Survival In Cirrhotic Patients Research Articles

Evaluation of Hand Grip Strength Test: As a Reliable, reproducible, Costeffective Tool to Assess the Nutritional Status and Outcomes of Cirrhotic Patients Awaiting Liver Transplant

Abstract Background Malnutrition is common comorbidity in patients with cirrhosis. Its prognostic value is indisputable as it greatly affects the evolution of liver disease. It has a major impact on both morbidity and mortality before and after liver-transplantation. Being now integrated in the definition of malnutrition and recognized as new entity in the international classification of disease, physicians have taken great interest in sarcopenia. Its negative impact on survival of cirrhotic patients is well demonstrated, particularly those on wait-list of liver-transplantation (LT). Aim of the Work The aim of this study is twofold; first, to assess the effect of malnutrition on mortality in patients awaiting Liver transplantation and, second, to evaluate hand grip strength HGS as a reliable, non-invasive, and inexpensive tool that can be used in routine clinical practice for early diagnosis and stratification of severity of malnutrition in patients awaiting Liver transplantation. Patients and Methods This is a prospective observational study, which was conducted at Ain- Shams specialized Hospital, liver transplantation department. The study was conducted after obtaining institutional ethics committee approval. Nutritional status assessment will be made by dominant hand grip strength (HGS) and all patients undergo a detailed nutrition assessment by a qualified Clinical Dietitian and nutritional intervention was recommended based on severity of malnutrition. Disease severity was classified according to the criteria proposed by Child-Pugh and the Model for End stage Liver Disease (CTP and MELD). The scores were noted during liver transplantation evaluation. Results We found in this study that 15 of the 29 included patients (51.7%) were 50-65 years old and 21 were males (72%) and 8 were females (27.6%). Six of the included patients were diagnosed as cryptogenic cirrhosis (21%) while 18 were diagnosed as post0viral cirrhosis (62%). Malnutrition was diagnosed in 25 out of the 29 included patients (86.2%) and only 4 patients were well- nourished (13.9) by SGA. In all included patients HGS was reduced and mean HGS was (21.9 ± 3.85 Kg), reflecting sarcopenia (reduced muscle strength). There was also reduction in MAMC (mean 18.7 ± 4.12 cm) with correlation between MAMC and HGS reflecting reduction in muscle mass and strength. Conclusion Malnutrition as assessed by SGA is very frequent in cirrhotic patients on wait-list for liver transplantation. This malnutrition in negatively affecting survival and should be managed by intensive nutritional intervention to improve post-transplant survival. HGS is reduced in most cirrhotic patients waiting for LT, this can worsen the prognosis independent of other confounders and should be assessed as predicted in all cirrhotic patients. HGS by dynamometer is a simple, cost effective and reasonably reliable to be used as screening tool to diagnose sarcopenia in patients with ESLD and can be followed by more confirmatory methods if needed as CT on Lumber 3 and determination of LMI (Lumber mass index)

Combination of Model for End-Stage Liver Disease (MELD) and Sarcopenia predicts mortality after transjugular intrahepatic portosystemic shunt (TIPS)

TIPS is the most effective treatment for portal hypertension. Patient selection remains important to achieving optimal post-TIPS outcomes. The study evaluates 1-year mortality factors in cirrhotic patients receiving TIPS.Methods: 87 cirrhotic patients received a TIPS between 2015 - 2021. Predictors of 1-year and overall mortality were assessed by estimating cumulative incidence functions and Grey's test to adjust for liver transplantation as a risk competing with mortality. Variables with p < 0.05 were checked for collinearity and included in the multivariate Cox proportional hazards model. Model discrimination was evaluated by calculating the area under the ROC curve.Results: 87 patients were included (68% men; 22% ≥70 years). ALD was the primary cirrhosis cause. Most patients were Child-Pugh class B, MELD-Na score was 13.6 ± 6.0 points. The most frequent indication for TIPS was bleeding (51.7%), followed by refractory ascites (42.5%). The variables positively associated with mortality in univariate analysis were ascites, clinically overt sarcopenia and MELD-Na score, while ongoing nutritional supplementation improved survival. In the multivariate analysis, only clinically overt sarcopenia and MELD-Na score remained independently associated with mortality. A MELD-Na/sarcopenia model demonstrated a good discrimination, AUROC: 0.86 (95% CI 0.77 – 0.95).Conclusion: MELD-Na score, and sarcopenia were significantly associated with 1-year survival in cirrhotic patients who received TIPS.

