Frequency Of Hepatic Encephalopathy Research Articles

Hepatogenous Diabetes as Compared to Type-2 Diabetes Mellitus and Non-diabetes in Patients With Liver Cirrhosis: Magnitude, Characteristics, and Implications

AimHepatogenous diabetes (HD) is frequently underestimated among cirrhosis patients. The current study assessed the magnitude, clinical characteristics, and implications of HD in cirrhosis patients as compared to the patients with type-2 diabetes mellitus (T2DM) and non-diabetes (ND) cirrhosis. MethodsIn a prospective observational study, 338 consecutive eligible cirrhosis patients were screened for diabetes mellitus. A 2-hour oral glucose tolerance test (OGTT) was used to detect HD. The clinical characteristics, complications, and outcomes were ascertained and compared amongst HD, T2DM, and ND patients. ResultsIn the final study cohort of 316 patients, the proportion of HD, T2DM and ND was 22.5% (n=71), 26.3% (n=83), and 51.3% (n=162), respectively. HD was the predominant form of diabetes (68.9%) in Child-Pugh class-C cirrhosis. The majority (73%) of HD patients had abnormal OGTT without fasting hyperglycaemia. A lower cut-off of 98.5 mg/dl for fasting blood glucose had a modest sensitivity (72%) and specificity (75%) for predicting HD. In comparison to T2DM patients, HD patients were younger, leaner, and had more advanced cirrhosis. In comparison to ND patients, HD patients were leaner but had higher glycemic indices, serum cholesterol, and arterial ammonia levels. During a median follow-up period of 12 (03-21) months, the frequency of hepatic encephalopathy and variceal haemorrhage were higher in HD and T2DM patients compared to that in the ND group. ConclusionsHD is prevalent in about one fifth of cirrhosis patients. It differs from T2DM and ND in a number of ways, and has association with complications of cirrhosis.

Опыт противовирусной терапии хронического гепатита D на стадии цирроза с нарушениями функции печени

Objective. To evaluate the possibility of using bulevirtide, the HBV and HDV entry inhibitor, in patients with chronic hepatitis D (CHD) at the stage of decompensated cirrhosis. Patients and methods. The results of the use of bulevirtide 2 mg in 14 patients with CHD at the stage of cirrhosis with impaired liver function – class B (13 patients) and C (1 patient) according to Child–Pugh were analyzed; 12 patients received monotherapy with bulevirtide, 2 patients received combination therapy with bulevirtide and peginterferon. Results. The use of bulevirtide for 48 weeks demonstrated a reduction in HDV RNA levels from 6.1 log10 to 3.6 log10 (p = 0.006); the achievement of a virological response in 70% of patients, a decrease in the level of alanine aminotransferase (ALT) from 52 to 29 U/L (р = 0,04), an increase in the frequency of detection of normal ALT levels compared with the baseline (from 43 to 82%), a decrease in liver stiffness from 20.8 kPa to 18.6 kPa (p = 0.016) (with a median decrease of 10.1 kPa); safety and good tolerability (no serious adverse events (AEs), severe or moderate AEs, cases of discontinuation of treatment). Positive dynamics of liver function parameters was observed: a decrease in the severity of liver disease to the level of compensated cirrhosis (decline in Child–Pugh score by 2 points), the frequency of hepatic encephalopathy (from 86 to 9%), ascites (from 64 to 18%), bilirubin levels, increased levels of albumin, prothrombin. The dynamics of the number of leukocytes and platelets during treatment did not require treatment correction. Conclusion. The analysis of the first experience in Russia of antiviral therapy for CHD and decompensated cirrhosis allows us to recommend the use of bulevirtide in this category of patients. Further studies are needed to clarify the optimal treatment regimens, the impact of treatment on clinical outcomes, the risk of hepatic complications (decompensation, HCC, death from liver failure or transplantation) and patient survival. Key words: bulevirtide, chronic hepatitis D, decompensated cirrhosis, chronic liver failure

Frequency of Hepatic Encephalopathy (HE) among Hepatitis Patients at Mardan Medical Complex, Mardan

Introduction: Hepatic encephalopathy (HE) represents severe neuropsychiatric condition of acute and chronic liver disease. Approximately 70% HE found in patients already suffering from liver cirrhosis. The aim of this study was to find the risk factors for developing Hepatic Encephalopathy in patients suffering from Chronic liver disease. Materials and Methods: This descriptive study was conducted in Mardan medical complex in four months duration. Data was collected from one hundred patients using non-probability sampling technique. All the data were analyzed through statistical software, JMP, 10.0 SAS, USA. Results: This study reports the frequency of HE among 100 hepatitis patients with mean age 55±9years. Out of these patients, 58% were males and 42% females. In our study, infection was the main precipitating factor found in most of the patients examined, followed by spontaneous bacterial peritonitis (20% patients), constipation (18% patients), GI bleeding (13% patients), and electrolyte imbalance such as hypokelmia (6% patients) and hypernatremia (3% patients). Conclusion: It is concluded that HE is more common in male patients than female. The risk of HE can be minimized by providing good hygienic conditions and germs free food in hospital. Keywords: Hepatic encephalopathy, Hepatitis, Cirrhosis, Chronic liver diseases

