Diagnosis Of Liver Cirrhosis Research Articles

Relationship between Child-Pough score and late complications in hospital patients with liver cirrhosis

This study aimed to determine the frequency of available complications in patients with liver cirrhosis and any dependence according to the Child-Pough score. A retrospective study of cases with newly diagnosed liver cirrhosis was conducted in the Gastroenterology Clinic of UMBAL Pleven from 2017 to 2021. Of them, 258 (71.5%) were men and 103 (28.5%) were women. The mean age of the studied population was 57.8 years ± 11.4 years. The leading aetiology was alcohol in 244 (67.6%) of them. All cases were classified according to Child-Pough score system into three groups: Child A 98(27%), Child B 141(39%), and Child C 122(34%). Ours findings show that the occurrence of ascites is most common in the studied population at 232 (64.5%). Esophageal varices were found in 164 (62.4%) patients out of 264 who underwent upper gastrointestinal endoscopy. Portal encephalopathy was found in 170 (47.09%), with a predominance of the minimal in 116 (68.23%) of them. Jaundice was found in 124 (34.34%), and more of them were in Child C. In 65 (18%), renal dysfunction was found, such as acute renal dysfunction in 12.4%. In conclusion, the high frequency of available complications is closely related to late diagnosis.

Safety of catheter ablation for atrial fibrillation in patients with liver cirrhosis.

Atrial fibrillation is the most prevalent cardiac arrhythmia, and catheter ablation (CA) has emerged as a viable treatment option for selected patients. However, its safety profile in liver cirrhosis (LC) populations remains underexplored. This was an observational analysis of the National Inpatient Sample Database 2016-2020; we analyzed adult encounters undergoing CA for atrial fibrillation who had a concomitant diagnosis of LC. Using propensity scores, encounters were divided into two cohorts based on the presence or absence of LC and matched in a 1:1 fashion using LC as the dependent variable. In-hospital mortality and postprocedure total complications were compared using regression models. 93 830 procedures were identified for non-LC patients and 960 involving LC patients; after propensity score matching, each cohort included 910 hospitalizations. The mean age in the LC-matched cohort was 66.5 ± 9.1 years. In-hospital mortality did not differ between the groups (aOR = 1.01; 95% CI [0.06-16.1]; p = .99). However, the LC cohort exhibited higher odds of total complications (aOR = 1.98; 95% CI [1.42-2.75]; p < .001). Length of stay (LOS) was comparable, but total costs were higher in the LC cohort: LOS was 2 days (95% CI [1-3]) in the LC group versus 3 days (95% CI [1-4]) (p < .11) and LC: $202,000 (95% CI [$142 000-$261 000]) versus non-LC: $189 000, (95% CI [$153 000-$222 000]) (p < .0001). In this national analysis of patients undergoing CA for AF, those with LC had similar in-hospital mortality, postprocedure complications, and LOS compared to noncirrhotic patients. Furthermore, longitudinal studies are needed to assess the safety profile of CA in this subpopulation.

Assessment and integration of multiparametric MRI for liver fibrosis staging in rat non-alcoholic steatohepatitis: Evaluation of diagnostic efficiency and model interpretation

ObjectivesMulti-parametric MRI techniques, including intravoxel incoherence motion (IVIM), iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL IQ), T2* mapping and T2 mapping, were employed to develop and validate a predictive model for non-alcoholic steatohepatitis (NASH) diagnosis and liver fibrosis (LF) staging in rats. The combined model was interpreted using SHapley Additive exPlanations (SHAP) values for model understanding. Materials and methods160 healthy Sprague-Dawley (SD) rats were divided into control (n = 24) and experimental (n = 136) groups, and the 12-week and 16-week groups were injected intraperitoneally with carbon tetrachloride (CCl4) for 4 weeks, one month before the final feeding period. All rats were subjected to pathological examination to determine LF stage. Upon the study’s completion, 147 SD rats were assessed for liver fibrosis. Results84 SD rats were diagnosed with NASH and 31, 10, and 43 rats were histologically diagnosed with no fibrosis (F0), early LF (F1-F2), and late LF (F3-F4). For diagnosis of NASH and staging of liver fibrosis associated with NASH, a combined multi-parameter magnetic resonance imaging prediction model has a higher area under the ROC curve (AUC) than individual diffusion parameters, especially in advanced stages of fibrosis, with an AUC of 0.929 for the combined model. In SHAP, the free fluid(FF) value contributes most to the model for diagnosing NASH and advanced liver fibrosis, while the T2 value contributes most for diagnosing liver fibrosis and the apparent diffusion coefficient (ADC) value contributes most for diagnosing liver cirrhosis. ConclusionsThe integration of several magnetic resonance imaging methods along with SHAP value analysis provides a more comprehensive and theoretical investigation into the mechanisms and factors contributing to the progression of liver fibrosis in NASH, offering insights from various angles.

