Degree Of Hepatic Encephalopathy Research Articles

Prevention and treatment of drug-induced liver injury in patients with breast cancer and ovarian cancer

Introduction: Drug-induced liver injury is one of the most serious problems in hepatology. In most cases the abolition of the “causative” drug is a sufficient condition for the reverse development of pathological changes. However, in the case of chemotherapy for cancer patients, the abolition of hepatotoxic drug is impossible without creating an immediate or delayed threat to the patient’s life. Objective: To develop optimal schemes for the prevention and treatment of drug-induced liver injury by studying of its characteristics of with various chemotherapy regimens in patients with breast cancer and ovarian cancer. Material and methods: The screening group included 291 patients who underwent chemotherapy courses for breast cancer and ovarian cancer. The diagnosis and type of drug-induced liver injury was based on laboratory data (alanine aminotransferase and/or alkaline phosphatase increased above 2 norms) and the exclusion of other etiologies of liver diseases. Chemotherapy hepatotoxicity was assessed using the Shaposhnikov scale. The degree of hepatic encephalopathy was determined using a critical flicker frequency test. Depending on chemotherapy mode, groups of the patients were divided into subgroups: cyclophosphamide + Methotrexate+ Fluorouracil, Doxorubici + Cyclophosphamide, Epirubicin + Cyclophosphamide + 5-fluorouracil, Paclitaxel + Cisplatin, Carboplatin + Cyclophosphamide. According to the type of drug-induced liver injury, patients with cholestatic type received preparations, with cytolytic type – S-adenosylmethionine for 8 weeks. Results and its discussion: It was found that the most common side effect of chemotherapy is leukopenia, anemia and increase in level of alanine aminotransferase and alkaline phosphatase. The use of ursodeoxycholic acid and S-adenosylmethionine as an accompanying therapy significantly reduces the level of alanine aminotransferase and alkaline phosphatase degree of hepatotoxicity and hepatic encephalopathy, clinical improves the quality of life of patients and contributes to a more rapid elimination of symptoms of astheno-vegetative, dyspeptic and pain syndromes. Conclusion: It has been proven that the use of a differentiated approach to the choice of a hepatoprotector: S-adenosylmethionine in hepatocellular type, ursodeoxycholic acid - in cholestatic type of drug-induced liver injury for 8 weeks in patients with oncological profile allowed to carry out the planned therapy without deviations from the protocol.

Predictive potential of the MELD and Child-Turcotte-Pugh II scores for SBP in patients with cirrhosis and ascites

It is very important for patients with spontaneous bacterial peritonitis (SBP) to assess the length of survival and the risk of death, primarily because of the wide range of potential complications that can lead to multisystem organ failure and fatal outcome. The aim of this study was to determine the predictive potential of MELD and Child-Turcotte-Pugh II score for SBP in patients with cirrhosis and ascites. Material and methods: The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included 70 hospitalized patients with established liver cirrhosis, regardless of etiology, divided into two groups, 35 patients with SBP and 35 non-SBP. Prognostic scores in patients with liver cirrhosis and ascites: MELD score, according to the formula: MELD = [(0.957 x Ln Creatinin) + (0.378 x Ln Bilirubin) + (1.12 x Ln INR) + (0.643) x 10]. The Child-Turcotte-Pugh II score includes 6 parameters: serum albumin and bilirubin, amount of ascites, degree of encephalopathy ( HE), prothrombin time (PT) and serum creatinine, and assessment of the degree of hepatic encephalopathy according to the West Haven criteria. Results: The average value of the MELD score in patients with SBP was 22.6 ± 8.27 and in non-SBP the average value was lower - 17.83±5.87. According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = 2.41; p = 0.015). A score of 30 to 39 was registered in 25.7% of patients with SBP, and only in 2.9% in non-SBP; the percentage difference was statistically significant for p <0.05 (Difference test, p = 0.0064 ). Patients with SBP had an average Child-Pugh score of 13.09 ± 2.48 or 100.0% C-class points. In patients with non-SBP, an average child-Pugh score of 9.63 ± 1.62 was recorded, or class B in 65.7% and class C in 34.3%. The percentage difference was statistically significant for p <0.05 (Difference test, p = 0.000000). According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = -5.44; p = 0.00001). ROC analysis indicated that the Child-Turcotte-Pugh II score contributed to the diagnosis of SBP - 90.7% (p = 0.000) (excellent predictor), closer to the ideal value of 1.0 and above the worst value of 0.5. ROC analysis indicated that the MELD score did not contribute to the diagnosis of SBP - 66.7% (p = 0.017) (weak predictor), closer to the worst value of 0.5. Conclusion:Our research confirmed that SBP occurs in patients with severe hepatic dysfunction calculated according to the CTP II score and MELD score. Mean value of the MELD score in patients with SBP was higher then in patients with non-SBP. On the other hand all patients with SBP had an average CTP II score, C-class points, while the largest percentage of patients with non-SBP were class B-class points. MELD score is a weak predictor of SBP. The best predictor for predicting SBP is the CTP II score (rank C).

