Liver Function Child-Pugh Grade Research Articles

Association of Omega-3 Polyunsaturated Fatty Acids with Sarcopenia in Liver Cirrhosis Patients with Hepatocellular Carcinoma.

Sarcopenia is associated with the prognosis of patients with liver cirrhosis and hepatocellular carcinoma (HCC). Given their diverse physiological activities, we hypothesized that plasma fatty acids might influence the progression of sarcopenia. This study aimed to clarify the association between fatty acids and sarcopenia in cirrhotic patients with HCC. In this single-center retrospective study, we registered 516 cases and analyzed 414 cases of liver cirrhosis and HCC. The skeletal muscle mass index was measured using a transverse computed tomography scan image at the third lumbar vertebra. The cutoff value for sarcopenia followed the criteria set by the Japan Society of Hepatology. Fatty acid concentrations were measured by gas chromatography. Fatty acid levels, particularly omega-3 (n-3) polyunsaturated fatty acid (PUFA), were lower in patients with poor liver function (Child-Pugh grade B/C) and were negatively correlated with the albumin-bilirubin score (p<0.0001). The prognosis of HCC patients with low PUFA levels was significantly worse. Among the different fatty acid fractions, only n-3 PUFAs significantly correlated with skeletal muscle mass index (p=0.0026). In the multivariate analysis, the n-3 PUFA level was an independent variable associated with sarcopenia (p=0.0006). A low level of n-3 PUFAs was associated with sarcopenia in patients with liver cirrhosis and HCC.

Portal Vein Thrombosis Associated with Trousseau Syndrome due to Urinary Bladder Squamous Cell Carcinoma in a Liver Cirrhosis Patient

A 75-year-old woman with liver cirrhosis was admitted for treatment of portal vein thrombosis (PVT). Computed tomography (CT) showed PVT, massive ascites, and multiple abdominal organ embolism. Blood tests revealed a decreased liver function (Child-Pugh grade C). Language impairment followed by progressive left hemi-paralysis was subsequently detected. Magnetic resonance imaging revealed multiple small acute cerebral infarctions and, on CT, a 30-mm bladder tumour; a biopsy specimen examination showed squamous cell carcinoma. Her general condition worsened rapidly, and the best supportive care was chosen. Our findings suggest that, in patients with PVT, Trousseau syndrome should be considered, even in cases of liver cirrhosis.

Role of Measurement of Hepatic Hemodynamics by Triphasic CT in the Evaluation of Patients with Liver Cirrhosis

AbstractBackground: Liver biopsy has been the main method for diagnosis, but it is an invasive method, with many complica-tions, so a non-invasive method is needed to assess the severity of liver cirrhosis.Aim of Study: To assess the severity of liver cirrhosis by measurement of hepatic blood flow using triphasic CT.Patients and Methods: Our case control, single centre study involved 30 patients with chronic diffuse parenchymatous liver disease (which were further divided into Child-Pugh A, B, and C subgroups) and 30 healthy volunteers. All cases underwent supervision of their medical history, clinical ex-amination, liver function tests, and triphasic CT scan. Meas-urement of contrast enhancement fraction (CEF) as a parameter of hepatic blood flow was calculated using triphasic CT, assessment of ROI (region of interest) in HU for the hepatic parenchyma in both arterial and venous phases were done. The contrast enhancement (CEF) was obtained by dividing the contrast concentration in the hepatic arterial phase by that in the portal venous phase using ROI measurement in HU. CEF values and the ROI measurements from the study and control groups were compared.Results: The differences in the ROI measurements were statistically significant between the subgroups with multiple comparisons, except between the control and the Child-Pugh (A) group. The ROI measurement in the portal phase was higher than that measured in the hepatic arterial phase in both the study and control groups. There was a decrease in ROI measurement in both the arterial and portal phases with increase of the Child-Pugh grade; more evident in the portal phase. The value of CEF in the control group was 0.74. The CEF values increased with increasing Child-Pugh grades in the study group. There were noticeable differences for CEF between Child-Pugh A and B groups, Child-Pugh A and C groups and Child-Pugh B and C groups. The CEF increased as liver function (Child-Pugh grade) deteriorated in the study group.Conclusion: Measurement of hepatic blood flow and CEF by using triphasic CT can be used to evaluate the liver hemo-dynamics and severity of liver cirrhosis.

