Liver Function In Cirrhosis Research Articles

Application of the albumin-bilirubin (ALBI) grade as predictive marker of atezolizumab plus bevacizumab (A+B) treatment outcomes for patients with advanced hepatocellular carcinoma (HCC): Real-world retrospective analysis at Veterans Health Administration (VHA).

4107 Background: Most clinical trials use Child-Pugh (CP) for patient selection; this subjective scale was originally developed to assess liver function in cirrhosis, thus cannot be applied to HCC patients with non-cirrhotic background. Alternatively, ALBI grade is an objective and validated prognostic system that has demonstrated improved accuracy to predict survival and liver function decline in HCC patients. Our real-world study aims to assess the ALBI grade as a predictive marker of treatment response in patients with advanced HCC who received (A+B) within the VHA. Methods: VHA patients with HCC receiving 1st line therapy with A+B were identified through EMR using ICD-9 or ICD-10 codes between 1 Jan 2007 and 31 Dec 2021. Patients were followed from their A+B initiation date through the earliest of the last VHA visit, loss to follow up, death, or end of study on Jan 31, 2023. Structured electronic health record and chart review data were retrospectively collected to determine patient baseline characteristics, treatment response, overall survival (OS), and progression-free survival. Survival rates were based on patients with at least 6 months or 1 year of time (as indicated) from A+B initiation until the chart was reviewed; patients without a scan or known date of scan were excluded from PFS calculations. The Chi-Squared test was used to compare rates. Results: 332 patients were included in the study. The median age was 67 yrs, 99% were males, 63% non-Hispanic White, 26% Black, 86% with ECOG < 1, 84% had CPS class A, 16% had CPS class B and C, 56% had viral hepatitis-caused HCC, 20% had no cirrhosis present, and 60% had prior local therapies. There was a statistically significant difference in progression free survival (PFS) and over survival (OS) amongst different ALBI grades as shown. Conclusions: In our retrospective cohort, it was clear that patients with ALBI grade 1 had improved PFS and OS compared to ALBI score grade 3. Patients with ALBI score grade 2 also had a moderate response to treatment with modest OS and PFS compared to patients with ALBI score grade 3. Utilizing stratification ability ALBI grade in future clinical trials may improve prognostic power facilitating ideal patient selection. [Table: see text]

Cystatin C as A Prognostic Biomarker to Monitor Renal Function in Liver Cirrhosis: A Narrative Review

Cystatin C (CysC) is a serum protein that has been accepted as an early and precise biomarker of chronic kidney disease (CKD) that is especially useful in patients for whom creatinine (Cr) is deemed an inadequate marker. Estimates of the glomerular filtration rate using serum CysC are proposed as good predictors of renal function. This narrative review was done to review the use of CysC and its estimated glomerular filtration rate as a prognostic marker for renal function in patients diagnosed with liver cirrhosis. A review of the literature was conducted using databases including PubMed, Google Scholar, Science Direct, and Medline. Twenty-eight studies were included in the review. The discovery of CysC has revolutionized early detection and potential reversal of kidney damage in cirrhotic patients, improving outcomes significantly. Unlike Cr-based equations, CysC offers a promising alternative for detecting decreased glomerular filtration rate (GFR) and shows significant associations with various factors, supporting its reliability as a biomarker. Its role extends beyond renal function, showing potential in cardiovascular disease (CVD), mortality, kidney transplant function, and transplant failure.

Опыт противовирусной терапии хронического гепатита D в Кабардино-Балкарской Республике

