortality (HR, 1.50 vs. ALF [95% confidence interval, CI, 1.02-2.19; p=0.04] and HR, 1.64 vs. non-ACLF [95% CI, 1.15-2.34; p=0.01]). ACLF has the least favorable waitlist and post-LT outcomes of all patients who are status 1A/1B. Increased prioritization on the LT waiting list may offer children with ACLF an opportunity for enhanced outcomes.

Gastrointestinal hemorrhage as an acute-on-chronic liver failure trigger in cirrhotic patients.

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with organ failures and very high short-term mortality. To assess the incidence and factors predisposing to ACLF in patients with liver cirrhosis hospitalized due to acute gastrointestinal bleeding (GIB). We collected and retrospectively analyzed the data of 89 consecutive patients (59 males (66.2%), median age 53 years (range: 44-62 years), mean Model for End-Stage Liver Disease (MELD) score 14.42 ±6.5, median Child-Turcotte-Pugh score 10 (range: 8-11), and acute GIB (72 variceal bleeding and 17 non-variceal bleeding cases). Acute-on-chronic liver failure was diagnosed based on European Association for the Study of the Liver - Chronic Liver Failure Consortium definition. Twenty-seven (30.33%) patients met the criteria of ACLF during hospitalization: 8 (30%) had ACLF grade 1, 13 (48%) had ACLF grade 2 and 6 (22%) had ACLF grade 3. The most frequent organ failures were respiratory (22 (25%)), kidney (18 (20.23%)) and brain (17 (19.1%)) failure. The MELD score value, creatinine level and presence of hepatic encephalopathy (HE) on admission were significant predictors of ACLF in the multivariate logistic regression model with optimal cutoff point for MELD score of 18.313 and optimal cutoff point for creatinine level of 1.35 mg/dL. In-hospital risk of ACLF in cirrhotic patients hospitalized for acute gastrointestinal hemorrhage is high despite successful arrest of bleeding. Elevated creatinine level, MELD score and the presence of HE on admission are the best predictors of ACLF during hospitalization in such patients.

Clinical Spectrum of Alcoholic Liver Disease in Subjects Attending Outpatient Department at a Tertiary Care Hospital

Background: Alcoholic liver disease is one of the primary medical complication of chronic ethanol abuse. It encloses a wide spectrum of diseases comprising of fatty liver, alcoholic hepatitis, alcoholic cirrhosis and hepatocellular carcinoma.&#x0D; Methodology: A prospective, observational study was done at AIG hospitals in the department of hepatology for a period of 6 months. A total of 200 patient’s diagnosed clinically and biochemically with various spectrum of ALD were recruited for the study.Non-invasive prognostic scores were calculated at the time of admission and correlated with severity of disease.&#x0D; Results: Among 200 study participants, 34.8% belongs to age group of 36-45 years. All were male patients with age group ranged from 25 to 73 years. We observed the high levels of alkaline phosphatese, aspartate aminotransferase/alanine aminotransferase ratio, mean corpuscular volume, total bilirubin and international normalized ratio in Severe Alcoholic hepatitis patients. Non-invasive prognostic markers like child-turcotte-pugh score,model for end stage liver disease-sodium and maddrey’s discriminant factor were assessed for all patients.Prevalence of different stages of ethanol mediated liver disease were-12% of alcoholic fatty liver,17.5% of alcoholic hepatitis,6% of acute on chronic liver failure,32.5% of chronic liver disease,24% of decompensated chronic liver disease,6% of past decompensated chronic liver disease with current living donor liver transplant and 2% cases of hepatocellular carcinoma.&#x0D; Conclusion: Hazardous ethanol abuse is more typical in adult males especially among productive age group. The subjects were cautioned on their personal basis regarding fallout of alcoholic liver disease, and guided for latency of alcohol not immediately but definitely.