The clinical practice of improvement the "Volume and Quality" of functional liver in autologous liver transplantation for the patients with alveolar echinococcosis

Objective: To investigate the clinical significance of accurate assessment of "volume and quality" of functional liver in Autologous liver transplantation (ALT) in the treatment of the advanced hepatic alveolar echinococcosis (HAE). Methods: The clinical data of 12 patients with advanced HAE who underwent ALT at the First Affiliated Hospital of Xinjiang Medical University from May 2015 to July 2016 were retrospectively analyzed. Results: The preoperative hepatic functions of 12 patients were 8 Child-Pugh Grade A, 1 Grade B, and 3 Grade C. Three of the patients had moderate or severe jaundice. Three of the patients calculated functional liver graft volume (GV) and standard liver volume (SLV) ratio (GV/SLV) were <30%. After the protection of liver function, anti-infection, percutaneous transhepatic cholangiography drainage (PTCD), selective portal vein embolization (PVE), and staging liver resection, liver function Child-Pugh grade of 11 patients was raised to A grade, and the other patient was B grade, meanwhile the bilirubin was reduced to 2 times the normal value. The GV/SLV ratios of 3 patients with low GV/SLV ratio had reached 44.4%, 47.2% and 56.2% respectively. In this study, the GV/SLV ratios of the 12 patients were between 73.2% and 40.8% with an average of 55.6%. Operation time was 11.5-20.5 h, with an average of 12.3 h. Anhepatic phase time was 193-375 min with median 253.5 min. The red blood cell suspension was 0-6 U during the operation. The average hospitalization was 10-42 d, with the average 22.7 d. Total hospital costs were 121 600-434 800 Yuan, with the median cost of 174 400 Yuan. One patient died of septic shock a week after surgery. Conclusion: (1)ALT may provide feasibility for the advanced HAE. (2)Accurate assessment of functional liver "volume and quality" appeared as the key points to the ALT. (3)Precise surgery and individualized treatment could improve and protect the functional liver "volume and quality" .

Clinical application of ultrasound-guided radiofrequency ablation for primary hepatocellular carcinoma near the liver surface

To explore the value of ultrasound-guided percutaneous radiofrequency ablation (RFA) in designing the indication, treatment protocol and operational skills for patients with primary hepatocellular carcinoma (HCC) near the liver surface. Sixty-one HCC patients with 69 lesions, confirmed by clinical examination and pathology, underwent percutaneous radiofrequency ablation. The study included 40 cases of liver function Child-Pugh grade A and 21 cases of grade B. The average size of tumors was (3.8 ± 1.2) cm, tumor diameter ≥ 4 cm accounted for 39.1% (27/69 lesions), and the average age was 58.2 years (range, 35-76 years). Taking comprehensive measures, such as intraperitoneal injection of saline adjacent to the tumor before RFA, increasing the puncture sites on the surface of tumor to avoid overlapping of the central portion of tumor, repeated ablation of the needle track to reduce needle tract metastasis, avoid vertical puncture, and other additional measures, to improve the inactivation of tumors adjacent to the liver surface. Enhanced CT/MRI was performed to evaluate the curative effect at 1, 3, 6 and 24 months after the treatment. The inactivation rate of tumor was 98.6% (68/69 lesions) and local recurrence rate was 5.8%(4/69) after RFA. The tumor-related marker AFP was 1 000-1 500 ng/ml before and reduced to (98.5 ± 42.5) ng/ml after radiofrequency ablation, among them returned to normal in 13 cases (21.3%). Since the ablation area was rather small, the level of serum alanine aminotransferase was elevated only to (148.5 ± 38.5) U/ml at one week after RFA and returned to normal at (1.8 ± 0.6) week after RFA. No patient experienced severe liver dysfunction. The local HCC recurrent rate after RFA was 5.8%(4/69 lesions) and intrahepatic heterotopic recurrence rate was 24.6% (15/61). The 20-61 months follow-up showed that the 1-, 2- and 3-year survival rate was 83.6%, 57.3% and 44.2%, respectively. Ultrasound-guided percutaneous radiofrequency ablation provides an effective minimally invasive treatment for primary HCC near the liver surface. Taking some additional measures such as intraperitoneal injection of saline, increase of percutaneous puncture sites, and avoiding vertical needle puncture, may reduce complications and improve the therapeutic outcome. RFA is one of effective and minimally invasive treatment and causing less liver damage for primary HCC near the liver surface.