Objective. To study the results of the application of an innovative strategy for antiviral therapy of chronic hepatitis D (CHD) in real practice. Patients and methods. Evaluation of the efficacy and tolerability of bulevirtide, HBV and HDV entry inhibitor, in 8 patients with CHD: in monotherapy in 3 patients, combined therapy with peginterferon alfa in 5 patients. Results. High virological efficacy of both treatment regimens was demonstrated for 48 weeks: all patients on monotherapy, 4 of 5 patients on combination therapy achieved a virological response. The maximum decline in viral load was 5.8 log10 from baseline with monotherapy, 6.6 log10 with combination therapy. HDV RNA undetectable level was observed in all patients on combination therapy (in 2 patients – by week 12, in 1 – by week 24, in 1 – by week 36) and in 1 patient on monotherapy (by week 24). In 2 patients with undetectable HDV RNA level, the resumption of viremia was noted after interruptions in treatment, which emphasizes the need for adherence to treatment for the formation of a stable virological response. The tolerability of treatment was good, no serious adverse events, cases of withdrawal of treatment, deterioration of liver function in cirrhosis were reported. The number of white blood cells remained stable (3.2–3.4 × 109/l), the number of platelets decreased by week 24 from 104 to 83 thousand cells × 109/l, followed by self-recovery to the baseline by week 48. Conclusion. The data obtained confirm the validity of the choice of an innovative strategy for antiviral therapy of HCD in real practice, indicate the high efficacy and good tolerability of bulevirtide in monotherapy and combination therapy in patients with CHD, including with compensated cirrhosis. Key words: bulevirtide, chronic hepatitis D, combination therapy, monotherapy, peginterferon, real practice

Противовирусная терапия хронического гепатита D в Республике Крым – опыт реальной практики

Objective. The analysis of the results of antiviral therapy of chronic hepatitis D (HDV) in real practice using bulevirtide, an inhibitor of the entry of hepatitis B and D viruses (HDV) into the hepatocyte. Patients and methods. Intermediate treatment results were studied in 6 patients with HDV, including 3 patients with compensated cirrhosis who received bulevirtide in combination with pegylated interferon-α for 48 weeks, as well as in 3 patients who continued treatment (in combination therapy or monotherapy) for up to 60–64 weeks. Results. After 48 weeks of combination therapy, the HDV RNA level decreased from 6.5 log10 to 1.0 log10 ( p = 0.015), the median decrease was 3.4 log10, the frequency of virological response was 83%, and aviremia was 50%. Virological efficacy increased with treatment. In 3 patients, an increase in the initially normal level of alanine aminotransferase (ALT) associated with the use of interferon was noted, followed by a decrease or normalization; in 2 patients with initially moderate and high liver activity, ALT levels decreased by 35 and 354 U/l, respectively. Virological and biochemical response was maintained in all 3 patients who continued treatment up to 60–64 weeks, including aviremia in 1 patient. No serious adverse events, cases of withdrawal of treatment or deterioration of liver function in cirrhosis have been reported. Conclusion. The analysis of the intermediate results of CHD treatment in real practice has demonstrated the effectiveness, safety and good tolerability of bulevirtide, including at the stage of compensated liver cirrhosis. Further study of optimal treatment regimens is needed to achieve treatment goals and improve the prognosis of the disease. Key words: bulevirtide, chronic hepatitis D

Bariatric surgery in liver cirrhosis.

Obesity is frequently associated with its hepatic manifestation, the nonalcoholic fatty liver disease (NAFLD). The most effective treatment for morbid obesity is bariatric surgery (BS) also improving NAFLD and liver function. In patients where NAFLD has already progressed to liver cirrhosis, BS can be considered a high-risk procedure. Hence, consideration of the procedure and the most appropriate timing is crucial. Obese patients suffering from NAFLD who underwent BS from two German University Medical Centers were retrospectively analyzed. Twenty-seven patients underwent BS. Most common procedures were laparoscopic Roux-en-Y-gastric (RYGB) and laparoscopic sleeve gastrectomy (SG). All patients suffered from liver cirrhosis Child A. A preoperative transjugular portosystemic shunt (TIPS) was established in three patients and failed in another patient. Postoperative complications consisted of wound healing disorders (n = 2), anastomotic bleeding (n = 1), and leak from the staple line (n = 1). This patient suffered from intraoperatively detected macroscopic liver cirrhosis. Excess weight loss was 73% and 85% after 1 and 2 years, respectively. Two patients suffered from postoperative aggravation of their liver function, resulting in a higher Child-Pugh score, while three could be removed from the waiting list for a liver transplantation. BS leads to weight loss, both after SG and RYGB, and potential improvement of liver function in liver cirrhosis. These patients need to be considered with care when evaluated for BS. Preoperative TIPS implantation may reduce the perioperative risk in selected patients.