Особливості синдрому надлишкового бактеріального росту та порушень мікрофлори кишечника у хворих з портальною гіпертензією

Мета: оцінити клінічні особливості хворих з портальною гіпертензією (ПГ) та синдромом надлишкового бактеріального росту (СНБР). Методи. Під спостереженням перебувало 67 хворих із синдромом портальної гіпертензії, віком від 43 до 81 року, які сформували 2 групи: І група — 60 пацієнтів із печінковою ПГ; ІІ група — 7 хворих із позапечінковою ПГ. Проводили оцінку СНБР за допомогою сучасного газоаналізатора Gastro + Gastolyzer та встановлювали взаємозв’язок отриманих результатів з клінічними даними. Результати. Встановлено, що для пацієнтів із печінковою ПГ СНБР зустрічається частіше (80 %), ніж з позапечінковою ПГ (57 %) (р < 0,05). У хворих із вірусним походженням ПГ та алкогольним етіологічним фактором ПГ СНБР зустрічався з однаковою частотою. Відмічали підвищення трансаміназ у 70,1 % (р < 0,05) пацієнтів з СНБР. Залежності від стадії компенсації захворювання печінки (за Чайлдом — П’ю) та частоти СНБР виявлено не було. Спостерігалась обернена залежність між ступенем печінкової енцефалопатії та частотою СНБР. Висновки. Визначення СНБР водневим дихальним тестом може бути рекомендовано як сучасний, неінвазивний, простий у використанні метод, що дає змогу підвищити оцінку прогнозування та контролю лікування СНБР у хворих із ПГ. Перед призначенням лікування різних форм ПГ слід обов’язково діагностувати СНБР з метою запобігання прогресуванню та розвитку ускладнень.

Tc-99m GSA scintigraphy within the first 3\xa0days after admission as an early predictor of outcome in severe acute liver injury

Patients with severe acute liver injury (SLI) usually recover spontaneously. However, some SLI patients progress to acute liver failure with varying degrees of hepatic encephalopathy. Acute liver failure is associated with high mortality and can be substantially reduced by liver transplantation. Therefore, distinguishing SLI patients who might progress to acute liver failure and are at a risk of death is important when evaluating patients needing liver transplantation. The present study aimed to determine whether technetium-99m-diethylenetriaminepentaacetic acid galactosyl human serum albumin (Tc-99m GSA) scintigraphy can predict the prognosis of patients with SLI. This prospective observational study included 69 SLI patients. The accuracy of Tc-99m GSA for predicting death or liver transplantation for 6 months was assessed. Between the two groups of patients stratified based on the cut-off values from the receiver operating characteristic curves, 6-month transplant-free survival was compared. Sixteen (23.2%) patients died or underwent liver transplantation from admission (poor outcome). The hepatic accumulation index was calculated by dividing the radioactivity of the liver region of interest by that of the liver-plus-heart region of interest at 15 min (i.e., LHL15). The LHL15 in the 16 patients (0.686) was significantly lower than that in survivors (0.836; P < 0.0001). The optimal LHL15 cut-off for distinguishing poor outcome and survival was 0.737 with a sensitivity of 81.3%, specificity of 88.7%, and area under the curve of 0.907 (95% CI, 0.832–0.981). When patients were divided into two groups based on the LHL15 cut-off value, the 6-month transplant-free survival was significantly lower in patients with an LHL15 level ≤ 0.737. Tc-99m GSA scintigraphy may help predict the prognosis of patients with SLI.

