Pugh Score Research Articles

Using AI and Gd-EOB-DTPA-enhanced MR imaging to assess liver function, comparing the MELIF score with the ALBI score

Monitoring disease progression is particularly important for determining the optimal treatment strategy in patients with liver disease. Especially for patients with diseases that have a reversible course, there is a lack of suitable tools for monitoring liver function. The development and establishment of such tools is very important, especially in view of the expected increase in such diseases in the future. Image-based liver function parameters, such as the T1 relaxometry-based MELIF score, are ideally suited for this purpose. The determination of this new liver function score is fully automated by software developed with AI technology. In this study, the MELIF score is compared with the widely used ALBI score. The ALBI score was used as a benchmark, as it has been shown to better capture the progression of less severe liver disease than the MELD and Child‒Pugh scores. In this study, we retrospectively determined the ALBI and MELIF scores for 150 patients, compared these scores with the corresponding MELD and Child‒Pugh scores (Pearson correlation), and examined the ability of these scores to discriminate between good and impaired liver function (AUC: MELIF 0.8; ALBI 0.77) and to distinguish between patients with and without cirrhosis (AUC: MELIF 0.83, ALBI 0.79). The MELIF score performed more favourably than the ALBI score and may also be suitable for monitoring mild disease progression. Thus, the MELIF score is promising for closing the gap in the available early-stage liver disease monitoring tools (i.e., identification of liver disease at a potentially reversible stage before chronic liver disease develops).

Prediction models combining zonulin, LPS, and LBP predict acute kidney injury and hepatorenal syndrome–acute kidney injury in cirrhotic patients

The development of acute kidney injury (AKI) and hepatorenal syndrome–acute kidney injury (HRS–AKI) in cirrhosis has been associated with intestinal barrier dysfunction and gut-kidney crosstalk. We use the related markers such as zonulin, lipopolysaccharides (LPS), and lipopolysaccharide-binding protein (LBP) to predict AKI and HRS–AKI in cirrhotic patients and evaluate their in vitro effects on intestinal (Caco-2) cells and renal tubular (HK-2) cells. From 2013 to 2020, we enrolled 70 cirrhotic patients and developed prediction models for AKI and HRS–AKI over a six-month period. There were 13 (18.6%) and 8 (11.4%) cirrhotic patients developed AKI and HRS–AKI. The prediction models incorporated zonulin, LPS, LBP, C-reactive protein, age, and history of hepatitis B for AKI, and zonulin, LPS, LBP, total bilirubin, and Child–Pugh score for HRS–AKI. The area under curve (AUC) for the prediction of AKI and HRS–AKI was 0.94 and 0.95, respectively. Furthermore, the conditioned medium of LPS+hrLBP pre-treated Caco-2 cells induced apoptosis, necrosis, and zonulin release in HK-2 cells, demonstrating the communication between them. This study found that zonulin, LPS, and LBP are potential practical markers for predicting AKI and HRS–AKI in cirrhotic patients, which may serve as potential targets for renal outcomes in cirrhotic patients.

A Study on Serum IL-6 Levels in Patients with Liver Cirrhosis of Any Cause and its Correlation with Child Pugh Score in Assessing the Disease Severity