Analysis of the related risk factors of bleeding esophageal varices of cirrhosis

Objective To explore the related risk factors of esophageal variceal bleeding(BEV). Methods 69 liver cirrhosis patients with BEV were selected as the observation group.60 liver cirrhosis patients with no BEV were selected as the control group. The two groups were observed of age and the degree of esophageal varices, portal vein diameter(PVD), splenic vein diameter(SVD),thickness of spleen(SPT), the maximum depth of ascites fluid dark area(ASmax) and other related ultrasound index. Laboratory indexes were including prothrombin time(PT), serum total bilirubin(TBIL),serum albumin(ALB). Results The average age of the observation group was(52.71±4.33) years old, which was higher than(46.83±5.19)years old of the control group(t= 4.08,P< 0.05).The liver function(Child-pugh) Grade A and grade C in the observation group patients were 78.33% and 0.00%, and compared with the control group,the difference was significant statistically(χ2= 4.97,P< 0.05). Esophageal varices with severe and mild of the observation group were 80.00% and 1.67%,and compared with the control group,the difference was statistically significant(χ2= 4.08,5.48,P< 0.05).RC of the observation group was 78.33%,which was higher than 30.43% of the control group(χ2= 5.11,P< 0.05).PVD,SVD,SPT and ASmax of the observation group were(16.05±3.14)mm,(11.24±3.21)mm,(46.90±6.26)mm and(57.91±6.11)mm,respectively,and compared with the control group,the differences were significant statistically(t= 4.37,6.12,5.18,7.22,all P<0.05).PT of the observation group was(17.66±2.08)s,which was higher than(13.93±1.67)s of the control group(t= 4.75,P<0.05).TBIL of the observation group was(172.63±16.50)μmol/L,which was higher than(138.44±12.71)μmol/L of the control group(t= 5.44,P< 0.05).ALB of the observation group patients was(27.36±3.44)g/L,which was lower than(30.85±2.75)g/L of the control group(t= 7.09,P< 0.05). Conclusion Age, liver function, PT and RC,PT, ASmax, PVD were related risk factors of patients with BEV. Key words: Esophageal and Gastric Varices; Hemorrhage; Liver Cirrhosis; Risk Factors

Effect of liver function Child-Pugh grade on prognosis in huge hepatocellular carcinoma after TACE therapy

Effect of liver function Child-Pugh grade on prognosis in huge hepatocellular carcinoma after TACE therapy

Effect of sevoflurane preconditioning on intestinal injury in patients undergoing resection for liver cancer

Objective To evaluate the effect of sevoflurane preconditioning on intestinal injury in the patients undergoing resection for liver cancer.Methods Forty patients of both sexes,aged 20-60 yr,weighing 5075 kg,of ASA physical status Ⅱ or Ⅲ (liver function Child-Pugh grade A),undergoing resection for right liver cancer,were randomly divided into 2 groups (n =20 each):sevoflurane preconditioning group (S group) and control group (C group).Anesthesia was induced with target-controlled infusion of propofol and remifentanil.Tracheal intubation was facilitated with cisatracurium.Anesthesia was maintained with target-controlled infusion of propofol and remifentanil.S group inhaled sevoflurane with the end-tidal concentration of 2.0％ for 30 min starting from the end of intubation,followed by washout.Before induction (T0),immediately after hepatic portal was clamped (T1),at 1,3 and 6 h after occlusion of hepatic portal was released (T2-4) and at 24 h after operation (T5),arterial blood samples were obtained for determination of serum tumor necrosis factor-alpha (TNF-α),intestinal fatty acids binding protein (Ⅰ-FABP) and D-lactate levels.Results The concentrations of serum TNF-α and D-lactate started to rise at T2,peaked at T4,and started to decline at T5,and the serum Ⅰ-FABP concentrations started to rise at T2,peaked at T3,and started to decline at T4 in the two groups.The concentrations of serum TNF-α,Ⅰ-FABP and D-lactate were significantly lower in S group than in C group.Conclusion Sevoflurane preconditioning can inhibit inflammatory responses and reduce intestinal injury in the patients undergoing resection for liver cancer. Key words: Anesthetics, inhalation; Ischemic preconditioning; Reperfusion injury; Intestines; Hepatectomy