ЭФФЕКТИВНОСТЬ ИСПОЛЬЗОВАНИЯ СТВОЛОВЫХ КЛЕТОК В ЛЕЧЕНИИ ЦИРРОЗА ПЕЧЕНИ (ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ)

Rationale. The need to find the most effective ways to restore liver function in cirrhosis. Goal. To evaluate the effectiveness of using cellular technologies in liver cirrhosis in an experiment.Materials and methods. The experiment included 132 individuals of c57black mice aged 12 to 18 weeks. All individuals are divided into 5 groups (30 individuals in group’s №1– №3, №5 and 12 individuals in group №4). Individuals of group 5 were removed from the experiment before it began in order to determine the normal weight of the liver and spleen. A model of liver cirrhosis was created for individuals of groups 1– 4. Group 4 individuals were removed from the experiment 30 days after the model was formed to confirm the presence of liver cirrhosis. Individuals of group 1 were given intravenous stem cells. Individuals of group 2 were intraportally injected with stem cells. Individuals of group 3 were not injected with stem cells. Changes in all three groups were evaluated 30 days after cell therapy.Results. Against the background of cell therapy, the greatest decrease in liver mass is observed in group 2 (intraportal administration of stem cells), where the liver mass exceeds normal values by 7%. In second place is group 1 (intravenous administration of stem cells), where the liver mass is higher than normal by 17%. In group 3, the liver mass exceeds normal values by 25.3%. The spleen mass 30 days after the application of cell technologies in the second group differed from normal values by 0.01 g; in group 1-by 0.06 g; in group 3-by 0.1 g. The level of total protein 30 days after the introduction of stem cells in group 1 increased by 5.9%; in group 2 by 28.8%; in group 3 by 1.1%. Albumin levels increased by 11% in group 1, 33.8% in group 2, and remained unchanged in group 3. The ALT level in group 1 decreased by 32.3%, in group 2 by 48.1%, and in group 3 remained unchanged. The AST level decreased by 7% in group 1, by 25.9% in group 2, and remained unchanged in group 3. Indicators of alkaline phosphatase decreased by 3.9% in group 1, by 14.3% in group 2, and did not improve in group 3.Conclusion. The use of cellular technologies in liver cirrhosis contributes to a faster recovery of liver function when intraportal introduction of cellular structures.

ECM1 modified HF-MSCs targeting HSC attenuate liver cirrhosis by inhibiting the TGF-\u03b2/Smad signaling pathway

Hair follicle-derived mesenchymal stem cells (HF-MSCs) show considerable therapeutic potential for liver cirrhosis (LC). To improve the effectiveness of naïve HF-MSC treatments on LC, we used bioinformatic tools to identify an exogenous gene targeting HSCs among the differentially expressed genes (DEGs) in LC to modify HF-MSCs. Extracellular matrix protein 1 (ECM1) was identified as a DEG that was significantly downregulated in the cirrhotic liver. Then, ECM1-overexpressing HF-MSCs (ECM1-HF-MSCs) were transplanted into mice with LC to explore the effectiveness and correlated mechanism of gene-overexpressing HF-MSCs on LC. The results showed that ECM1-HF-MSCs significantly improved liver function and liver pathological injury in LC after cell therapy relative to the other treatment groups. Moreover, we found that ECM1-HF-MSCs homed to the injured liver and expressed the hepatocyte-specific surface markers ALB, CK18, and AFP. In addition, hepatic stellate cell (HSC) activation was significantly inhibited in the cell treatment groups in vivo and in vitro, especially in the ECM1-HF-MSC group. Additionally, TGF-β/Smad signal inhibition was the most significant in the ECM1-HF-MSC group in vivo and in vitro. The findings indicate that the genetic modification of HF-MSCs with bioinformatic tools may provide a broad perspective for precision treatment of LC.