Background: Liver cirrhosis is a chronic and progressive disease characterized by the development of fibrosis and distortion of the liver architecture. One potential biomarker that has gained attention in recent years is interleukin-6 (IL-6), a pro-inflammatory cytokine that plays a crucial role in the immune response and inflammatory processes. In the present study, serum IL-6 levels will be measured using enzyme-linked immunosorbent assay (ELISA) and correlated with the Child-Pugh score. Methods: This study was a cross-sectional design conducted at ASCOMS Jammu from June 2021 to November 2021. Fifty patients who presented with symptoms of liver cirrhosis, such as abdominal pain, abdominal distention, jaundice, and reduced urine output, were randomly selected from the outpatient or emergency departments. Results: The study analyzed data from 50 patients, finding that 6% were below the age of 30, 24% were between 30 and 40, and 70% were over 40. 94% of patients were male, while only 6% were female. The study found a significant increase in the mean portal vein diameter as the Child class increased, and a significant correlation between PT prolongation and mean IL-6 levels. However, there was no significant correlation between Child class and SAAG value. Conclusion: The severity of varices in patients with liver cirrhosis was found to be strongly associated with the level of serum IL-6, suggesting that serum IL-6 can be used as a non-invasive way to identify varices in patients with liver cirrhosis, particularly when OGD scopy is not available or if the patient is too sick to be moved to the OGD room. Elevated levels of IL-6 have also been associated with hepatic encephalopathy, liver fibrosis, and cirrhosis. Keywords: Interleukin 6, liver cirrhosis, hepatic encephalopathy, child Pugh score

Effects of iodine-125 seed brachytherapy on patients with heterochronous pulmonary metastasis from hepatocellular carcinoma: A propensity score matching study.

To investigate the effects of iodine-125 seed brachytherapy (ISB) on the overall survival (OS) of patients with heterochronous pulmonary metastasis (HPM) secondary to hepatocellular carcinoma (HCC). The clinical and imaging data of 123 patients with HPM secondary to HCC treated at a single center from July 2012 to July 2020 were analyzed retrospectively. The patients were divided into ISB and non-ISB groups based on ISB treatment. Propensity score matching yielded 46 pairs of patients. A total of 191 lesions were treated, and the data were evaluated for 6 months after ISB. The OS rates of the two groups were compared using the Kaplan-Meier method. Independent prognostic factors were determined using a Cox proportional hazards regression model. The percentages of lung lesions in complete remission, partial remission, disease stable, and disease progression stages were 49.2%, 32.8%, 9.6%, and 8.4%, respectively. The disease control rate was 91.6%. The median follow-up time from the initial diagnosis was 47 months and 33 months for the ISB and non-ISB groups, respectively. Patients in the ISB group had a longer OS than those in the non-ISB group (1-year: 95.7% vs. 80.3%; 3-year: 62.9% vs. 45.7%; 5-year: 37% vs. 20.9%; P < 0.05). Multivariate analysis demonstrated that ISB treatment, tumor differentiation, vascular invasion, and Child - Pugh score were independent prognostic factors for survival. ISB improves local control and OS rates of HPM secondary to HCC; thus, it is an effective and feasible option for patients with HPM secondary to HCC.

Oxidative stress-related markers as prognostic factors for patients with primary sclerosing cholangitis in Japan.

Primary sclerosing cholangitis (PSC) is a rare chronic liver disease. The mechanisms and prediction of PSC progression are unclear. Recent investigations have shown that general conditions, such as oxidative stress, affect the course of chronic diseases. We investigated the clinical course and oxidative stress-related condition of PSC to determine prognostic factors. We recruited 58 patients with PSC (mean age; 37.4years, mean observation period; 1382days) who visited our department from 2003 to 2021. Clinical characteristics were investigated to define prognostic factors. Oxidative stress status was evaluated using two types of markers: an oxidative stress marker (serum reactive oxygen metabolite; dROM) and an antioxidant marker (serum OXY adsorbent test; OXY). The revised Mayo risk, Child-Pugh, model for end-stage liver disease-sodium (MELD-Na) scores or fibrosis-related FIB-4 index significantly predicted poor overall survival. High intestinal immunoglobulin A (IgA) levels predicted poor survival. Among patients with high and intermediate revised Mayo risk scores, those with physiologically high dROM levels showed better survival than those with lower dROM levels. In this population, dROM was negatively correlated with AST and IgA, which are both correlated with survival. High and intermediate revised Mayo risk score group predicted a poor clinical course in PSC. Additionally, the Child-Pugh score, MELD-Na score, FIB-4 index, and serum IgA were significantly correlated with survival. In patients with high and intermediate revised Mayo risk scores, physiologically high oxidative stress status correlated with low IgA levels and a good prognosis.