The Value of Neutrophil-to-Lymphocyte Ratio in Predicting Mortality After Transjugular Intrahepatic Portosystemic Shunt Placement.

The objective of this study was to investigate the effect of neutrophil-to-lymphocyte ratio (NLR) on the survival of cirrhotic patients with esophagogastric variceal bleeding (EGVB) treated with transjugular intrahepatic portosystemic shunt (TIPS). A total of 293 patients treated with TIPS were included. The receiver operator characteristic curve (ROC) was used to calculate the optimal cut-off values of parameters such as NLR. The Kaplan-Meier curve and Cox proportional risk model were used to evaluate the effects of NLR and other variables on 2-year all-cause mortality. The area under the ROC for NLR was 0.634, with an optimal cutoff value of 4.9. Two-year mortality rates for patients with high (≥4.9) and low (<4.9) NLR were 22.1% and 9.3%, respectively (Log rank test: P = 0.002). After correcting for confounders, multivariate analysis demonstrated that NLR ≥ 4.9 (HR = 2.741, 95% CI 1.467-5.121, P = 0.002), age ≥ 63 (HR = 3.403, 95% CI 1.835-6.310, P < 0.001), and gender (male) (HR = 2.842, 95% CI 1.366-5.912, P = 0.001) were independent risk factors for the mortality outcome. Considering the stratification of early and selective TIPS treatment, high NLR still significantly increased the risk of mortality for patients (Log rank test: P = 0.007, HR = 2.317, 95% CI 1.232-4.356). NLR can help to predict survival in EGVB patients after TIPS, and the type of TIPS should also be considered in practical applications.

High incidence of periodontitis in patients with ascitic decompensated cirrhosis.

Periodontitis has been associated with various liver diseases. However, the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive. In particular, it is unclear whether the common periodontitis pathogens, Porphyromonas gingivalis (P. gingivalis) and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), can be detected not only in the oral mucosa but also in ascites and stool. To investigate the significance of periodontitis, P. gingivalis, and A. actinomycetemcomitans in cirrhosis patients with ascitic decompensation. This prospective study was conducted at the University Hospital Hamburg-Eppendorf, a tertiary center in Northern Germany. A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis, as well as patient outcomes. PCR was used to test gingival samples, ascites, and stool for the presence of P. gingivalis and A. actinomycetemcomitans. Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab. Periodontitis was diagnosed in 22 out of 27 (82%) ascite patients, which is significantly more common than in a control cohort of 100 unselected patients (59%, P = 0.04). P. gingivalis was detected in the gingiva of six patients, and one of them also had P. gingivalis in their stool. However, P. gingivalis was not found in the ascites of any patient. Five out of six patients with P. gingivalis had periodontitis (83%). A. actinomycetemcomitans was not detected in any sample. Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis, and survival (Kaplan-Meier analysis) was longer in patients with periodontitis (P = 0.02). Transplant-free survival was also more common in patients with periodontitis compared to those without (63% vs 0%, P = 0.02). Decompensated cirrhotic patients frequently suffer from periodontitis. However, there was no evidence of the translocation of P. gingivalis or A. actinomycetemcomitans into ascites. The survival of cirrhotic patients with periodontitis was not reduced.