A Study of Thyroid Profile (FT3, FT4, TSH) in Liver Cirrhosis in Jharkhand - A Hospital based Study

in people with liver disorders. Aim: To determine the prevalence of thyroid dysfunction in liver cirrhosis patients. Materials and Methods: This case-control study was carried out in a group of randomly selected liver cirrhosis patients in the Department of Medicine at Rajendra Institute of Medical Sciences (R.I.M.S), Ranchi, Jharkhand (India) between September 2017 to August 2018. The equal number of age (>18 years) and sex-matched cases &controls were included in this study. Radioimmunoassays were used to evaluate early morning fasting blood thyroid-stimulating hormone (TSH), serum total free thyroxine (FT4), and free triiodothyronine (FT3) in 100 index patients with liver cirrhosis who had no history of thyroid disorders. Results: In the cases that were studied, which consisted of cirrhotic patients, males (80%) outnumbered females (20%). The mean age of cases was 47.9 years, and the maximum numbers of the patient were between 41-55 years of age group (47%). Among the cirrhotic patients, the commonest etiology was alcoholic liver disease which contributed to 78% of the total cases studied. The rest of the cases included cirrhotics from other etiologies, which included NAFLD (22%), HBsAg positive individuals (07%), and other cases of cryptogenic origin. The mean FT3, FT4, and TSH values in cases were 2.29±0.83; 1.20±0.55 & 3.76±2.43 respectively & the mean FT3, FT4, and TSH of the control group were 2.95±0.52; 1.40±0.25 & 2.70±0.94 respectively. From these data, we can say that there is significant derangement of thyroid function in liver cirrhosis in favor of hypothyroidism (p<0.05). Conclusion: Hypothyroidism, or abnormalities in circulating thyroid hormone concentrations, is seen in people with alcoholrelated liver cirrhosis and is linked to more severe liver disease

Endothelial and microvascular function in liver cirrhosis: an old concept that needs re-evaluation?

Liver cirrhosis is characterized by significant circulatory dysregulation, related to an imbalance among several vasodilating agents, mainly nitric oxide. In contrast to portal vein and macrovascular hemodynamic alterations, which have been rather well described, the peripheral microcirculatory and endothelial structure and function in this population are less well studied. Endothelial dysfunction is characterized by an imbalance between endothelium-derived relaxing and contracting factors. A number of methods have been used to assess endothelial and microvascular function in human studies. Venous occlusion plethysmography was used for many years as the gold standard for evaluating endothelial function, but flow-mediated dilatation (FMD) of the forearm is currently the most frequently used method. In patients with cirrhosis, the few existing studies have mainly used FMD, but the relevant results are largely contradictory. In recent years, several noninvasive and easily applicable methods, such as near-infrared spectroscopy, laser speckle contrast imaging, peripheral arterial tonometry, optical coherence tomography and nailfold video-capillaroscopy, have been increasingly used to assess peripheral microvascular function and have demonstrated a number of advantages. In this review, we present functional methods to evaluate peripheral microvascular and endothelial function, and we discuss the existing evidence on circulatory dysfunction in patients with liver cirrhosis.

Mitochondrial Dysfunction in Advanced Liver Disease: Emerging Concepts.

Mitochondria are entrusted with the challenging task of providing energy through the generation of ATP, the universal cellular currency, thereby being highly flexible to different acute and chronic nutrient demands of the cell. The fact that mitochondrial diseases (genetic disorders caused by mutations in the nuclear or mitochondrial genome) manifest through a remarkable clinical variation of symptoms in affected individuals underlines the far-reaching implications of mitochondrial dysfunction. The study of mitochondrial function in genetic or non-genetic diseases therefore requires a multi-angled approach. Taking into account that the liver is among the organs richest in mitochondria, it stands to reason that in the process of unravelling the pathogenesis of liver-related diseases, researchers give special focus to characterizing mitochondrial function. However, mitochondrial dysfunction is not a uniformly defined term. It can refer to a decline in energy production, increase in reactive oxygen species and so forth. Therefore, any study on mitochondrial dysfunction first needs to define the dysfunction to be investigated. Here, we review the alterations of mitochondrial function in liver cirrhosis with emphasis on acutely decompensated liver cirrhosis and acute-on-chronic liver failure (ACLF), the latter being a form of acute decompensation characterized by a generalized state of systemic hyperinflammation/immunosuppression and high mortality rate. The studies that we discuss were either carried out in liver tissue itself of these patients, or in circulating leukocytes, whose mitochondrial alterations might reflect tissue and organ mitochondrial dysfunction. In addition, we present different methodological approaches that can be of utility to address the diverse aspects of hepatocyte and leukocyte mitochondrial function in liver disease. They include assays to measure metabolic fluxes using the comparatively novel Biolog’s MitoPlates in a 96-well format as well as assessment of mitochondrial respiration by high-resolution respirometry using Oroboros’ O2k-technology and Agilent Seahorse XF technology.