MÚLTIPLOS ABSCESSOS ESPLÊNICOS EM PACIENTE COM CIRROSE HEPÁTICA NO AMAZONAS

A 38-year-old male patient with a diagnosis of liver cirrhosis for 5 years, irregularly treated with lactulose and furosemide, presented with fever, confusion, fatigue, jaundice, and ventilator-dependent pleuritic pain when seeking medical attention. Upon examination, he was lucid but exhibited slowed thinking, a sleep-wake cycle inversion, and flapping. The physical examination revealed edema in the lower limbs, jaundice, and pain in the left subcostal region. Due to the presence of decompensated cirrhosis, monitoring and diagnostic investigation for possible etiologies were initiated. Laboratory tests, ECG, chest X-ray, and echocardiogram were performed. A computed tomography (CT) scan revealed splenomegaly with regular contours and heterogeneous attenuation coefficients, showing hypodense, non-enhancing collections occupying the entire upper half, as well as a left pleural effusion and signs of chronic liver disease and portal hypertension. A transverse incision was made, revealing splenomegaly with the presence of thick fluid collections in the upper pole of the spleen, consistent with a diagnosis of splenic abscess. The patient progressed to hypovolemic shock and underwent reoperation after 72 hours for active bleeding control. Ciprofloxacin and clindamycin were administered for 28 days. The patient improved well after discharge from the ICU, with clinical and laboratory improvement. Follow-up was conducted with amoxicillin 250 mg for two years, and he continues outpatient follow-up with a gastroenterologist. Splenic abscess (SA) usually arises from endocarditis or other forms of hematogenous transmission, such as pneumonias, gastrointestinal perforations, or arteriovenous malformations. Although not always present, risk factors for the development of endocarditis include immunosuppression, diabetes mellitus, trauma, or microorganisms. Diagnosis is based on clinical findings and imaging studies (ultrasound and CT). Treatment depends on the number, size, and location of the abscesses. Antibiotic therapy can drastically reduce mortality associated with this condition, and percutaneous drainage has been successful. However, in some cases, splenectomy is necessary. Splenic abscess is a rare condition, and its early diagnosis requires a high degree of suspicion, and there is still no best approach for treatment.

VALUE OF AMINOTRANSFERASES IN LIVER CIRRHOSIS

Aim: To ditermine values of ASAT and ALAT and their ratio in different stages of liver cirrhosis. Material and methods: A retrospective study was conducted, including patients with newly diagnosed liver cirrhosis from 01.01. 2017 to 31.12. 2021. Of all, 258 (71%) were men and 103 (29%) were women. The mean age of the study population was 57±11.4 years, with alcohol as the leading etiology in 262 (72.6%) of all cases. AT were measured at an upper reference limit of 40UI/ml. All were staged by Child-Pough and MELD Na score. IBM SPSS 26 and Excel statistics for data processing were used at a significant level of p&lt; 0.05. Results: Of all 361 individuals, normal AT were measured at 89 (24.7%), at 96 (25.76%) only with normal ASAT and at 233 (66.77%) only with normal ALAT. The mean value of ASAT increases significantly depending on the Child stage (p=.004) and is close to the significance of MELD Na (p=.036). Mean ALAT values were minimal to moderately elevated, with no significant association with them (p=.647, p=.020). 90% of individuals had an ASAT/ALAT ratio above 1, which showed substantial dependence on Child and MELD Na (p=.000, p=.000). A ratio above 2 was found at 194 (53.7%) mainly in Child C, which was associated with alcohol etiology. Conclusion: The absolute values of ASAT and ALAT have no relationship with the severity of liver cirrhosis, unlike their ratio, which significantly increases.