Absolute eosinophil count is a reliable prognostic marker in patients with liver cirrhosis: a cross-sectional study at rural central India

BackgroundVarious laboratory parameters like C-reactive protein (CRP), Cortisol, and Von Willebrand factor antigen have been evaluated independently in foreseeing outcomes of cirrhotic patients. As these parameters lack cost-effectiveness in a rural setup, there is a need for a cost effective and feasible prognostic marker for cirrhotic patients. The present study was aimed at evaluating the role of Absolute Eosinophil Count (AEC) as a prognostic marker in cirrhotic patients.MethodsThis cross-sectional study was conducted at a rural tertiary care teaching hospital in central India from August 2019 to September 2021. AEC was measured from counter report as a part of automated complete blood counts. Child-Turcotte-Pugh (CTP) score and Model for end stage liver disease (MELD) score were calculated at the time of admission. AEC levels on admission were correlated with mortality and with CTP score and MELD score.ResultsA total of 110 patients were enrolled with mean age of 46.37 ± 11.6 years. AEC was the significant predictor of mortality at cut off point of ≤ 120 with 80.30% (AUC 0.803; 95% CI: 0.716 to 0.873). AEC was the significant predictor of CTP score ≥ 11 at cut off point of ≤ 148 (AUC 0.726; 95% CI: 0.633 to 0.807). AEC was the significant predictor of MELD score ≥ 25 at cut off point of ≤ 136 (AUC 0.74; 95% CI: 0.647 to 0.819). Significant negative correlation was seen between AEC with Child–Pugh score and MELD score with correlation coefficient of -0.257 and -0.258.ConclusionLow level of AEC on admission fairly predicted raised CTP score and MELD score on admission. Low AEC levels predicted increased mortality in cirrhotic patients making it a cheap and reliable prognostic marker in a rural setup.

Necroptosis-related signatures identify two distinct hepatocellular carcinoma subtypes: Implications for predicting drug sensitivity and prognosis

BackgroundNecroptosis is associated with oncogenesis, tumor immunity and progression. This research aims to investigate the association of necroptosis-related genes with drug sensitivity and prognosis in hepatocellular carcinoma (HCC). MethodsBased on necroptosis-related signatures, HCC patients retrieved from the TCGA database were categorized. Survival outcomes, mutation profile, immune microenvironment, and drug sensitivity between HCC subtypes were further compared. Then, LASSO analysis was performed to construct a necroptosis-related prognostic signature, which was further evaluated using another independent cohort. ResultsA total of 371 patients with HCC could be categorized into two necroptosis-related subtypes. About 36% of patients were allocated to subtype A, with worse survival, more mutant TP53, and a lower likelihood of immunotherapy response. In contrast, patients in subtype B had a favorable prognosis, with lower expression of immunosuppressive signatures but a lower abundance of B and CD8+ T-cell infiltration. The prognostic risk score calculated using the expression levels of nine genes involved in the necroptosis pathway (MLKL, FADD, XIAP, USP22, UHRF1, CASP8, RIPK3, ZBP1, and FAS) showed a significant association with tumor stage, histologic grade, and Child‒Pugh score. Additionally, the risk score model was proven to be accurate in both the training and independent external validation cohorts and performed better than the TNM staging system and three well-recognized risk score models. ConclusionsBased on necroptosis-related signatures, we identified two HCC subtypes with distinctive immune microenvironments, mutation profiles, drug sensitivities, and survival outcomes. A novel well-performing prognostic model was further constructed.