Addition of Kidney Dysfunction Type to MELD-Na for the Prediction of Survival in Cirrhotic Patients Awaiting Liver Transplantation in Comparison with MELD 3.0 with Albumin.

It is well known that renal dysfunction has a devastating effect on the prognosis of liver cirrhosis. In this study, the aim was to assess whether the incorporation of the kidney dysfunction type into the MELD-Na score enhances its predictive capacity for outcomes in patients awaiting liver transplantation (LT), compared to utilizing the MELD 3.0 score with albumin. In total, 2080 patients awaiting the LT were enrolled at two tertiary care institutions in Korea. Discrimination abilities were analyzed by using Harrell's c-index and iAUC values between MELD-Na-kidney dysfunction type (MELD-Na-KT) and MELD 3.0 with albumin. Clinical endpoints encompassed 3-month survival, 3-month transplant-free survival (TFS), overall survival (OS), and total TFS. Out of the total of 2080 individuals, 669 (32.16%) were male. Regarding the types of renal function impairment, 1614 (77.6%) were in the normal group, 112 (5.38%) in the AKD group, 320 (15.35%) in the CKD group, and 34 (1.63%) were in the AKD on CKD group. MELD 3.0 with albumin showed better discrimination (c-index = 0.714) compared to MELD-Na-KT (c-index = 0.708) in predicting 3-month survival. Similar results were observed for OS, 3-month TFS, and total TFS as well. When divided by sex, MELD 3.0 with albumin showed the comparable prediction of 3-month survival to MELD-Na-KT (c-index 0.675 vs. 0.671, p-value 0.221) in males. However, in the female group, MELD 3.0 with albumin demonstrated better results compared to MELD-Na-KT (c-index 0.733 vs. 0.723, p-value 0.001). The integration of kidney dysfunction types into the MELD-Na did not yield superior prognostic results compared to the MELD 3.0 score with albumin. Rather, in the female group, the MELD 3.0 score with albumin was better able to predict survival. These findings suggest that laboratory values pertaining to liver dysfunction or creatinine levels may be more significant than the type of kidney dysfunction when predicting the short-term prognosis of LT candidates.

Covert hepatic encephalopathy is associated with aggressive disease progression and poor survival in patients with cirrhosis.

Covert hepatic encephalopathy (CHE) negatively affects the health-related quality of life and increases the risk of overt HE (OHE) in patients with liver cirrhosis. However, the impact of CHE on long-term patient outcomes remains controversial. This study aimed to explore the association between CHE and disease progression and survival among cirrhotic patients. This was a single-center prospective study that enrolled 132 hospitalized patients with cirrhosis, with an average follow-up period of 45.02 ± 23.06 months. CHE was diagnosed using the validated Chinese standardized psychometric hepatic encephalopathy score. CHE was detected in 35.61% cirrhotic patients. During the follow-up, patients with CHE had a higher risk of developing OHE (log-rank 5.840, P = 0.016), exacerbation of ascites(log-rank 4.789, P = 0.029), and portal vein thrombosis (PVT) (log-rank 8.738, P = 0.003). Cox multivariate regression analyses revealed that CHE was independently associated with the occurrence of OHE, exacerbation of ascites, and PVT. Furthermore, patients with progression of cirrhosis were more likely to be diagnosed as CHE (log-rank 4.462, P = 0.035). At the end of the follow-up, patients with CHE had a lower survival rate compared to those without CHE (log-rank 8.151, P = 0.004). CHE diagnosis (hazard ratio 2.530, P = 0.008), together with elder age and higher Child-Pugh score, were risk factors for impaired survival in cirrhotic patients. CHE is associated with disease progression and poor survival in patients with cirrhosis, indicating that CHE may serve as an independent predictor of poor prognosis among these patients.

Survival in Patients with Liver Cirrhosis: A Prospective Study.