Real-world analysis on the use of gamma-hydroxybutyric acid for alcohol withdrawal syndrome in hospitalized patients with diagnosis of cirrhosis.

The present real-world analysis aimed to evaluate and describe the use of gamma-hydroxybutyric acid (GHB) for alcohol withdrawal syndrome (AWS) in hospitalized patients with diagnosis of liver cirrhosis. An 11-year observational retrospective study on patients affected by liver cirrhosis and alcohol use disorder (AUD) was performed using data from the Medical Toxicology Unit of Careggi University Hospital in Florence (Italy). A multivariate logistic regression was performed to estimate the probability of having a CIWA-Ar Max 3-4 during hospitalization, an AWS length > 36h, a hospitalization > 9days, and the probability of developing drowsiness. A total of 166 AUD patients were included, of these 77 received GHB (70.13% within the first day of hospitalization) and 89 were treated without GHB. The majority were ≥ 40years of age (87.35%) and males (80.12%). GHB patients were more likely to have a CIWA-Ar Max 3-4 during hospitalization (OR 3.76 [CI 95% 1.02-13.85]), and a longer hospitalization (OR 3.08 [95% CI 1.23-7.71]). Early GHB administration decreased the probability of CIWA-Ar Max worsening (OR 0.06 [95% CI 0.01-0.49]). GHB dose ≥ 100mg/kg was not associated with the occurrence of drowsiness. Patients exposed to other sedative agents were more likely to experience drowsiness (OR 7.22 [95% CI 1.46-35.61]). The present real-world analysis underlines that GHB could be a valuable and safe option for the management of AWS in AUD patients affected by liver cirrhosis, also when administered early and even at higher than recommended dosages.

Evaluation of MELD Scores and Thyroid Hormones as Prognostic Factors of Liver Cirrhosis.

Background and Objectives: Hepatic cirrhosis is a disease with an increasing frequency globally, but its mechanisms of disease development are not yet completely known. The aim of this study was to evaluate the relationship between thyroid hormone levels (T3, fT4, and TSH) and survival in patients with chronic liver disease. Materials and Methods: A total of 419 patients diagnosed with liver cirrhosis were included in the study. The MELD score was computed, and TSH, T3, and fT4 were collected from each patient using the ELISA procedure. Signs and symptoms of liver failure and portal hypertension confirmed the clinical diagnosis of liver cirrhosis, and biological tests and imaging methods confirmed the diagnosis. Results: The MELD score was positively associated with TSH on admission and TSH on discharge and negatively associated with T3 at discharge. TSH levels were higher in non-survivors than in survivors. The values of T3 and fT4 present no significant changes to be considered as prognostic factors. Conclusions: Although the differences between the median TSH values of the patients who died and those who survived are not very large, the statistical significance of the data obtained demonstrates that there are changes in metabolism of the thyroid hormones during the progression of liver cirrhosis. It is possible that TSH is the one which maintains the normal balance of thyroid activity for patients with liver cirrhosis, so it can be considered as an important marker of evolution of these patients.

FREQUENCY OF ACUTE KIDNEY INJURY IN CASES OF LIVER CIRRHOSIS: A CROSS-SECTIONAL STUDY

Acute kidney injury (AKI) frequently complicates the clinical course of liver cirrhosis, impacting patient outcomes significantly. Understanding the epidemiology of AKI in this population is crucial for timely intervention and management. Objective: To assess the frequency and clinical outcomes of acute kidney injury in patients with liver cirrhosis. Methods: Following ethical approval, this descriptive cross-sectional study was conducted at the Department of Nephrology from December 2023 to June 2024. A total of 231 patients aged 18 years and older with a confirmed diagnosis of liver cirrhosis were included. The frequency of AKI was determined using standard criteria. Data analysis was performed using SPSS 24, employing Independent samples t-tests to evaluate differences between patients with and without AKI, with a significance level set at P &lt; 0.05.Results: Among the 231 cirrhotic patients (mean age: 52.5±10.61 years; 83.1% male), AKI was identified in 55 patients (23.8%). Patients with AKI exhibited higher mean serum creatinine (2.99±0.44 mg/dL) and blood urea nitrogen (66.64±9.92 mg/dL), along with lower sodium levels (129.37±4.14 mmol/L) and elevated total bilirubin (5.23±1.37 mg/dL) compared to their non-AKI counterparts. The average length of hospital stay was significantly longer for AKI patients (14.35±3.22 days) compared to non-AKI patients (7.37±1.92 days), and mortality was higher in the AKI group (12.7% vs. 1.7%). Conclusion: Our study highlights a significant prevalence of AKI among patients with liver cirrhosis, particularly affecting those with viral hepatitis B and C. The findings emphasize the need for vigilant monitoring and early therapeutic interventions in this vulnerable population to improve outcomes.