Bone Marrow Assessment in Liver Cirrhosis Patients with Otherwise Unexplained Peripheral Blood Cytopenia

We performed a retrospective single-center analysis to investigate the diagnostic yield of bone marrow puncture in patients with liver cirrhosis and cytopenia. Liver cirrhosis patients receiving bone marrow aspiration or biopsy for the diagnostic work-up of otherwise unexplained peripheral blood cytopenia at our institution between 2004 and 2020 were enrolled in this study. We evaluated findings from cytologic, histologic and immunologic assessment and final diagnostic outcomes. A total of 118 patients with a median age of 55 years and a median Child–Pugh score of B (8 points) were enrolled. The main etiologies of liver cirrhosis were viral hepatitis (B and C) or chronic alcohol consumption. The majority of patients (60%) exhibited concurrent anemia, leukocytopenia and thrombocytopenia. Bone marrow assessment revealed normal, unspecific or reactive alterations in 117 out of 118 patients (99%). One patient was diagnosed with myelodysplastic syndrome. Our findings suggest that peripheral blood cytopenia in patients with liver cirrhosis is rarely associated with a primary bone marrow pathology.

Сorrelation between somatotypes and body fat changes in patients with liver cirrhosis

Objective. To evaluate the nature of changes in body fat composition in cirrhotic patients of various somatotypes.Materials and methods. The data of 46 cirrhotic patients and 20 volunteers were analyzed. Anthropometric examination was carried out according to methodological requirements with assessing the body composition of patients by means of bioimpedance analysis using ABC-01 Medass system (NTC Medass, Russia). Somatotypes were determined according to the Heath–Carter method. Ranks for the somatotype scale were assigned as endomorphy scores increased. Spearman rank correlation was used to identify the relationships between the variables. Differences between continuous variables were determined using the Mann–Whitney test. Statistical analysis was performed using Statistica 10 (StatSoft Inc., USA).Results. Child–Pugh scores for men and women were 9 (7.3–11.8) and 7 (6–9), respectively. Body fat percentage (BFP) of cirrhotic patients accounted for 27.7% (23.3–33) in men and 41.2% (33.6–46.3) in women. In healthy volunteers, the BFP was 21.9% (13.9–26.3) in men and 32.7% (29.3–41.6) in women. Assessment of the relationships between liver cirrhosis severity and body fat was characterized by a correlation coefficient of r = -0.47528 (p-value &lt; 0.001). A significant negative correlation was determined between the liver cirrhosis severity according to Child–Pugh scores and somatotypes (r = -0.30536, p = 0.03905).Conclusion. The results of this study emphasize the correlation between somatotypes and changes in BFP in patients with liver cirrhosis of various degrees of severity. The sum of Child–Pugh scores and endomorphic indicators demonstrated the inverse relationship, which must be taken into account when developing mathematical models of the personalized prognosis of liver cirrhosis.

Assessing severity of liver injury in clinical practice: an improved Child–Turcotte–Pugh score (CTP score)

Journal Article Assessing severity of liver injury in clinical practice: an improved Child–Turcotte–Pugh score (CTP score) Get access Seamas C Donnelly Seamas C Donnelly Editor-in-Chief, QJM Email: seamas.donnelly@tcd.ie Search for other works by this author on: Oxford Academic PubMed Google Scholar QJM: An International Journal of Medicine, Volume 116, Issue 6, June 2023, Page 411, https://doi.org/10.1093/qjmed/hcad088 Published: 08 June 2023