Effect of creatine phosphate on perioperative myocardial injury caused by living donor fiver transplantation in adult patients

Objective To investigate the effect of creatine phosphate on perioperative myocardial injury caused by living donor liver transplantation(LDLT)in adult patients.Methods Forty ASA Ⅱ -Ⅳ patients(liver function Child-Pugh grade B or C)aged 45-62 yr weighing 47-91 kg undergoing LDLT were randomly divided into 2 groups(n = 20 each): control group(group C)and creatine phosphate group(group CP).In group CP,creatine phosphate 30 mg/kg was injected intravenously at skin incision followed by creatine phosphate infusion at 4 mg· kg- 1 · h- 1 until the end of surgery.In group C,equal volume of normal saline was infused instead of creatine phosphate.HR,MAP,CVP,PCWP,CO and SvO2 were recorded immediately before skin incision,at 5 and 30 min of anhepatic phase,at 5 and 30 min of neohepatic phase and at the end of operation.Blood samples were taken from central vein immediately before skin incision(baseline,T0),at 30 min of anhepatic phase(T1),at 30min of neohepatic phase(T2),at the end of operation(T3)and at 4 and 24 h after operation(T4,5)for determination of serum cardiac troponin I(cTnI)and creatine kinase MB(CK-MB)concentrations and lactate dehydrogenase(LDH)activity.Postoperative adverse events were recorded.Results The serum cTnI and CK-MB concentrations and LDH activity were significantly increased at T2-5 as compared with the baseline value at T0 in both groups(P ＜0.05 or 0.01).MAP and CO were significantly higher from 5 min of neohepatic phase to the end of operation,the serum cTnI and CK-MB concentrations and LDH activity were significantly lower at T2-5,and the incidence of ventricular arrhythmia was significantly lower in group CP than in group C(P ＜ 0.05 or 0.01).Conclusion Creatine phosphate can attenuate perioperative myocardial injury caused by LDLT in adult patients. Key words: Phosphocreatine; Liver transplantation; Myocardial reperfusion injury

Comparison of perioperative myocardial injury caused by live donor liver transplantation performed under sevoflurane and propofol combined anesthesia in adult patients

Objective To compare the severity of periopemtive myocardial injury caused by live donor liver transplantation (LDLT) performed under sevoflurane and pmpofol combined anesthesia in adult patients. Methods Forty ASA Ⅱ-Ⅳ patients(liver function Child-Pugh grade B or C)aged 40-67 yr weighing 47-95 kg undergoing right lobe LDLT were randomly divided into 2 groups(n=20 each):sevoflurane combined anesthesia group (group S) and propofol combined anesthesia group(group P).Anesthesia was maintained with 1.6%-3.0% sevoflurane in group S or PCI of pmpofol(Cp 2-4μg/ml)in group P combined with sufentanil infusion at 0.5- 1.0 μg·kg-1·h-1 and intermittent iv boluses of cisatracurium in both groups.MAP,HR,CVP,MPAP,PCWP, CO and mixed venous O2 saturation(S(v)O2)were recorded before skin incision at 5 and 30 min of anhepatic phase and 5 and 30 min of ncohepatic phase and the end of operation:Blood samples were taken from central vein before skin incision(T0,baseline)at 30 min of anhepatic phase(T1),30 min of neohepatic phase(T2),the end of surgery (T3) and 24,48,72 h after operation (T4,5,6) for determination of serum concentrations of cardiac troponin I (cTnI) and creatine kinase MB(CK-MB).Postoperative adverse effects were recorded.Results The two groups were comparable with respect to 8ex ratio(M/F),age,body weight,duration of operation,duration of anhepatic phase,blood loss,dopamine and nitroglycerin consumption.There was no significant difference in MAP, HR,CVP,MPAP,PCWP,CO and S(v)O2 between the two groups.The serum concentrations of cTnI and CK-MB were significantly increased at T2-5 as compared with the baseline value at T0 in both groups. There was no significant difference in serum concentrations of cTnI and CK-MB and in the incidence of myocardial ischemia and arrythmia between the two groups. Conclusion Sevoflurane and propofol combined anesthesia have similar effects on myocardial injury caused by LDLT in adult patients. Key words: Anesthetics, inhalation; Propofol; Liver transplantation; Myocardial reperfusion injury