Thyroid Profile in Liver Cirrhosis Patients-Correlation with Disease Severity and Recommendations for Clinical Practice: A Cross-sectional Observational Study.

Liver diseases are increasingly recognized as significant public health concerns in India, prompting investigations into novel approaches for assessing disease severity and prognosis. Recognizing the potential utility of thyroid hormone levels in these assessments, we conducted an observational cross-sectional study at our tertiary care hospital. Our study included 89 patients aged 12 years and above, admitted to medicine wards with ultrasound-diagnosed liver cirrhosis, excluding pregnant women and those on thyroid-altering medications. Our findings revealed a male-to-female ratio of 4.23:1, with the majority of patients falling within the 40-60 age-group, averaging 46.93 years. Notably, 87.6% of patients exhibited thyroid abnormalities, primarily low free T3 (FT3) syndrome and subclinical hypothyroidism. Classifying patients according to Child-Pugh (CP) score, 2.2% were CP class A, 22.5% were CP class B, and the remaining 75.3% were CP class C. Across all CP classes, low FT3 syndrome was prevalent, particularly in CP class C. Correlations between thyroid hormone levels and liver disease severity, assessed via CP and model for end-stage liver disease (MELD) scoring systems, were observed. Specifically, FT3 levels demonstrated a negative correlation with liver disease severity (p = 0.001), while no significant correlations were found for free T4 (FT4) and thyroid-stimulating hormone (TSH) levels. Based on our findings, we recommend routine thyroid function testing for all liver cirrhosis patients, irrespective of disease severity, to facilitate early detection and intervention. However, our study had limitations, including a small sample size and a precision error of 10% due to resource constraints for thyroid function testing. Moreover, reliance solely on ultrasound for liver cirrhosis diagnosis may lead to missed diagnoses, highlighting the need for complementary noninvasive tests such as FibroScan and aspartate aminotransferase to platelet ratio index (APRI) scores. Our study underscores the importance of considering thyroid function in the management of liver cirrhosis patients and provides valuable insights for enhancing clinical practice in this context.

Severe Alcoholic Hepatitis-optimizing Medical Management: Whether we need a Liver Transplant

Severe alcoholic hepatitis is an ethical and clinical conundrum, wherein a liver transplant is often recommended. The adequacy of medical treatment versus the risk of recidivism after transplant is often debated. Complete recovery in 26 of 27 patients with severe alcoholic hepatitis was observed, and hence the data was retrospectively analysed. Methods: 27 patients, with severe alcoholic hepatitis, with Maddrey's discriminant function between 59.7 to 165.2 (mean 107.53), from June 2017 to May 2022, were followed up for between 11 months to 6 years. INR ranged from 1.99 to 3.7 (mean 2.709), and bilirubin was between 7.6 to 37.01, (mean 20.859). 8 patients had pre-existing liver cirrhosis. All patients received probiotics, nutritional support, physical rehabilitation, saturated fat (clarified butter/ desi ghee) supplementation, and anti-oxidant support. At 90 days, total bilirubin improved to between 1.0 to 6.8 (mean 2.625). ALT (Alanine Transaminase/ SGPT) ranged from 65 to 550 (mean ALT – 197); and AST (Aspartate Transaminase / SGOT) ranged from 58 to 810 (mean AST – 271.51). Both the AST and ALT were near normal after 90 days. One patient died due to bacterial pneumonia and sepsis; the remaining 26 patients made a complete recovery. All patients including those with diagnosed liver cirrhosis, had complete resolution of their ascites, and near-normal liver function. At the last outpatient visit, none had ascites, edema, or encephalopathy, and had normal albumin levels and INR values. Conclusion: Probiotics, nutrition, a saturated fat diet, and exercise; all have shown benefits in patients with severe alcoholic hepatitis when tested individually. Concomitant use of all the above has not been reported in the treatment of alcoholic hepatitis. The role of nutrition alone versus the contribution of nutritional deficiencies and the role of gut-derived endotoxemia need to be studied in detail. How to identify patients who need a transplant, if it is needed at all, remains a challenge.