RIFAXIMIN EFFECTIVENESS IN PREVENTING THE RECURRENCE OF HEPATIC ENCEPHALOPATHY AMONG PATIENTS WITH LIVER CIRRHOSIS

Objective: To determine the effectiveness of rifaximin in reducing the frequency of recurrence of hepatic encephalopathy among patients with liver cirrhosis.
 Study Design: Descriptive case series.
 Place and Duration of Study: Outpatient department of Combined Military Hospital Peshawar from Jan to Jun 2017.
 Methodology: We included one hundred patients of either gender having liver cirrhosis with child Pugh B or C class with at least two previous episodes of hepatic encephalopathy. Patients were followed for six months to have any recurrence of hepatic encephalopathy. Conventional group was defined as having standard regimen including lactulose. Rifaximin treatment was defined as a 550mg BD daily dosing along with standard prescription.
 Results: Fifty patients were on conventional treatment to prevent recurrence of hepatic encephalopathy while 50 patients were using rifaximin in addition to standard prescription. The average age of 54.8 ± 6.1 years with 58% male patients and 48% in child-pugh B class. Thirty (30%) patients developed hepatic encephalopathy among the study population. 14 patients with recurrence belong to rifaximin group while 16 were on conventional treatment (p-value >0.05) showing a non-significant difference. Post stratification revealed only age as a significant predictor of recurrence of hepatic encephalopathy in our study population (p<0.05).
 Conclusion: Frequency of hepatic encephalopathy is similar in conventional treatment with Lactulose over six months of follow up as compared with rifaximin.

Tolerance and Effectiveness of Oral Direct Acting Antivirals in Treatment of HCV Egyptian patients with Decompensated Liver Cirrhosis

Background: Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV-related decompensated cirrhosis. Objective: The current study aimed to evaluate the efficacy and safety of DAAs in managing HCV patients with decompensated cirrhosis and the impact of achieving sustained virological response on improving the quality of life, short term survival and if viral eradication would step down CTP score. Patients and Methods: The study included a treatment group I (n = 25) composed of HCV patients with decompensated cirrhosis Child B and group II (n = 22) with decompensated cirrhosis Child C. both groups received DAAs (sofosbuvir 400 mg, daclatasvir 60 mg) plus ribavirin as tolerated for 3 months and follow-up was done for 6 months. Results: In both treated groups, there were improvements in platelet count, albumin, Child-Torcout-Pugh (CTP) (p = 0.001) and a significant reduction in the frequency of hepatic encephalopathy (HE). Also, there was improvement in quality of life of both treated groups. Conclusion: Treatment of HCV with decompensated cirrhosis with DAAS had improved CTP score, quality of life and survival.

Management of HCV-related decompensated cirrhosis with direct-acting antiviral agents: who should be treated?

Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis. The study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who received DAAs for 3months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for 24-31months. In treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores (p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2months, p = 0.001). Liver volume by ultrasound at a cutoff 495ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%. HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival. (NCT03547895).

Radiological anatomy of spontaneous splenorenal shunts in patients with chronic liver disease

We evaluated anatomical variations of spontaneous splenorenal shunt (SSRS) and the prevalence of portosystemic shunts in patients with chronic liver disease by CT. A total of 451 patients with chronic liver disease underwent contrast-enhanced computed tomography between October 2010 and April 2011. The prevalence of portosystemic shunts including SSRS and gastrorenal shunt, and the frequency of hepatic encephalopathy were examined. The course of the shunt and the point of confluence with the renal vein of the SSRS were analyzed. SSRSs or gastrorenal shunts were found in 11.1 and 5.0% of the patients, respectively. Anatomical variations were classified into three types according to the point of confluence as follows: type 1=the SSRS joined the inferior phrenic vein (n=33), type 2=the SSRS joined the gonadal vein (n=7), and type 3=the SSRS joined the left renal vein (n=14). The course of the SSRS from the splenic hilum was classified as medial (n=46), posterior (n=2), or anterolateral (n=2). SSRSs were classified into three types depending on the confluence point with the renal vein, and into three types of course. These findings are useful for preoperative information.

The effect of coingestion of aspirin and nsaids on paracetamol-induced liver failure: a single centre case controlled study

IntroductionAcute liver failure (ALF), which has a high risk of death or emergency liver transplantation, is most commonly caused by paracetamol overdose (POD) in the UK. A murine study suggested...

Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial

Transjugular intrahepatic portosystemic shunt (TIPS) has recently been reported to be effective in the treatment of cirrhotic patients with refractory ascites. However, the clinical utility of TIPS in the subset of refractory ascitic patients with good hepatic and renal function is uncertain. The aim of this study was to compare the efficacy of TIPS to that of large-volume paracentesis in cirrhotic patients with refractory ascites who have good hepatic and renal function. Sixty cirrhotic patients with refractory ascites who presented with a Child-Pugh score of <11, serum bilirubin of <3 mg/dl and creatinine of <1.9 mg/dl were assigned randomly to TIPS (n = 30) or large-volume paracentesis plus albumin (n = 30). The primary endpoint was survival. The secondary endpoints were response to treatment and development of hepatic encephalopathy. The baseline characteristics were similar in the two groups. Seventeen patients treated with TIPS and 21 treated with paracentesis died during the study period. The cumulative probabilities of survival at 1 and 2 years were 80 and 64% in the TIPS group and 49 and 35% in the paracentesis group (p < 0.005). TIPS was significantly superior to paracentesis in the control of ascites (p < 0.005). Treatment failure was more frequent in the paracentesis group, whereas the frequency of hepatic encephalopathy was greater in the TIPS group. In cirrhotic patients with refractory ascites who have good hepatic and renal function, TIPS improves survival and provides better control of ascites than large-volume paracentesis.

Prophylaxis with beta blockers as a performance measure of quality health care in cirrhosis

Prophylaxis with beta blockers as a performance measure of quality health care in cirrhosis