Introduction: The differences in the survival time of cirrhotic patients reported by different studies are probably caused by the influence of many contributing factors. The aim of the study was to evaluate the survival over a one-year period, to register the occurrence of acute decompensation (AD) and to determine the most frequent causes of death. Material and methods: Out of 71 patients enrolled in the study, 63 completed the prospective one-year follow-up. During the follow-up, we evaluated the occurrence of AD, the causes of death, and we registered three-month, six-month and one-year survival regarding the AD status at presentation. Results: Of the 63 patients, 24 (38.09%) died before the end of the study (14 patients before the end of three months, 6 before the end of six months and 4 patients before the end of one year). The overall survival was 38.09% and the mean survival time was 108 ± 98.53 days. The most prevalent cause of death was bleeding from esophageal varices (5 patients, 20.83%). AD patients had a significantly shorter survival than patients without AD (97±90.54 vs. 229±138.59) and 78.57% of them died during the follow-up. The estimated six-month and one-year median survival time were 272.8 [95% CI (238.4-307.2)] and 267.1 [95% CI (232.9-301.2)] days, respectively. The six-month and one-year survival were significantly shorter in AD patients (p<0.0001). Conclusion: The etiology, stage of liver disease and the presence of AD are important factors that influence on the survival in cirrhotic patients.

Outpatient albumin infusions reduce hospitalizations and improve outcomes in decompensated cirrhosis: A real-world cohort study.

Long-term human albumin (HA) infusions improve survival in cirrhotic patients with diuretic resistant ascites. We aimed to determine whether there is a significant benefit in a more unwell real-world cohort. This is a single-center retrospective cohort study. Patients received outpatient HA between April 2017 and June 2021. Inclusion criteria were age ≥18 years, cirrhosis with ascites, and received at least 1 month of HA. Patients with significant comorbidities and ongoing alcohol use were not excluded. Outcomes assessed were transjugular intrahepatic portosystemic shunt (TIPS)/transplant-free survival (TTFS), and biochemical and prognostic outcomes. Twenty-four patients were included. Median age was 59.5 years. Seven were female (29.2%). Etiology included were alcohol (50%), non-alcoholic steatohepatitis (16.7%), and viral/alcohol (12.5%). Median model for end-stage liver disease-sodium (MELD-Na) was 18.5, with Child-Pugh scores (CPS) A (4.2%), B (50%), and C (45.8%). Improvements in serum sodium (P = 0.014), albumin (P = 0.003), and CPS (P = 0.017) were observed. Reduction in hospitalizations (P = 0.001), particularly portal hypertensive related admissions was observed (relative risk 0.39; 95% confidence interval [CI] 0.21-0.69, P = 0.003), needed to treat 2.09 (95% CI 1.25-3.67). There was a reduction in total paracentesis requirements (P = 0.005). On multivariate analysis, type 2 diabetes mellitus significantly increased risk of TIPS/transplant/death (hazard ratio 6.16; 95% CI 1.23-30.84, P = 0.027). Median TTFS improved in patients with a change in MELD-Na ≤1 at 1 month: 29.4 months versus 7.7 months (P = 0.011). Outpatient HA infusions decrease portal hypertensive related hospital admissions, improve serum sodium, albumin levels, and CPS. Type 2 diabetes mellitus and change in MELD-Na score help discriminate those likely to benefit most.

Effects of endoscopic variceal ligation on survival in cirrhotic patients

Acute esophageal variceal bleeding (AEVB) is a serious complication of liver cirrhosis and is leading cause in hepatic failure and death. Endoscopic variceal ligation (EVL) is the mainstream treatment mode for management of esophageal varices. The aim of the study was to investigate survival rate in urgent - elective (secondary AEVB prophylaxis) and elective (primary AEVB prophylaxis) groups. This article intends to investigate regimens and long-term outcomes of primary or secondary prophylaxis of AEVB in 161 cirrhotic patients. A new risk factor for cirrhosis decompensation stratification is proposed. It is based on a number of necessary EVL bands to achieve sustained (at least 12 months) varix elimination. This study showed that survival rate was strongly inversely dependent on this newly proposed varix elimination index.