Bioimpedance analysis of body composition and changes in basic metabolism in patients with liver cirrhosis

Objective: to evaluate basic metabolism and its relationship with changes in body composition in patients with liver cirrhosis. Material and methods. A retrospective study was conducted, which included an analysis of data from 110 patients with a confirmed diagnosis of liver cirrhosis from 02.2020 to 12.2022. Assessment of body composition and basic metabolic data was carried out using ABC-01 MEDASS (STC MEDASS, Russia). Results. The basic metabolism in men with cirrhosis was 1631.0 (1577.5-1760.0) kcal/day, in women — 1337.0 (1256.0-1421.5); p=0.005. At the same time, among women, the indicator was reduced by an average of 18.1 % relative to the reference values of the main exchange for their age group. According to the results of multivariate regression analysis, gender (p&lt;0.001), active cell mass (p&lt;0.001), proportion of skeletal muscles (p&lt;0.001), mineral mass (p=0.0034) and phase angle (p&lt;0.001) were significantly associated with basic metabolism in patients with liver cirrhosis. The correlation coefficient between basic metabolism and extracellular fluid was r=0.807; p&lt;0.001; between active cell mass index r=0.877; p&lt;0.001, respectively. Conclusion. The level of basic metabolism against the background of cirrhosis of the liver is determined by changes that affect the components of the body composition against the background of the disease. Active cell mass, skeletal muscle fraction, mineral mass, phase angle and sex are important parameters to consider when predicting changes in basal metabolism and its correction in patients with cirrhosis.

Frequency of Hypoglycemia in Cirrhotic Patients Undergoing Endoscopy.

Liver cirrhosis isthe replacement of normal liver parenchyma by fibrous tissue and nodularity. Cirrhosis liver has a negative effect on the body's ability to regulate blood glucose levels because the liver cannot release the amount of glucose it wouldultimately cirrhotic patients are atrisk of hypoglycemia. To determine the frequency of hypoglycemia in cirrhotic patients just before endoscopy after being nil per mouth (NPO) for 6 hours. This cross-sectional study was done at the Department of Gastroenterology Lady Reading Hospital, Peshawar from 1st April 2023 to 30th September 2023.Patients aged > 20 years of both genders, having Child-Pugh class C cirrhosis, and undergoing upper gastrointestinal (GI) endoscopy were enrolled in the study while patients with a history of diabetes using oral or parenteral hypoglycemic medications, patients taking steroids, patients with hepatocellular carcinoma and patients with hepatic encephalopathy were excluded. Diagnosis of liver cirrhosis was based on clinical examination, serum albumin level, and prothrombin time followed by characteristic findings on ultrasound. Serum glucose level was determined in the blood sample of the patient from the hospital laboratory. Results:One hundred and ninety-six patients were enrolled including 130 (67.4%) males and 66 (32.6%) females. Age of the patients ranged from 20 to 60 years. The mean age of the participants was 46.68±10.239 years. Hypoglycemia was found in 48% of patients with liver cirrhosis. A significant association of hypoglycemia was found with disease duration and Child-Pugh class. Hypoglycemia is a frequent finding in patients with liver cirrhosis and needs urgent management to prevent complications. Prolonged illness and patients with Child-Pugh class C cirrhosis are more likely to have hypoglycemia.