Overview of bile acid signaling in the cardiovascular system.

Bile acids (BAs) are classically known to play a vital role in the metabolism of lipids and in absorption. It is now well established that BAs act as signaling molecules, activating different receptors (such as farnesoid X receptor, vitamin D receptor, Takeda G-protein-coupled receptor 5, sphingosine-1-phosphate, muscarinic receptors, and big potassium channels) and participating in the regulation of energy homeostasis and lipid and glucose metabolism. In addition, increased BAs can impair cardiovascular function in liver cirrhosis. Approximately 50% of patients with cirrhosis develop cirrhotic cardiomyopathy. Exposure to high concentrations of hydrophobic BAs has been shown to be related to adverse effects with respect to vascular tension, endothelial function, arrhythmias, coronary atherosclerotic heart disease, and heart failure. The BAs in the serum BA pool have relevant through their hydrophobicity, and the lipophilic BAs are more harmful to the heart. Interestingly, ursodeoxycholic acid is a hydrophilic BA, and it is used as a therapeutic drug to reverse and protect the harmful cardiac effects caused by hydrophobic elevated BAs. In order to elucidate the mechanism of BAs and cardiovascular function, abundant experiments have been conducted in vitro and in vivo. The aim of this review was to explore the mechanism of BAs in the cardiovascular system.

Echocardiographic Assessment of Cardiac Function in Liver Cirrhosis: A Cross-sectional Study

Introduction: Echocardiography is a noninvasive method to assess the cardiac dysfunction in liver cirrhosis. Early detection of cardiac dysfunction helps prevent morbidity in patients undergoing haemodynamics altering procedures like liver transplant or Transjugular Intrahepatic Portosystemic Shunt (TIPSS) or those who have haematemesis. Aim: This study had been planned to assess the cardiac dysfunction and its incidence among patients of liver cirrhosis. Materials and Methods: In this cross-sectional study total of 150 individuals with liver cirrhosis were enrolled and cardiac assessment was done in the form of systolic and diastolic dysfunction by 2D Echocardiography. It was correlated with the aetiology and severity of liver cirrhosis was assessed by Child Pugh’s criteria. The grading of diastolic dysfunction was done on the basis of Early/Late (E/A) Left Ventricular (LV) filling ratio as Grade I (impaired relaxation pattern) E/A<0.8, Grade II (Pseudo normal) as E/A 0.8-1.5, and Grade III (Restrictive filling) E/A >2. Statistical analysis was done by using Chi-square test and Pearson’s Correlation Coefficient and p<0.05 is considered as level of significance. Results: Out of the 150 patients of liver cirrhosis, cardiac dysfunction was noted in 51. Among 93 (62%) patients who had alcoholic aetiology, 4 (44.4%) had systolic dysfunction whereas 29 (69.04%) had diastolic dysfunction. Among 9 patients of Left Ventricular (LV) systolic dysfunction 2 (22.2%) patients were in grade A Child Pugh, 4 (44.4%) in grade B and 3 (33.4%) in grade C, all being statically significant (r=0.195; p=0.017). LV diastolic dysfunction was seen in 17 (20.2%) of Grade A, 14 (25%) of Grade B and 11 (100%) of Grade C of Child Pugh Score, all being statistically significant and well correlated according to severity (r=0.199; p=0.004). Conclusion: The cardiac dysfunction was directly correlated with severity of liver cirrhosis according to Child Pugh scoring criteria thereby suggesting that possible cardiac changes were due to cirrhosis and not alcohol.