Circulating microRNAs improve bacterial infection diagnosis and overall survival prediction in acute decompensation of liver cirrhosis

Bacterial infections are the most frequent precipitating event in patients with acute decompensation of cirrhosis (AD) and are associated with high mortality. Early diagnosis is challenging due to cirrhosis-related systemic inflammation. Here we investigated the potential of circulating microRNAs to diagnose bacterial infections and predict survival in cirrhotic patients with AD. High throughput profiling of circulating microRNAs was performed using the Nanostring technology in 57 AD patients and 24 patients with compensated cirrhosis (CC). Circulating miRs profiling showed that: (a)miRs differentially detected in AD vs. CC were mostly down-regulated; (b)a composite score including absolute neutrophil count, C reactive protein and miR-362-3p could diagnose bacterial infection with an excellent performance (AUC of 0.825 [95% CI= 0.671-0.980; p<0.001]); (c)a composite score including miR-382-5p, miR-592 and MELD-Na improved 6-month survival prediction. Circulating miRs are strongly dysregulated in patients with AD and may help to improve bacterial infection diagnosis and survival prediction.

THU-242 - Phascolarctobacterium as a predictor for survival in cirrhotic patients

THU-242 - Phascolarctobacterium as a predictor for survival in cirrhotic patients

Massive spontaneous portosystemic shunt is a solid, easily identifiable prognostic factor in patients with cirrhosis.

Spontaneous portosystemic shunts (SPSSs) are associated with complications and death in cirrhosis. We evaluated chronic portosystemic encephalopathy (CPSE) and survival in cirrhotic patients with massive (>10 mm diameter) SPSS (MSPSS). We have retrospectively compared 77 cirrhotic patients with MSPSS and 77 paired-matched patients without SPSS. More patients with MSPSS presented with CPSE (40.3% vs. 20.8%, P = 0.010) or died (33.8% vs. 18.2%, P = 0.039). Model for Endstage Liver Disease (MELD) score [hazard ratio (HR) 1.146, 95% confidence interval (CI) 1.099-1.195], follow-up (FU) ascites (HR 5.128, 95% CI 2.396-10.973) and age (HR 1.048, 95% CI 1.017-1.080) were associated with CPSE; and MELD score (HR 1.082, 95% CI 1.035-1.131), FU renal failure (HR 9.319, 95% CI 3.595-24.158), and FU ascites (HR 4.320, 95% CI 1.615-11.555) were associated with death. Liver function worsened faster in the MSPSS group. Among patients with better liver function (MELD < 11.5), MSPSS patients presented worse survival (P = 0.048, Breslow test). Comparing patients by the Child-Pugh group, we did not find differences in survival; in patients from Child-Pugh group B + C, the MSPSS group presented less time free of CPSE (P < 0.05, log-rank test). Patients with splenorenal MSPSS presented better survival (P = 0.04, log-rank test), and patients with umbilical MSPSS had shorter time free of CPSE (P < 0.016, log-rank test). MSPSS increased CPSE and death risks during long FU. Even with better liver function (MELD < 11.5), MSPSS was associated with lower survival. Splenorenal MSPSS presented better survival and the umbilical type was associated with shorter time free of CPSE.

Portal Fibrotic Cord is Associated with Transjugular Intrahepatic Portosystemic Shunt Failure and Death in Cirrhotic Patients.