Ascities after Liver Cirrhosis Diagnosis and Treatment

Ascites, the accumulation of fluid in the abdominal cavity, is a common complication in patients with cirrhosis. Approximately 50% of patients with compensated cirrhosis will develop ascites over a 10-year period, marking a significant milestone in the progression of end-stage liver disease. Survival rates decrease after the onset of ascites, with only 50% of patients surviving 2 to 5 years, depending on the underlying cause of cirrhosis, The management of ascites involves salt restriction and diuretic use, which are effective in about 90% of patients in reducing fluid accumulation and symptoms. In cases where ascites does not respond to these measures, additional interventions such as large-volume paracentesis may be necessary as a temporary solution or for symptomatic relief while awaiting liver transplantation, for patients with refractory ascites, the transjugular intrahepatic portosystemic shunt (TIPS) procedure can be considered. This involves creating a shunt between the portal vein and hepatic vein to reduce portal hypertension. TIPS can serve as a bridge to liver transplantation or provide long-term palliation, but careful monitoring for bacterial peritonitis is essential. Patients at high risk for bacterial peritonitis should receive antibiotic prophylaxis to prevent this serious infection. Prompt diagnostic paracentesis is necessary when spontaneous bacterial peritonitis is suspected, involving the removal and analysis of fluid from the abdominal cavity

A near-infrared fluorescent probe for differentiating cancer cells from normal cells and early diagnosis of liver cirrhosis

BackgroundCirrhosis represents the terminal stage of liver disease progression and timely intervention in a diseased liver can enhance the likelihood of recovery. Viscosity, a crucial parameter of the cellular microenvironment, is intricately linked to the advancement of cirrhosis. However, viscosity monitoring still faces significant challenges in achieving non-invasive and rapid early diagnosis of cirrhosis. Near-infrared (NIR) fluorescence imaging has the advantages of high sensitivity, non-destructive detection, and ignoring background fluorescence interference, plays an important role in diagnosing and treating various biological diseases. Hence, monitoring cellular viscosity changes with NIR fluorescence probe holds great significance in the early diagnosis of cirrhosis. ResultsIn this study, the NIR fluorescence probe based on the intramolecular charge transfer (TICT) mechanism was developed for imaging applications in mouse model of liver cirrhosis. A molecular rotor-type viscosity-responsive probe was synthesized by linking dioxanthracene groups via carbon-carbon double bonds. The probe demonstrated remarkable sensitivity, high selectivity and photostability, with its responsiveness to viscosity largely unaffected by factors such as polarity, pH, and interfering ions. The probe could effectively detect various drug-induced changes in cellular viscosity, enabling the differentiation between normal cells and cancerous cells. Furthermore, the enhanced tissue penetration capabilities of probe facilitated its successful application in mouse model of liver cirrhosis, allowing for the assessment of liver disease severity based on fluorescence intensity and providing a powerful tool for early diagnosis of cirrhosis. SignificanceA NIR viscosity-sensitive fluorescent probe was specifically designed to effectively monitor alterations in cellular and organ viscosity, which could advance the understanding of the biological characteristics of cancer and provide theoretical support for the early diagnosis of cirrhosis. Overall, this probe held immense potential in monitoring viscosity-related conditions, expanding the range of biomedical tools available.

National Analysis of Clinical Outcomes Associated With Cirrhotic Blunt Trauma Patients Undergoing Emergency Laparotomy Versus Non-operative Management: A Propensity Case-Matched Analysis.

This study aims to evaluate clinical outcomes among severely injured trauma patients presenting with isolated blunt abdominal solid organ injuries with a pre-diagnosis of liver cirrhosis (LC) undergoing emergency laparotomy vs nonoperative management (NOM). This retrospective cohort study utilized the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) dataset from 2017 to 2021. Adults (≥18years) with a pre-existing diagnosis of LC who presented with severe blunt (ISS ≥ 16) isolated solid organ abdominal injuries and underwent laparotomy or NOM were included. Outcomes of interest included in-hospital mortality, intensive care unit length of stay (ICU-LOS), and in-hospital complications such as acute renal failure and deep vein thrombosis. 929 patients were included in this analysis, with 355 undergoing laparotomy and 574 managed nonoperatively. Laparotomy patients suffered greater in-hospital mortality (n = 186, 52.3% vs n = 115, 20.0%; P < .01), required significantly more blood within 4hours (8.9 units vs 4.3 units, P < .01), and had a significantly longer ICU-LOS (10.2days vs 6.7days, P < .01). In the 1:1 propensity score matched analysis of 556 matched patients, in-hospital mortality was greater for laparotomy patients (52.3% vs 20.0%, P < .01). Laparotomy was associated with significantly higher in-hospital mortality in propensity-matched trauma patients, longer ICU-LOS, and more blood products given at 4hours compared to NOM. These findings illustrate that NOM may be a safe approach in managing severely injured trauma patients with isolated blunt abdominal solid organ injuries and a pre-diagnosis of LC.