Evaluation of liver function using Gd-EOB-DTPA-enhanced MRI with T1 mapping

PurposeTo evaluate the value of MRI T1 mapping with Gd-EOB-DTPA for assessing liver function.MethodsSeventy-two patients who underwent Gd-EOB-DTPA-enhanced MRI for focal liver lesions at Beijing Friendship Hospital from August 2020 to March 2022 were prospectively enrolled, and variable-flip-angle T1 mapping was performed before and 20 min after enhancement. The Child–Pugh (C-P) score and albumin-bilirubin (ALBI) grade of liver function were assessed using the clinical data of the patients. Correlation analysis was used to evaluate the correlation between T1 mapping parameters and liver function grading and laboratory tests. Nonparametric tests were used to compare the differences among different liver function groups. The liver function classification efficiency of each image index was evaluated with receiver operating characteristic (ROC) curves.ResultsT1post was positively correlated with the C-P grade and the ALBI grade (r = 0.717 and r = 0.652). ΔT1 was negatively correlated with the C-P grade and the ALBI grade (r = -0.790 and r = -0.658). T1post and ΔT1 significantly differed among different liver function grades (p < 0.05). For the C-P grade, T1post and ΔT1 were significantly different between each pair of groups (p < 0.05), and ΔT1 had a better diagnostic efficiency than T1post. For the ALBI grade, ΔT1 and T1post were significantly different between the NLF and ALBI1 groups (p < 0.05), and ΔT1 had a better diagnostic efficacy than T1post. T1post significantly differed between the ALBI1 and ALBI2 + 3 groups (p < 0.05), while ΔT1 had a weak ability to differentiate between these two groups.ConclusionT1post and ΔT1 were strongly correlated with the two liver function grades and can be noninvasive imaging indexes for evaluating liver function.

Sequential therapy versus first-line tyrosine kinase inhibitor plus immune checkpoint inhibitor therapy for unresectable hepatocellular carcinoma.

e16122 Background: The treatment landscape of hepatocellular carcinoma (HCC) evolves, but the optimal sequential strategy for tyrosine kinase inhibitor (TKI) and immune checkpoint inhibitor (ICI)-based combination therapy is still unclear. This study compared the outcome and efficacy of TKI-(TKI+ICI) sequential therapy versus first-line TKI+ICI combination therapy in unresectable HCC. Methods: The patients who had received TKI (lenvatinib or sorafenib) plus ICI (anti-PD-1/PD-L1 monoclonal antibody) as first-line therapy or TKI-(TKI+ICI) sequential therapy were retrospectively included. Treatment efficacy (progression-free survival (PFS) and overall survival (OS)) to sequential therapy or TKI+ICI combination therapy as well as treatment-related adverse events (TRAEs) were assessed. Results: Among 392 patients included, 55 underwent TKI-(TKI+ICI) sequential therapy and 337 underwent first-line TKI+ICI combination therapy. The median PFS was significantly longer in TKI-(TKI+ICI) group than that in TKI+ICI group (16.2 months versus 7.7 months, HR 0.65 [0.47-0.90]; p=0.009). The median OS was not reached in TKI-(TKI+ICI) group and was 22.8 months in TKI+ICI group (HR 0.53 [0.33-0.83]; p=0.006). Multivariate analyses revealed that Child- Pugh score, BCLC stage and sequential therapy were independently associated with PFS. Child-pugh score, macrovascular invasion (MVI), AFP levels and sequential therapy were independently associated with OS. Subgroup analysis indicated that patients with younger age, male gender, an ECOG PS 1, Child-Pugh score A, HBV(+), HCV(-), BCLC stage C, presence of MVI or extrahepatic metastasis could remarkably benefit from sequential therapy. The survival outcome and objective response to TKI+ICI combination therapy was comparable between groups. The incidence of TRAEs were slightly higher in TKI-(TKI+ICI) group ( p=0.022), but the difference was not significant for Grade≥3 events ( p=0.126). Conclusions: TKI-(TKI+ICI) sequential therapy is a valid therapeutic strategy for patients with HCC compared with first-line TKI+ICI combination therapy.

Real world impact of hepatocellular carcinoma stage and hepatic function on health-related quality of life.