Occlusive portal vein thrombosis (PVT) often causes portal hypertension-related complications in cirrhotic patients. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for this difficult problem. However, the factors influencing TIPS success and overall survival in patients with occlusive PVT are unknown. This study investigated the factors influencing TIPS success and overall survival in cirrhotic patients with occlusive PVT. Cirrhotic patients with occlusive PVT were selected from a prospective database of consecutive patients treated with TIPS in Xijing Hospital between January 2015 and May 2021. Baseline characteristics, TIPS success rate, complications, and survival were collected, and the factors associated with the TIPS success rate and transplant-free survival were analyzed. A total of 155 cirrhotic patients with occlusive PVT were enrolled. TIPS succeeded in 126 (81.29%) cases. The 1-year survival rate was 74%. Compared with those without, patients with portal fibrotic cord had a lower TIPS success rate (39.02% vs. 96.49%, p<0.001), shorter median overall survival (300 vs. 1,730 days, p<0.001) and more operation-related complications (12.20% vs. 1.75%, p<0.01). Logistic regression analysis found that portal fibrotic cord (odds ratio 0.024) was a risk factor for TIPS failure. Univariate and multivariate analysis showed that portal fibrotic cord was an independent predictor of death (hazard ratio 2.111; 95% CI: 1.094-4.071, p=0.026). Portal fibrotic cord increased the TIPS failure rate and is a risk factor for poor prognosis in cirrhotic patients.

Systematic review with meta-analysis: Branched-chain amino acid supplementation in liver disease.

Dietary supplementation with branched-chain amino acids (BCAA) is often used in cirrhotic patients to improve nutritional status. We wanted to explore the evidence for BCAA supplementation in chronic liver disease. We searched MEDLINE and EMBASE for studies with BCAA supplementation with the presence of a disease-control group (placebo or no intervention) using search terms 'liver cirrhosis', 'hepatocellular carcinoma', 'branched chain amino acids' and relevant synonyms. Risk of bias was assessed using ROBINS-I and RoB 2.0 tools. Meta-analyses were performed with a random-effects model. Results were reported following EQUATOR guidelines. Of 3378 studies screened by title and abstract, 54 were included (34 randomized controlled trials, 5 prospective case-control studies, 13 retrospective case-control studies: in total 2308 patients BCAA supplementation, 2876 disease-controls). Risk of bias was high/serious for almost all studies. According to meta-analyses, long-term (at least 6months) BCAA supplementation in cirrhotic patients significantly improved event-free survival (p=.008; RR .61 95% CI .42-.88) and tended to improve overall survival (p=.05; RR .58 95% CI .34-1.00). Two retrospective studies suggested the beneficial effects during sorafenib for hepatocellular carcinoma. Available studies reported no beneficial effects or contradictory results of BCAA after other specific therapeutic interventions (resection or radiological interventions for hepatocellular carcinoma, liver transplantation, paracentesis or variceal ligation). No convincing beneficial effects of BCAA supplementation on liver function, nutritional status or quality of life were found. No study reported serious side effects of BCAA. Prophylactic BCAA supplementation appears safe and might improve survival in cirrhotic patients.

HPB P24 Comparison of outcomes of Deb-TACE in patients with HCC larger than 5cm compared with HCC less than 5cm