Health-related Quality of Life in Patients With Liver Cirrhosis: A Randomized Study

BackgroundHealth-related quality of life (HRQoL) relates to how people perceive illness and treatment affects their physical health, emotional health, functional status, and social position. Along with clinical goals, HRQoL is significant. Therefore, the present study evaluates the effect of patient counseling and education on HRQoL of cirrhotic patients. MethodologyThis prospective study was conducted in a tertiary care center of coastal Karnataka, Kasturba Medical College, Manipal, Karnataka from October 2022 with a three-month follow-up. Patients with a confirmed diagnosis of liver cirrhosis visiting the outpatient department of age ≥18 were enrolled in the study and divided on the basis of compensated and decompensated cirrhosis. Patients were randomized into two groups i.e., case and control in compensated and decompensated group through the envelop method of randomization. The case group received patient education and counseling along with standard medical therapy. CLDQ was used to evaluate HRQoL scores on baseline and after the third month. ResultsA total of 104 patients were enrolled with a mean age of 53.49±11.25, with most being male (80.7%). Out of 104, 60 and 44 had compensated and decompensated cirrhosis. Case and control groups did not differ significantly on baseline. However, on follow-up, the compensated group showed significant improvement in abdominal symptoms, fatigue, and emotional functions. Meanwhile, the decompensated group showed significant improvement in activity, emotional function, and worry domain of CLDQ. Higher MELD scores were the significant factor associated with lower HRQoL scores. ConclusionPatient education and counseling positively impacted the fatigue, emotional, and worry domain of the CLDQ. Hence, the present study recommends making an effort to promote patient counseling and education via leaflets or videos.

THE IMPACT OF PERMANENT STRESS CAUSED BY THE WAR IN UKRAINE ON THE STATE OF PATIENTS WITH PORTAL HYPERTENSION DUE TO LIVER CIRRHOSIS

The aim of the study was to evaluate the impact of permanent stress and features of medical care in martial law on the indicators of liver function and quality of life of patients with portal hypertension due to liver cirrhosis.&#x0D; Materials and methods. The study included 37 patients with a confirmed diagnosis of liver cirrhosis complicated by portal hypertension and esophageal variceal bleeding. According to performed interventions all patients were divided into 3 groups: Group 1 – endoscopic band ligation and partial splenic artery embolization; Group 2 – endoscopic band ligation; Group 3 – endoscopic band ligation. The difference between Group 2 and Group 3 patients was that Group 2 patients were in a state of permanent stress due to the war. There were 4 visits with an interval of 1 month. At each time point, the levels of laboratory parameters of functional state of the liver and quality of life using RAND SF-36 questionnaire were evaluated.&#x0D; Results. Patients in all three groups during the first month showed an improvement in both laboratory indicators of liver function and integrated quality of life. In patients of Group 1 there was a progressive improvement in both the functional status of the liver and quality of life. In Group 2 the lack of any manipulations and maintenance therapy led to a lack of positive dynamics in patients. Staying in a state of permanent stress led to a progressive deterioration in the condition of patients in Group 3 starting from the second visit. Initially, the deterioration affected only the quality of life, but later it also manifested itself as a violation of the indicators of the functional state of the liver.&#x0D; Conclusions. The cumulative effect of permanent stress in patients with liver cirrhosis complicated by portal hypertension is manifested by an early deterioration in the quality of life with later violations of liver function.

Thirteen-Year Follow-Up of a Patient with Liver Cirrhosis Resulting from the Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis: Severe COVID-19 and Liver Transplantation

Aim: to present the difficulties of long-term management of a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) who suffered from severe COVID-19 infection.Key points. The diagnosis of liver cirrhosis as an outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) was established at the patient’s age of 33 years. At the age of 40, the patient became pregnant for the first time, the pregnancy proceeded well, and a cesarean section was performed at 36 weeks. At the age of 45, the patient suffered a severe new coronavirus infection, followed by decompensation of liver cirrhosis, which required liver transplantation 4 months after COVID-19, followed by a favorable postoperative course.Conclusion. This clinical case demonstrates the successful onset and outcome of pregnancy in a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis). The pronounced activity of the disease after severe new coronavirus infection required liver transplantation with successful outcome.