Acute Liver Failure in Patients with Classic Heat Stroke

Background: Classic heat stroke is defined by a core temperature greater than 40° C, severe dehydration and neurological alterations. Patients with liver disease due to heat stroke have been described, mostly by exercise. Hepatic failure is defined as the presence of a coagulopathy accompanied by any degree of hepatic encephalopathy. The primary objective of the study lies in the fact that patients who developed acute liver failure during their hospital stay had a higher risk of mortality.&#x0D; Methods: A retrospective, analytical study of patients admitted to the General Hospital of Mexicali who suffered from classic heat stroke from March 2006 through August 2010, and a second period from June 2018 to August 2019.&#x0D; Results: Fifty patients were recruited, the group included 48 (96%) male, with a total of 10 fatalities, representing 20%. INR greater than 1.5, AST and ALT levels were not related to an increased mortality rate.&#x0D; Conclusion: Neither transaminase levels, nor liver failure, were related to a higher mortality rate in this cohort of patients with classic heat stroke.

Approach to the patient with acute severe autoimmune hepatitis.

SummaryAutoimmune hepatitis is associated with varied clinical presentations and natural history, as well as somewhat unpredictable treatment responses. Understanding how to stratify patients who require further escalation of therapy will help clinicians manage these patients. The presentation of acute severe autoimmune hepatitis (AS-AIH) is relatively uncommon, although its prevalence is potentially greater than currently perceived. Previous studies consist of small retrospective single-centre series and are not directly comparable due to the diversity of presentations, disease definitions and non-standardised treatment regimens. We define AS-AIH as those who present acutely with AIH and are icteric with an international normalised ratio ≥1.5 and no evidence of hepatic encephalopathy. Those with hepatic encephalopathy should be defined as having AS-AIH with acute liver failure. In this review, we provide a structured practical approach for diagnosing and managing this unique group of patients.

The course and survival of patients with liver cirrhosis and acute liver failure on the background of chronic

Aims. We comparative investigated the frequency, precipitating factors, lifetimes and predictive factors of survival in patients with liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF). Material and methods. We collected data from 310 hospitalized patients with LC. Patients divided into groups: 1 — patients with compensation of LC; 2 — patients with decompensation of LC, but without organ failure (OF) and 3 — patients with ACLF. Diagnostic criteria for ACLF based on consensus recommendations of EASL. Survival was assessed according to the Kaplan-Meier method. Results. 48 patients with LC reported clinical signs of ACLF. 28-day mortality was in 4,8% of patients without ACLF and in 42,0% of patients with ACLF. 90-day mortality of patients with ACLF was 50% versus 11.6% in patients without ACLF. 6-month survival rate of patients with the development of acute decompensation with organ failure was only 33,3%. The lifetimes of patients with ACLF was only 136,65 ± 18,96 days. The predictive factors of survival of patients with LC and ACLF are: the number of organ failure, indicators of CLIF-SOFA and MELD, Child-Pugh score, degree of hepatic encephalopathy, leukocytosis, hyperbilirubinemia, hypercreatininemia and increased INR. Conclusion. The prevalence of ACLF in patients with LC is 15,5% and develops against a background of stable compensated or decompensated CP. The frequent trigger of ACLF is infection, which causes acute decompensation with the development of multiple organ failure and a high incidence of short-term mortality. The 28-day mortality rate in patients with ACLF was 8.7 times greater than the mortality rate in patients with decompensated LC without ACLF.

3:09 PM Abstract No. 53 Incidence and degree of hepatic encephalopathy after VIATORR controlled expansion transjugular intrahepatic portosystemic shunt creation

3:09 PM Abstract No. 53 Incidence and degree of hepatic encephalopathy after VIATORR controlled expansion transjugular intrahepatic portosystemic shunt creation