THU139 - Impaired splenic function in liver cirrhosis: a study in 69 patients with cirrhosis from outpatient hepatology clinic in a tertiary hospital in northern Greece

THU139 - Impaired splenic function in liver cirrhosis: a study in 69 patients with cirrhosis from outpatient hepatology clinic in a tertiary hospital in northern Greece

ЗАСТОСУВАННЯ ПЕРКУТАННОЇ ХІМІЧНОЇ АБЛЯЦІЇ В ЛІКУВАННІ ПАЦІЄНТІВ З ГЕПАТОЦЕЛЮЛЯРНОЮ КАРЦИНОМОЮ

Щороку частота виявлення ГЦК невпинно зростає. У період з 1990 по 2015 рік показник вперше діагностованих випадків ГЦК збільшився на 75%. В Україні за 2018 рік спеці- альним лікуванням охоплено лише 18,0% первинних хворих: тільки хірургічним лікуванням - 4,9%, комбінованим та комплексним лікуванням — 2,0 %. Незадовільні результати з охоплення спеціальним лікування пов'язані з особливостями етіопатогенезу ГЦК, асимптоматичним пе- ребігом та недосконалою системою скринінгу пацієнтів групи ризику, що утруднює діагнос- тику захворювання на ранніх стадіях. Вибір тактики лікування ГЦК асоційованою з вірусним гепатитом і цирозом печінки досі залишається складною клінічною проблемою, оскільки “за- стосування радикального лікування на ранній стадії є наріжним каменем для покращення за- гальної виживаності таких пацієнтів. Пацієнтам з ГЦК на ранніх стадіях з цирозом печінки, що не підлягають радикальному хірургічному лікуванню на момент звернення, показано засто- сування методів перкутанної абляції — радіочастотна абляція, хімічна абляція, кріоабляція, мікрохвильова абляція тощо. Основними показаннями для застосування локальної абляції в лікуванні ГЦК — дуже рання та рання стадія (за BCLC – стадія 0 та А), компенсована або субкомпенсована функція печінки при цирозі (Child - Pugh клас A та B), загальносоматичний статус за ECOG 0–1, діаметр пухлинного вогнища до 5,0 см (найбільш оптимально до 3,0 см), вогнищеве вузлове ураження, солітарне або множинне ураження. Перкутанну абляцію застосо- вують у якості “брідж”-терапії з метою локального контролю пухлинного росту у пацієнтів, що відповідають Міланським критеріям, критеріям UCSFC і знаходяться в списку очікуван- ня на трансплантацію. Також дані методи показали свою ефективність як неоад'ювантна “downstaging”-терапія у хворих, що не відповідають критеріям для трансплантації печінки та/або з первинно нерезектабельним ураженням. Протягом багатьох десятиліть перкутан- на хімічна абляція була “золотим” стандартом мініінвазивного лікування ГЦК. Даний метод простий у виконанні, не потребує спеціального обладнання, добре переноситься пацієнтами, безпечний та економічно вигідний. Основні хімічні агенти - етанол та оцтова кислота. Про- цедура перкутанної хімічної абляції передбачає інтратуморальне введення хімічного агенту “real-time” під контролем методів візуалізації (УЗД або КТ). Хімічна абляція - це метод дру- гої лінії і застосовується лише у випадках, наявності протипоказань до виконання радіочас- тотної абляції. Даний метод не супроводжується тяжкими специфічними ускладненнями та летальністю. Ефективність її клінічного застосування безпосередньо залежить від розміру пухлинного вогнища. Оптимальний розмір пухлинного вогнища становить не більше 3,0 см. Інтратуморальне введення етанолу призводить до некротизації 90% -100% пухлинних вузлів ГЦК діаметром ≤ 2,0 см та 70% при пухлинах 2,0 - 3,0 см.