Abstract Background Transarterial chemoembolization (TACE) improves survival in cirrhotic patients with intermediate-stage hepatocellular carcinoma (HCC). Drug-eluting bead (Deb)-TACE is associated with a reduction in liver toxicity and drug-related adverse effects compared with chemotherapy-TACE. This retrospective paired cohort study compares the outcomes of DEB-TACE in patients with HCC greater than and less than 5 centimeters. Methods Sixty-nine patients had Deb-TACE as the primary treatment for HCC over a 3-year period from May 2019 -to May 2022. Patients were paired into two unmatched groups according to tumour size. Group A; tumour size &amp;gt; 5cm and group B tumour size &amp;lt; 5cm. Each group was then compared following a single or repeated treatment of Deb-TACE. Tumour response was evaluated using the standardised modified Response Evaluation Criteria in Solid Tumours (mRECIST) to detect evidence of tumour size regression. Patients were classified as having either a complete response (CR), partial response (PR), stable disease (SD),or progressive disease (PD). Also, any adverse outcomes including hepatic decompensation were recorded Results Group A,(34.48%) 10 patients had a single session of Deb-TACE. Post-treatment surveillance showed that 4 patients (44.44%) showed CR, PR in 2 patients (22.22%), SD in 1 patient (11.11%), 2 patients (22.22%) had PD, one patient was still waiting for his follow-up surveillance. On the other hand,(65.52%)19 patients had repeated sessions, CR was evident in 2 patients (10.5%), PR in 1 patient (5.2%), SD in 3 patients (15.7%), PD in 2 patients (10.5%), 7 patients (36.84%) had initial PR followed by CR, 2 patients (10.5%) showed initial SD then PD and finally 2 patients (10.5%) were PR and became PD. Group B, 18 (45%) patients had single Deb-TACE, Patients showing CR were 7(58.3%), PR was detected in 2 patients (16.67%), one patient (8.33%) had SD, 2 patients (16.67%%) showed PD, and 6 patients were still waiting for their surveillance, no response recorded for them. (55%) 22 patients had repeated Deb-TACE sessions. 3 patients(13.6%) showed CR, PR were 4 patients (18.18%), one patient (4.5%) had SD, PD were 6 patients (27.27%). However, 3 patients (13.6%) were PR then showed CR,3 patients (13.6%) were PR became PD and finally 2 patients (9%) were PD became CR. Conclusions DEB-TACE is effective for HCCs &amp;gt; 5cm with a response rate of 66.67% in patients who had a Single DEB-TACE dose as their first treatment and it increased to 79% in patients who had repeated deb-TACE; however, that was not statistically significantly different (P = 0.48). The Patients group who had HCC &amp;lt;5 cm showed responses up to 83% with single-dose compared to 59% for repeated DEB-TACE, this was not statistically significant with (P = 0.25) . There was no difference in complications between the two groups.

Markers of cell death predict therapy response in patients with cirrhosis and hepatorenal syndrome.

Hepatorenal syndrome is a major complication in patients with cirrhosis and associated with high mortality. Predictive biomarkers for therapy response are largely missing. Cytokeratin18-based cell death markers are significantly elevated in patients with complications of chronic liver disease, but the role of these markers in patients with HRS treated with vasoconstrictors and albumin is unknown. We prospectively analyzed a total of 138 patients with HRS, liver cirrhosis without HRS and acute kidney injury treated at the University Medical Center Mainz between April 2013 and July 2018. Serum levels of M30 and M65 were analyzed by ELISA and clinical data were collected. Predictive ability was assessed by Kaplan-Meier curves, logistic regression and c-statistic. Primary endpoint was response to therapy. M30 and M65 were significantly increased in patients with HRS compared to non-HRS controls (M30: p<0.0001; M65: p<0.0001). Both serum markers showed predictive ability for dialysis- and LTX-free survival but not overall survival. Logistic regression confirmed M30 and M65 as independent prognostic factors for response to therapy. A novel predictive score comprising bilirubin and M65 showed highest predictive ability to predict therapy response. Serum levels of M30 and M65 can robustly discriminate patients into responders and non-responders to terlipressin therapy with a good predictive ability for dialysis- and LTX-free survival in cirrhotic patients. Cell death parameters might possess clinical relevance in patients with liver cirrhosis and HRS.