Fecal Calprotectin in Patients with Hepatic Encephalopathy

Background and study aim: Cal-protectin is a cytoplasmatic protein of neutrophilic granulocytes and it is an established marker for the assessment of localized intestinal inflammation .Bacterial translocation is known to play an important role in the pathogenesis of certain complications of cirrhosis such as hepatic encephalopathy (HE). This study amid to assess: the value of fecal calprotectin in the diagnosis of hepatic encephalopathy, relationship between level of fecal calprotectin and the degree of hepatic encephalopathy. Patients and Methods: This cross sectional study was conducted on 90 patients attended to the Hepatology, Gastroenterology and Infectious Diseases Department of Benha University Hospital between March and July 2016. All medical diseases which are known to influence the level of fecal calprotectin were excluded (as: gastro-intestinal bleeding or inflmmatory bowel disease). The degree of liver insufficiency was assessed according to the Child Pugh classifiation and Model of End Stage Liver Disease (MELD); and degree of hepatic encephalopathy by West-Haven criteria, and the number connection test. Results: The mean value of fecal calprotectin in patients with overt HE was 304.4 ± 41.05 μg/g, and in patients with MHE was 74.4 ± 23.9 μg/g and in the group of liver cirrhosis without encephalopathy was 57.55± 8.92 and in healthy group was 25.22 ± 8.63, respectively with high significant difference (p<0.001). There was no significant correlation between fecal calprotectin and (age, psychometric test, Child-Pugh classification, MELD score and West-Haven criteria). Conclusion: This study confirmed significantly higher values of fecal calprotectin in patients with hepatic encephalopathy. Among patints with OHE and patients of MHE, no significant correlation between fecal calprotectin and age, psychometric test, Child classification, MELD score and West-Haven criteria were detected.

A new multiparameter integrated MELD model for prognosis of HBV-related acute-on-chronic liver failure.

Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) is one of the most deadly diseases. Many models have been proposed to evaluate the prognosis of it. However, these models are still controversial. In this study, we aimed to incorporate some characters into model for end-stage liver disease (MELD) to establish a new reliable and feasible model for the prognosis of HBV-ACLF.A total of 530 HBV-ACLF patients who had received antiviral therapy were enrolled into a retrospective study and divided into the training cohort (300) and validation cohort (230). Logistic regression analysis was used to establish a model to predict the 3-month mortality from the patients in the training cohort, and then, the new model was evaluated in the validation cohort.Except for MELD score, 4 other independent factors, namely degree of hepatic encephalopathy (HE), alpha-fetoprotein (AFP), white blood cell (WBC) count, and age, were important for the new model called HBV-ACLF MELD (HAM) model: R = 0.174 × MELD + 1.106 × HE - (0.003 × AFP) + (0.237 × WBC) + (0.103 × Age) - 11.388. The areas under receiver-operating characteristic curve of HAM in the training and validation cohort were 0.894 and 0.868, respectively, which were significantly higher than those of other 7 models. With the best cut-off value of -1.191, HAM achieved higher sensitivity and negative predictive value.We developed a new model that has a great prognostic value of the 3-month mortality of patients with HBV-ACLF.

Functional brain network changes associated with clinical and biochemical measures of the severity of hepatic encephalopathy

Functional properties of the brain may be associated with changes in complex brain networks. However, little is known about how properties of large-scale functional brain networks may be altered stepwise in patients with disturbance of consciousness, e.g., an encephalopathy. We used resting-state fMRI data on patients suffering from various degrees of hepatic encephalopathy (HE) to explore how topological and spatial network properties of functional brain networks changed at different cognitive and consciousness states. Severity of HE was measured clinically and by neuropsychological tests. Fifty-eight non-alcoholic liver cirrhosis patients and 62 normal controls were studied. Patients were subdivided into liver cirrhosis with no outstanding HE (NoHE, n=23), minimal HE with cognitive impairment only detectable by neuropsychological tests (MHE, n=28), and clinically overt HE (OHE, n=7). From the earliest stage, the NoHE, functional brain networks were progressively more random, less clustered, and less modular. Since the intermediate stage (MHE), increased ammonia level was accompanied by concomitant exponential decay of mean connectivity strength, especially in the primary cortical areas and midline brain structures. Finally, at the OHE stage, there were radical reorganization of the topological centrality—i.e., the relative importance—of the hubs and reorientation of functional connections between nodes. In summary, this study illustrated progressively greater abnormalities in functional brain network organization in patients with clinical and biochemical evidence of more severe hepatic encephalopathy. The early-than-expected brain network dysfunction in cirrhotic patients suggests that brain functional connectivity and network analysis may provide useful and complementary biomarkers for more aggressive and earlier intervention of hepatic encephalopathy. Moreover, the stepwise deterioration of functional brain networks in HE patients may suggest that hierarchical network properties are necessary for normal brain function.

Drug-induced Liver Disease in Patients with Diabetes Mellitus.