Risk factors associated with non-malignant portal vein thrombosis in patients with decompensated cirrhosis : a case-control study

Backgrounds and Aim: Portal vein thrombosis (PVT) is defined as thrombosis of the portal vein and branches of spleno-portal axis. Incidence of PVT in compensated liver disease is between 0.6-5% and up to 25% in advanced disease. Presence of PVT in decompensated chronic liver disease (DCLD) is associated with significant morbidity and mortality. We evaluated the proportion and risk factors associated with non-malignant PVT in DCLD patients. Methods: 502 patients with DCLD were enrolled over a period of 1.5 years. Patients underwent detailed clinical history and evaluation, baseline investigation and ultrasonography. CECT Abdomen was performed in patients with USG evidence of PVT or alteration in portal flow dynamics. Results: 39 patients were excluded. 51 of the 463 patients included had PVT (11.0%). Duration of cirrhosis >4years(p<0.01), NASH related etiology (p<0.01), prior history of obesity(p<0.01), dyslipidaemia with high serum cholesterol and LDL(p<0.01), clinically evident sarcopenia (p<0.01), first initial decompensation of cirrhosis as upper gastro-intestinal bleed (UGIB), prior UGIB (p=0.002), poorly controlled ascites (p<0.01), 2 history of episodes of SBP(p<0.01), platelet count <66.5x109/L(p=0.002), leucocyte count <5350/cu mm(p<0.01) were significantly associated with PVT group. There was no difference between CHILD B and C status, among the 2 groups. On multiple logistic regression analysis, prior endoscopic variceal ligation, SAAG >1.95 were found as independent risk factors for development of PVT in DCLD patients. Conclusions: Proportion of non-malignant PVT in decompensated cirrhosis was 11%. Presence of poorly controlled ascites, prior history of UGIB, high SAAG, low Platelet count as markers of severity of portal hypertension in cirrhosis are significantly associated with non-malignant PVT in DCLD. Patients with prior history of obesity and dyslipdemia, with NASH related cirrhosis are at high risk for PVT development.

Progressive Perianal Necrotising Soft Tissue Infection in Decompensated Chronic Liver Disease: A Case Report

Necrotising soft tissue infection in diabetics is known to carry a significant risk of mortality, while if it is associated with chronic liver disease (CLD) Child C, the mortality further increases. CLD alone has a predicted 5-year survival of 50%. This case report selectively highlights the occurrence of perianal spreading cellulitis in the presence of liver disease and diabetes with stress on special considerations. A 50-year-old male, presented with decompensated Child’s C CLD in metabolic acidosis with reduced urine output, deranged renal function, ascites and elevated bilirubin levels along with perianal pathology that began as a seemingly innocuous painful swelling. He was found to have extensive necrotising infection extending beyond the perianal region to involve the gluteal skin, perineum and scrotum and had poor anal sphincter tone. MRI revealed an extensive collection of pus involving both ischiorectal fossae extending extra-peritoneally into the left side of the pelvis. Special preoperative considerations involved optimising hydration (while avoiding overload), correcting acidosis arranging adequate blood products in view of coagulopathy and anaemia. The necessity of debridement for source control carried with it the attendant risk of further decompensation of CLD besides major haemorrhage from porto-systemic collaterals. Diversion, though imperative, carried the risk continuous peri-stomal seepage of ascites We describe a case of diversion after physiological stabilisation and highlight graded damage control measures for optimal outcomes and preventing stoma related complications in such immunocompromised patients.

Comparitive study of AARC score with CTP, MELD NA score in patients with acute-on-chronic failure

Background and Aim: Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute decompensation of chronic liver disease often triggered by ethanol intake, infections with high mortality. Although a variety of scoring systems have been developed to assess prognosis in ACLF, most of them are based rapidly changing classic Child Turcotte Pugh (CTP) and Model of End-stage Liver Disease (MELD) at diagnosis necessitating the need for comparison with AARC score in patients with ACLF.

NUTRITIONAL APPROACHES TOWARDS PREVENTION AND TREATMENT OF DCLD

Decompensated chronic liver disease (DCLD) is also known as decompensating cirrhosis. Cirrhosis is a chronic liver disease that is commonly resulting of hepatitis or alcohol use disorder. It is the severe scarring of liver seen at the terminal stages of chronic liver disease. The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. In this study we detailed a patient having decompensated chronic liver disease and observed all require parameter in dietary management. The patient undertook a dietary counselling for 16 days and dietary modification was done according to the patient condition. The HB level was 9.1g/dl, so beetroot juice in the mid-morning and soybean and 2 egg whites were suggested to increase the protein level. Later it was seen that Hb level was increased to 9.9g/dl and protein level was increased to 6g/dl. Also, the potassium level was below normal, so coconut water suggested. what to avoid and what to include and a sample menu and a diet chat was given to the patient at the time of discharge. Malnutrition is a potentially reversible condition that, when identified and treated appropriately, can lead to improvement of the outcomes of patients with DCLD.