Evaluation of Renal Function in Liver Cirrhosis in a Tertiary care Teaching Hospital at Agartala

Evaluation of Renal Function in Liver Cirrhosis in a Tertiary care Teaching Hospital at Agartala

The Association between The Degree of Liver Cirrhosis Severity and Zinc Serum Level

Background: Impaired liver function in LC (Liver Cirrhosis) can cause Zinc deficiency (Zn). One of the causes of Zn deficiency in LC is decreased albumin synthesis, whereas albumin is required as the main Zn binding protein in plasma. However, some studies of the severity of LC with Zn serum levels still provide controversial results.Objective: To determine the association between the degree of LC severity and Zn serum level.Methods: The subjects of this study were LC patients in Gastroentero-Hepatology Unit and Internal medicine wards in of Dr. Soetomo General Hospital Surabaya for three months. Diagnosis of LC was based on clinical examination according to Soehardjno-Soebandiri criteria and other findings (ultrasound or endoscopy). The degree of LC severity was determined based on the CTP score (Child-Turcotte-Pugh). Serum Zn concentration was measured by atomic absorption spectrophotometry method. The research design used the cross-sectional method. The statistical test used was Spearman correlation.Results: Forty-three patients fulfilled the study criteria. The subjects consisted of 27 males (62.8%) and 16 females (37.2%) with the mean age of 53.81 ± 8.67 years. Based on the CTP scores, we obtained CTP A of 4 patients (9.3%), CTP B of 19 patients (44.2%) and CTP C of 20 patients (46.5%). The mean of Zn serum level in CTP A, CTP B, and CTP C score was 58.3 ± 19.6 μg/dl, 43.4 ± 14.5 μg/dl and 31.6 ± 10 μg/dl respectively. The result of the statistical test showed a significant correlation between LC severity and Zn serum level (p <0.05 and r = -0.583).Conclusion: The heavier the severity of LC, the lower Zn serum levels.

Serum Wisteria floribunda agglutinin-positive Mac-2-binding protein evaluates liver function and predicts prognosis in liver cirrhosis.

Wisteria floribunda agglutinin-positive Mac-2-binding protein (WFA+ -M2BP) is a novel glycobiomarker for evaluating liver fibrosis, but less is known about its role in liver cirrhosis (LC). This study aimed to investigate the utility of WFA+ -M2BP in evaluating liver function and predicting prognosis of cirrhotic patients. We retrospectively included 197 patients with LC between 2013 and 2016. Serum WFA+ -M2BP and various biochemical parameters were measured in all patients. With a median follow-up of 23 months, liver-related complications and deaths of 160 patients were recorded. The accuracy of WFA+ -M2BP in evaluating liver function, predicting decompensation and mortality were measured by the receiver operating characteristic (ROC) curve, logistic and Cox's regression analyses, respectively. WFA+ -M2BP levels increased with elevated Child-Pugh classification, especially in patients with hepatitis B virus (HBV) infection. ROC analysis confirmed the high reliability of WFA+ -M2BP for the assessment of liver function using Child-Pugh classification. WFA+ -M2BP was also significantly positively correlated with the model for end-stage liver disease (MELD) score. Multivariate logistic regression analysis indicated WFA+ -M2BP as an independent predictor of clinical decompensation for compensated patients (odds ratio 11.958, 95% confidence interval [CI] 1.876-76.226, P = 0.009), and multivariate Cox's regression analysis verified WFA+ -M2BP as an independent risk factor for liver-related death in patients with HBV infection (hazards ratio 10.596, 95% CI 1.356-82.820, P = 0.024). Serum WFA+ -M2BP is a reliable predictor of liver function and prognosis in LC and could be incorporated into clinical surveillance strategies for LC patients, especially those with HBV infection.