The study presented here was accomplished to assess the course of drug-induced liver diseases in patient’s rheumatoid arthritis receiving long-term methotrexate therapy. Diabetes mellitus was revealed as the most significant risk factor. The combination of diabetes mellitus with other risk factors (female sex) resulted in increased hepatic fibrosis, degree of hepatic encephalopathy and reduction of hepatic functions. The effectiveness and safety of ursodeoxycholic acid and cytolytic type-with S-Adenosyl methionine was also evaluated.Abbreviations13C-MBT: 13C-methacetin breath test; ALT: alanine aminotransferase; AP: alkaline phosphatase; AST: aspartic transaminase; DILD: drug-induced liver disease; DM: diabetes mellitus; HE: hepatic encephalopathy; HFM: hepatic functional mass; SAMe: S-Adenosyl methionine; UDCA: ursodeoxycholic acid.How to cite this articleIryna K, Helen M, Elena S. Drug-induced Liver Disease in Patients with Diabetes Mellitus. Euroasian J Hepato-Gastroenterol 2015;5(2):83-86.

Diagnosis and management of fulminant Wilson's disease: a single center's experience.

Medical therapy is rarely effective in patients with fulminant Wilson's disease (FWD). Liver transplantation is limited by the lack of donor liver in most patients with FWD at the time of diagnosis. New Wilson's index, model for end-stage liver disease (MELD) and Child-Pugh score are useful tools for decision-making of liver transplantation; however, none of them is an independent decisive tool. It is worthwhile to explore a more effective and practical therapeutic strategy and reevaluate the prediction systems for patients with FWD. Nine patients with FWD associated with hemolytic crisis and fulminant hepatic failure (FHF) were investigated. The clinical presentation, prognostic score and medical therapies of the patients were analyzed. In 7 of the 9 patients with FWD who received the comprehensive therapy of corticosteroid, copper-chelating agent (dimercaptopropansulfonate sodium) and therapeutic plasma exchange (TPE), 6 patients recovered from FHF. The remaining one had been improved through the comprehensive therapy but died of septicemia 51 days later. Two patients with spontaneous bacterial peritonitis (SBP) died from liver failure in three or five hospital days without plasma exchange or chelating therapy. All of the 9 patients with FWD presented with acute hepatic failure, severe jaundice and mild to severe hemolytic anemia. No marked difference in the incidence of severe hemolytic anemia was detected between the survival and deceased groups. However, the incidence and the degree of hepatic encephalopathy (HE) in the non-survival group were higher than those in the survival group. Unlike the deceased group, the survival group had no complications induced by bacterial infection. Compared to new Wilson's index, Child-Pugh score and MELD score, the variation of prothrombin activity (PTA) between the survival and deceased groups was more evident. For patients with FWD, the episode of severe hepatic encephalopathy or/and spontaneous bacterial peritonitis indicates worse prognosis, and PTA is a recommendable predictor. An emergent liver transplantation should be considered for patients whose PTA is below 20%, or for those with severe HE or/and SBP. The comprehensive therapy of corticosteroid, copper-chelating agent and TPE is effective for patients without SBP and whose PTA is higher than 20%.

Acute liver failure in Cuban children.

Acute liver failure is rare in pediatric patients and is one of the most challenging medical emergencies due to its prognostic and therapeutic implications. The best scientific evidence worldwide comes from multicenter studies in developed countries. In Cuba, there are no prior studies of this disorder in children. Describe the main clinical features of Cuban children treated at a national referral center for acute liver failure, as defined by recognized diagnostic criteria for pediatric patients. A case series study was conducted comprising patients diagnosed with acute liver failure treated from 2005 to 2011 in the hepatology and liver transplant service at Havana's William Soler University Children's Hospital. Variables were age group, etiology of acute liver failure, grade of hepatic encephalopathy, blood chemistry variables, and clinical outcome (whether or not spontaneous recovery of liver function occurred). Associations between variables were assessed using contingency tables, and case fatality was calculated, as well as relative risk with its 95% confidence interval. The Mann-Whitney U test was used to compare means of laboratory test results. Median age of the 31 patients studied (14 boys and 17 girls) was 24 months (range 1-180). Time between symptom onset and diagnosis of acute liver failure was 25.1 days (SD 16.8). Infection was the most common etiology, present in 61.3% of cases (19/31); nonhepatotropic viruses, especially cytomegalovirus, predominated in infants. Spontaneous recovery occurred in 15 patients (48.4%), 3 (9.7%) received transplants, and 13 died, for a case fatality of 41.9%. Outcome was not associated with etiology (p = 0.106), but was statistically associated with degree of hepatic encephalopathy (p <0.01): 77.8% of patients (7/9) with grades III-IV encephalopathy died, for a relative risk of 4.0 (95% CI 1.15-13.8), versus 11.1% (1/9) with grade II or less encephalopathy. Cholesterol levels were significantly lower in patients who failed to recover spontaneously (p <0.01). Patients' clinical characteristics in this case series were similar to those described in developed countries.The fact that nonhepatotropic viruses (basically, cytomegalovirus in infants) are the main cause of acute liver failure in Cuban children calls for further epidemiologic study and identification of local underlying determinants of this phenomenon.