e16215 Background: Health-Related Quality of Life (HRQoL) is an important prognostic indicator and clinical endpoint for patients with hepatocellular carcinoma (HCC). The relationship between cancer stage, liver function, performance status, and HRQoL in HCC in a real-world clinical setting is not well defined. Methods: A retrospective chart review was undertaken of consecutive patients with HCC treated at our institution's liver multidisciplinary clinic between February 2020 and August 2022. We examined the relationship between Barcelona Clinic Liver Cancer (BCLC) stage, Child Pugh (CP) score, and Eastern Cooperative Oncology Group (ECOG) performance status on HRQoL at diagnosis. HRQoL was assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire. Results: Fifty-one patients met our inclusion criteria. The median age was 69 and the mean FACT-Hep score was 130.3 ± 20.3. FACT-Hep total and subscales showed no significant association with BCLC stages A, B, and C (p =0.224), except in the Emotional Well Being (EWB) subscale (p =0.001). There was no impact of ECOG performance status on the FACT-Hep scores, except for the Functional Well Being (FWB) subscale (p=0.006). Patients with a CP B had significantly more impairment in FACT-Hep than patients with CP A, including FACT-Hep total score (118.5 ±27.3 versus 134.3 ±23.8; p =0.021) and subscales including the Physical Well Being (p =0.018), FWB (p =0.030), Hepatobiliary Cancer Subscale (p &lt;0.001), and FACT-Hep Trial Outcome Index score (p =0.003). Conclusions: Cancer stage poorly correlates with HRQoL at diagnosis in HCC patients. Impaired liver function reduces overall quality of life in HCC patients. Further large-scale prospective studies should be undertaken which incorporate validated HRQoL tools in the routine assessment of HCC patients. [Table: see text]

A study of the risk factors and outcome in patients with upper gastrointestinal bleed presenting to a tertiary care center in Kumaon region of Uttarakhand

Background: Upper gastrointestinal (GI) bleeding refers to blood loss within the intraluminal GI tract from any location between the upper esophagi to the duodenum at the level of the ligament of Treitz. Bleeding from the upper GI tract may present as hematemesis, melena, hematochezia, occult GI bleeding, and anemia. Aims and Objectives: The aims of this study were to study the risk factors and outcome in upper GI bleed patients presenting to a tertiary care center in Kumaon region of Uttarakhand. The primary objective was to estimate the proportion of mortality in upper GI bleed patients attending a tertiary care center. The secondary objective was to study the risk factors associated with upper GI bleed and their effect on mortality. Materials and Methods: This was a hospital-based observational prospective clinical study, carried out in the Department of General medicine, Dr. Susheela Tiwari Memorial Hospital and associated Government Medical College, Haldwani, from January 2020 to September 2021 after obtaining ethical clearance from the Institutional Review Committee and informed consent from the patient or patient relatives. Statistical testing has been conducted with the Statistical Package for the Social Science software (SPSS version 20.0). Results: The factors associated with mortality using multivariate analysis were high international normalized ratio (INR), low albumin, raised serum glutamic oxaloacetic transaminas, high Child Pugh Score, and high model for end stage liver disease (MELD) score found to be significant. Conclusion: The mortality rate in our patients was 18% and factors associated with increased mortality were high INR, low Albumin, raised creatinine, high Child Pugh Score, high MELD score, and presence of spontaneous bacterial peritonitis.

Frequency of hyponatremia in decompensated chronic liver disease patients.

Objectives: To find the frequency of hyponatremia in decompensated chronic liver disease patients. Study Design: Descriptive, Cross-sectional study. Setting: Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan. Period: October 2022 to March 2023. Material &amp; Methods: A total of 118 patients of either gender aged 40-70 years having decompensated chronic liver disease were analyzed. Five ml blood was drawn under aseptic environment and was properly preserved, and sent to the hospital laboratory for analysis of sodium levels. Frequency of hyponatremia was determined and hyponatremia was labeled as serum sodium level &lt; 130 mEq/liter. Results: In a total of 118 patients, the mean age was 53.69 ±7.11 years (ranging between 40-70 years) while 69 (58.5%) patients were aged between 41 to 55 years of age. There were 64 (54.2%) male and 54 (45.8%) female patients. The mean duration of chronic liver disease was 10.49±3.48 months whereas the mean BMI was 30.26±2.50 kg/m2. The mean serum bilirubin, serum globulin, serum albumin, mean albumin to globulin ratio, PT, child Pugh score and serum sodium levels were 5.43±2.41 mg/dl, 4.87±1.89 g/dl, 2.13±0.87 g/dl, 1.65±0.73, 11.33±3.41 seconds, 8.12 ± 2.68 and 118.67±9.87 mEq/liter respectively. The frequency of hyponatremia in patients with decompensated liver cirrhosis was found in 39 (33.1%) patients. Conclusion: This study concluded that frequency of hyponatremia in decompensated chronic liver disease patients is quite high.