Noninvasive diagnosis of liver cirrhosis: qualitative and quantitative imaging biomarkers.

A diagnosis of cirrhosis initiates a shift in the management of chronic liver disease and affects the diagnostic workflow and treatment decision of primary liver cancer. Liver biopsy remains the gold standard for cirrhosis diagnosis, but it is invasive and susceptible to sampling bias and observer variability. Various qualitative and quantitative imaging biomarkers based on ultrasound, CT and MRI have been proposed for noninvasive diagnosis of cirrhosis. Qualitative imaging features are easy to apply but have moderate diagnostic sensitivity. Elastography techniques allow quantitative assessment of liver stiffness and are highly accurate for cirrhosis diagnosis. Ultrasound elastography are widely used in clinical practice, while MR elastography has narrower availability. Although not applicable in clinical practice yet, other quantitative imaging features, including liver surface nodularity, linear and volumetric measurement, extracellular volume fraction, liver enhancement on hepatobiliary phase, and parameters derived from diffusion-weighted imaging, can provide additional information of liver morphology, perfusion, and function, thus may increase diagnosis performance. The introduction of radiomics and deep learning has further improved diagnostic accuracy while reducing subjectivity. Several imaging features may also help to assess liver function and outcomes in patients with cirrhosis. In this review, we summarize the qualitative and quantitative imaging biomarkers for noninvasive cirrhosis diagnosis, and the assessment of liver function and outcomes, and discuss the challenges and future directions in this field.

Impact of an Automated Population-Level Cirrhosis Screening Program Using Common Pathology Tests on Rates of Cirrhosis Diagnosis and Linkage to Specialist Care (CAPRISE): Protocol for a Pilot Prospective Single-Arm Intervention Study.

People with compensated cirrhosis receive the greatest benefit from risk factor modification and prevention programs to reduce liver decompensation and improve early liver cancer detection. Blood-based liver fibrosis algorithms such as the Aspartate Transaminase-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) index are calculated using routinely ordered blood tests and are effective screening tests to exclude cirrhosis in people with chronic liver disease, triaging the need for further investigations to confirm cirrhosis and linkage to specialist care. This pilot study aims to evaluate the impact of a population screening program for liver cirrhosis (CAPRISE [Cirrhosis Automated APRI and FIB-4 Screening Evaluation]), which uses automated APRI and FIB-4 calculation and reporting on routinely ordered blood tests, on monthly rates of referral for transient elastography, cirrhosis diagnosis, and linkage to specialist care. We have partnered with a large pathology service in Victoria, Australia, to pilot a population-level liver cirrhosis screening package, which comprises (1) automated calculation and reporting of APRI and FIB-4 on routinely ordered blood tests; (2) provision of brief information about liver cirrhosis; and (3) a web link for transient elastography referral. APRI and FIB-4 will be prospectively calculated on all community-ordered pathology results in adults attending a single pathology service. This single-center, prospective, single-arm, pre-post study will compare the monthly rates of transient elastography (FibroScan) referral, liver cirrhosis diagnosis, and the proportion linked to specialist care in the 6 months after intervention to the 6 months prior to the intervention. As of January 2024, in the preintervention phase of this study, a total of 120,972 tests were performed by the laboratory. Of these tests, 78,947 (65.3%) tests were excluded, with the remaining 42,025 (34.7%) tests on 37,872 individuals meeting inclusion criteria with APRI and FIB-4 being able to be calculated. Of these 42,025 tests, 1.3% (n=531) had elevated APRI>1 occurring in 446 individuals, and 2.3% (n=985) had elevated FIB-4>2.67 occurring in 816 individuals. Linking these data with FibroScan referral and appointment attendance is ongoing and will continue during the intervention phase, which is expected to commence on February 1, 2024. We will determine the feasibility and effectiveness of automated APRI and FIB-4 reporting on the monthly rate of transient elastography referrals, liver cirrhosis diagnosis, and linkage to specialist care. Australian New Zealand Clinical Trials Registry ACTRN12623000295640; https://tinyurl.com/58dv9ypp. DERR1-10.2196/56607.