Renal dysfunction in liver cirrhosis and its correlation with Child-Pugh score and MELD score

Renal dysfunction (RD) is a serious and common complication in a patient with liver cirrhosis. It provides a poor prognosis. The aim of our study was to evaluate the renal function in liver cirrhosis, also to determine the correlation with the graduation of liver disease assessed by Child-Pugh Score (CPS) and MELD score. This was a cross-sectional study included patients with liver cirrhosis admitted to Adam Malik Hospital Medan in June - August 2016. We divided them into two groups as not having renal dysfunction (serum creatinine < 1.5 mg/dL) and having renal dysfunction (serum creatinine ≤ 1.5 mg/dL). For the processing of data, SPSS 22.0 was used. Statistical methods used: Chi-square, Fisher exact, one way ANOVA, Kruskal Wallis test and Pearson coefficient of correlation. The level of significance was p<0.05. 55 patients with presented with renal dysfunction were 16 (29.1 %). There was statistically significant inverse correlation between GFR and CPS (r = -0.308), GFR and MELD score (r = -0.278). There was a statistically significant correlation between creatinine and MELD score (r = 0.359), creatinine and CPS (r = 0.382). The increase of the degree of liver damage is related to the increase of renal dysfunction.

Reduced platelet activation and platelet aggregation in patients with alcoholic liver cirrhosis

Results from previous studies regarding platelet function in liver cirrhosis are discordant. The aim was to investigate platelet activation and platelet aggregation in patients with alcoholic liver cirrhosis. We included 27 patients with alcoholic liver cirrhosis and 22 healthy individuals. A recently established flow cytometric approach was used to measure platelet activation and platelet aggregation independent of sample platelet count. Platelet aggregation was further investigated using light transmission aggregometry (LTA) (for platelet count >100 × 109/L). Platelet agonists were adenosine diphosphate, thrombin receptor-activating peptide, arachidonic acid, collagen, and collagen-related peptide. Patients had lower median platelet count than healthy individuals, 125 × 109/L (interquartile range [IQR] 90˗185) versus 240 × 109 (IQR 204˗285), p < 0.001. Platelet activation levels in stimulated samples were lower in patients versus healthy individuals, e.g., after collagen-related peptide stimulation, the median percentage of platelets positive for activated glycoprotein IIb/IIIa was 85% (IQR 70–94) in patients versus 97% (IQR 94–99) in healthy individuals, p < 0.001; lower platelet activation capacity being associated with low platelet count and Child–Pugh class B/C cirrhosis. Flow cytometric platelet aggregation was reduced in patients for collagen-related peptide and for adenosine diphosphate, e.g., platelet aggregation (mean ± standard deviation) was 57% ± 4 in patients versus 70% ± 1 in healthy individuals for collagen-related peptide, p = 0.01. Light LTA showed reduced collagen-induced platelet aggregation in some patients compared with healthy individuals. In conclusion, platelet function was reduced in some patients with alcoholic liver cirrhosis and the severity was associated with platelet count and severity of liver cirrhosis.

Associations of systemic sphingolipids with measures of hepatic function in liver cirrhosis are related to cholesterol

Lipoprotein particles are composed of various lipid classes including cholesterol and sphingolipids, and are low in serum of patients with liver cirrhosis. Hepatic decompensation is associated with a further decline of lipoproteins. Aim of the present work was to evaluate whether ceramide and sphingomyelin species are similarly changed in patients with liver cirrhosis and whether these variations are related to systemic cholesterol levels. In a cohort of 45 patients suffering from liver cirrhosis, cholesteryl ester species and subsequently total cholesterol were identified to be negatively associated with model of end stage liver disease (MELD) score. Indeed, the negative correlations of ceramide (Cer) and sphingomyelin (SM) species with MELD score, bilirubin and anti-thrombin 3 were non-significant after adjustment for cholesterol. Cer/SM ratios of species with identical acyl chains were not related to Child-Pugh or MELD score indicating that both lipids are comparably changed. Further, cholesterol levels and concentrations of all sphingolipids measured were similar in systemic, hepatic vein and portal vein blood. Cholesterol and distinct sphingolipids were similar before and 3 months after insertion of a transjugular intrahepatic portosystemic shunt while hexosylceramide 24:1 was significantly induced. It is concluded that analysis of distinct systemic sphingolipid species is not superior to measurement of cholesterol as non-invasive marker of hepatic injury in patients with liver cirrhosis.