Global Leadership Initiative on Malnutrition criteria for the diagnosis of malnutrition and prediction of mortality in patients awaiting liver transplant: A validation study

ObjectivesThe Global Leadership Initiative on Malnutrition (GLIM) is a framework aiming to standardize malnutrition diagnosis. However, it still needs to be validated, in particular for patients with chronic liver disease. This study aimed to validate the GLIM criteria in patients with liver cirrhosis awaiting liver transplant (LTx). MethodsThis was a retrospective observational study carried out with adult patients on the waiting list for LTx, consecutively evaluated between 2006 and 2021. The phenotypic criteria were unintentional weight loss, low body mass index, and reduced muscle mass (midarm muscle circumference [MAMC]). The etiologic criteria were high Model for End-Stage Liver Disease (MELD) and MELD adjusted for serum sodium (MELD-Na) scores, the Child–Pugh score, low serum albumin, and low food intake and/or assimilation. Forty-three GLIM combinations were tested. Sensitivity (SE), specificity (SP), positive and negative predictive values, and machine learning (ML) techniques were used. Survival analysis with Cox regression was carried out. ResultsA total of 419 patients with advanced liver cirrhosis were included (median age, 52.0 y [46–59 y]; 69.2% male; 68.8% malnourished according to the Subjective Global Assessment [SGA]). The prevalence of malnutrition by the GLIM criteria ranged from 3.1% to 58.2%, and five combinations had SE or SP >80%. The MAMC as a phenotypic criterion with MELD and MELD-Na as etiologic criteria were predictors of mortality. The MAMC and the presence of any phenotypic criteria associated with liver disease parameters and low food intake or assimilation were associated with malnutrition prediction in ML analysis. ConclusionsThe MAMC and liver disease parameters were associated with malnutrition diagnosis by SGA and were also predictors of 1-y mortality in patients with liver cirrhosis awaiting LTx.

Hypocalcemia on Admission Is a Predictor of Disease Progression in COVID-19 Patients with Cirrhosis: A Multicenter Study in Hungary.

Hypocalcemia is a common condition in liver cirrhosis and is associated with the severity of SARS-CoV-2 infection. However, there is a lack of data demonstrating the prognostic value of hypocalcemia in COVID-19 patients with cirrhosis. This study aimed to evaluate the prognostic value of hypocalcemia for COVID-19 severity, mortality and its associations with abnormal liver function parameters. We selected 451 COVID-19 patients in this retrospective study and compared the laboratory findings of 52 COVID-19 patients with cirrhosis to those of 399 COVID-19 patients without cirrhosis. Laboratory tests measuring albumin-corrected total serum calcium were performed on admission, and the levels were monitored during hospitalization. The total serum calcium levels were significantly lower in cirrhosis cases (2.16 mmol/L) compared to those without cirrhosis (2.32 mmol/L). Multivariate analysis showed that hypocalcemia in COVID-19 patients with cirrhosis was a significant predictor of in-hospital mortality, with an OR of 4.871 (p < 0.05; 95% CI 1.566-15.146). ROC analysis showed the AUC value of total serum calcium was 0.818 (95% CI 0.683-0.953, p < 0.05), with a sensitivity of 88.3% and a specificity of 75%. The total serum calcium levels showed a significant negative correlation with the Child-Turcette-Pugh score (r = -0.400, p < 0.05). Hypocalcemia on admission was a significant prognostic factor of disease progression in COVID-19 patients with cirrhosis.