Study of the Correlation between Helicobacter pylori Infection and Hepatic Encephalopathy in Patients with Liver Cirrhosis

Background and study aim: Ammonia plays a major role in hepatic encephalopathy pathogenesis. Most of ammonia is known to be produced by the action of colonic bacteria which possess a urease enzyme activity. H. pylori which infects the stomach possesses a stronger urease activity which produce a large amount of ammonia that may precipitate hepatic encephalopathy (HE). The aim of the present study is to determine the correlation between Helicobacter pylori infection and HE in patients with liver cirrhosis. Patients and Methods: One hundred patients (50 patients of liver cirrhosis with hepatic encephalopathy and 50 patients of liver cirrhosis without hepatic encephalo-pathy) were evaluated for presence of H. pylori by stool antigen test (ELISA method) and for blood ammonia level estimation. Results: Pevalence of H. pylori infection in the study groups (patients of liver cirrhosis with and without hepatic encephalopathy) was 70% (liver cirrhosis with hepatic encephalopathy group (A) 80%, and liver cirrhosis without hepatic encephalopathy group (B) 60%). Mean blood ammonia levels were: 82.14± 47.9 mmol/l for group A (liver cirrhosis with hepatic encephalopathy) and 36.44± 17.9 mmol/l for group B (liver cirrhosis without hepatic encephalopathy). Prevalence of H. pylori and blood ammonia level were found significantly increasing with the severity and the degree of hepatic encephalopathy. Conclusion: There is a significant association between H. pylori and hepatic encephalopathy in patients with liver cirrhosis. There may be a role of anti-H. pylori therapy in patients of hepatic encephalopathy and should be investigated further.

Complications in acute liver failure: managing hepatic encephalopathy and cerebral oedema

Acute liver failure (ALF) is a term that first became established in the 1960s to describe a rare clinical syndrome that is characterised by severe hepatocyte injury, jaundice, and hepatic encephalopathy, usually in the absence of pre-existing chronic liver disease. ALF has a variety of aetiologies, and is associated with a high mortality and morbidity. While it is a disease of multiorgan failure, all patients with ALF will have some degree of hepatic encephalopathy, which when advanced, is associated with a high incidence of cerebral oedema and intracranial hypertension. When these symptoms are combined with other failing bodily systems, this group of patients is extremely challenging to manage. This article presents an overview of hepatic encephalopathy and the management of cerebral oedema in this group of patients, examining both current medical and nursing strategies.

Selective Plasma Exchange With Dialysis in Patients With Acute Liver Failure

Selective plasma exchange with dialysis is a blood purification therapy in which simple plasma exchange is performed using a selective membrane plasma separator while the dialysate flows out of the hollow fibers. To evaluate the effect of plasma exchange with dialysis, biochemical examination of the blood, for example, the oxidative stress regulation system and interleukin 18 levels, was performed in patients with acute liver failure. We studied four patients with acute liver failure in whom the therapy was performed (nine times in total). The degree of hepatic encephalopathy and interleukin 18 levels decreased significantly after treatment. However, total protein levels did not change significantly. The level of reactive oxygen species and total antioxidant capacity did not change significantly. Plasma exchange with dialysis may be a useful blood purification therapy in cases of acute liver failure in terms of the removal of water-soluble and albumin-bound toxins.

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Relationship between clock and star drawing and the degree of hepatic encephalopathy

Purpose of the studyCurrent hepatic encephalopathy grading tools are limited because of complexity or subjectivity. The degree of constructional apraxia could serve as a simple, objective and reproducible tool to...

The use of vaptan in hyponatremic patients with liver cirrhosis

The use of vaptan in hyponatremic patients with liver cirrhosis