Treatment of Tuberculosis in special situations

Treatment of Tuberculosis in special situations implies overcoming special challenges in patients with diabetes, pregnant women, people aged over 65 years, and those with chronic kidney or liver disease.Rifampicin is a potent hepatic enzyme inducer, may lower plasma levels of sulphonyl urea and can increase the hypoglycemic effect of metformin. Since insulin is not metabolized, no pharmacokinetic interactions with anti-TB drugs occur. Gastrointestinal upset and hepatitis are reported as the most frequent adverse events in older people. In patients &gt;80 years,pyrazinamide may be omitted. In TB patients with chronic kidney disease (CKD), an inappropriate dosage of anti-TB drugs can result in unsuccessful treatment or side effects. Current guidelines for first-line anti-TB drugs therefore recommend that dosages of ethambutol (EMB) and pyrazinamide (PZA) be adjusted according to patient renal function and body weight, although no change in dosage is necessary for patients with mild renal insufficiency . However, it remains unknown how the renal function-based dosage adjustments recommended by the guidelines affect efficacy outcomes for TB patients with CKD. In chronic liver disease (CLD) patients, The Child–Turcotte–Pugh (CTP) score can be used as a guide for designing appropriate regimens. In stable CLD (CTP d”7), a treatment regimen including isoniazid, rifampicin, and ethambutol is recommended, a 2-month intensive phase with the three drugs, followed by isoniazid and rifampicin continuation phase for 7 months partially liver-sparing regimen consisting of Ethambutol, Rifampicin, and a quinolone for 9 months is advisable in case of more severe CLD (CTP 8–10).If CLD is very advanced (CTP £11), a total liver-sparing regimen consisting of Ethambutol and a quinolone (Levofloxacin or Moxifloxacin) for 12 months. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 196-197

Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma.

Liver resection is an effective therapeutic option for patients with hepatocellular carcinoma. However, posthepatectomy liver failure (PHLF) remains a major cause of hepatectomy-related mortality, and the accurate prediction of PHLF based on preoperative assessment of liver functional reserve is a critical issue. The definition of PHLF proposed by the International Study Group for Liver Surgery has gained acceptance as a standard grading criterion. Liver function can be estimated using a variety of parameters, including routine blood biochemical examinations, clinical scoring systems, dynamic liver function tests, liver stiffness and fibrosis markers, and imaging studies. The Child-Pugh score and model for end-stage liver disease scores are conventionally used for estimating liver decompensation, although the alternatively developed albumin-bilirubin score shows superior performance for predicting hepatic dysfunction. Indocyanine green clearance, a dynamic liver function test mostly used in Japan and other Asian countries, serves as a quantitative estimation of liver function reserve and helps determine indications for surgical procedures according to the estimated risk of PHLF. In an attempt to improve predictive accuracy, specific evaluation of liver fibrosis and portal hypertension has gained popularity, including liver stiffness measurements using ultrasonography or magnetic resonance elastography, as well as noninvasive fibrosis markers. Imaging modalities, including Tc-99m-labeled galactosyl serum albumin scintigraphy and gadolinium-enhanced magnetic resonance imaging, are used for preoperative evaluation in combination with liver volume. This review aims to provide an overview of the usefulness of current options for the preoperative assessment of liver function in predicting PHLF.

A study of thyroid function profile in patients of chronic liver disease and its correlation with child Pugh score

Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease. Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Serum TSH, FT3, FT4 levels were measured for all the patients. Results: Out of 103 patients and it was found that 19 (18.44%) patients belonged CTP class A, 40 (38.83%) patients had CTP score of class B, while maximum 44 (42.71%) patients belonged CTP class C. There was significant positive correlation between CTP class and TSH values (p&lt;0.001) with mean (SD) of CTP class A, B and C were 2.42 (0.76), 3.9 (1.02) and 5.91 (1.08) respectively. There was significant negative correlation between CTP class and FT3 values (p&lt;0.001) and between CTP class and FT4 values (p&lt;0.001). Conclusions: Our study found that there was significant positive correlation of S.TSH values with severity of CLD as assessed by CTP score, while FT3 and FT4 were having significant negative correlation.