Rifaximin improves clinical symptoms and short-term survival in cirrhotic patients with refractory type ascites

Objective: To investigate the effects of rifaximin treatment outcomes on complications and 24-week survival rate in cirrhotic patients with refractory type ascites. Methods: A retrospective cohort study was conducted on 62 cases with refractory ascites, and were divided into rifaximin treatment group (42 cases) and control group (20 cases) according to the actual treatment conditions. Rifaximin treatment group patients were administered oral rifaximin-α 200 mg four times daily for 24 consecutive weeks, and the other treatments were basically the same in both groups. Fasting body weight, ascites, complications and survival rate between the two groups were observed. Measurement data of the two groups using t-test, Mann-Whitney U test, and repeated measures analysis of variance were compared. χ2 test or Fisher's exact test were used to compare the enumeration data between the two groups. Kaplan-meier survival analysis was used to compare the survival rates. Results: At 24-week of rifaximin treatment, patients average body weight was reduced by 3.2 kg and the average ascites depth was reduced by 4.5 cm with B-ultrasound measurement, while in the control group at 24-week, the average body weight was reduced by 1.1 kg and the average ascites depth was reduced by 2.1 cm with B-ultrasound measurement, and the differences between the two groups were statistically significant (F=4.972, P=0.035; F=5.288, P=0.027). Hepatic encephalopathy incidence of grade II or above, hospitalization rates due to exacerbation of ascites, and spontaneous bacterial peritonitis were significantly lower in the rifaximin treatment group than those in the control group (2.4% vs. 20.0%, χ2=5.295, P=0.021; 11.9% vs. 50.0%, χ2=10.221, P=0.001; 7.1% vs. 25.0%, χ2=3.844, P=0.050). The 24-week survival rate was 83.3% in the rifaximin treatment group and 60.0% in the control group, P=0.039. Conclusion: Rifaximin treatment can significantly improve ascites symptoms, reduce the incidence of cirrhosis complications and improve the 24-week survival rate in cirrhotic patients with refractory type ascites.

Comparison of survival prediction values of different scoring models for patients undergoing transjugular intrahepatic portal shunt: A multicenter retrospective study

AbstractAimThe aim of this study is to compare the prognostic values of the Child–Pugh, integrated model for end‐stage liver disease (iMELD), albumin–bilirubin (ALBI), and Freiburg index of postsurvival (FIPS) scores in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS).MethodsWe conducted a multicenter retrospective study including patients who underwent TIPS by collecting data from several hospitals in southwest China between January 2014 and February 2021. We compared the performance of different scoring models for survival prediction in these patients. The performance of each scoring model was assessed via area under the receiver‐operating characteristic (AUROC) curve analysis.ResultsThe study included 378 TIPS patients (268 men, 110 women; median age 52 [interquartile range, 45–60] years). Age; cirrhosis etiology; ascites severity; albumin levels; international normalized ratio; total bilirubin levels; sodium levels; and Child–Pugh, iMELD, ALBI, and FIPS scores were significant prognostic factors in cirrhotic patients who underwent TIPS. The Child–Pugh, iMELD, ALBI, and FIPS scores were all independent predictors of survival in TIPS patients. Survival analysis showed that all scoring models effectively stratified the prognostic risk of these patients. The Child–Pugh score was the best predictor of postoperative survival, followed by the ALBI and FIPS scores. The iMELD score was the worst predictor. The Child–Pugh, iMELD, ALBI, and FIPS scores predicted the 1‐year postoperative survival, with AUROC values of 0.832, 0.677, 0.761, and 0.745, respectively, and the 3‐year postoperative survival, with AUROC values of 0.710, 0.668, 0.721, and 0.658, respectively. The calibration curve showed that the Child–Pugh, ALBI, and FIPS models performed well in predicting 1‐ and 3‐year survival, whereas the iMELD model was a poor predictor.ConclusionsThe four scoring models can predict survival in cirrhotic patients after TIPS and can effectively stratify prognostic risk. The Child–Pugh score may be more suitable for predicting survival after TIPS in patients with liver cirrhosis.

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury.

BACKGROUNDAcute kidney injury (AKI) is a common and severe complication in patients with cirrhosis, and is associated with poor prognosis. Therefore, identifying cirrhotic patients with AKI who are at high risk of mortality is very important and may be helpful for providing timely medical interventions to improve the prognosis of these patients. However, studies focused on investigating the risk factors for the mortality of cirrhotic patients with AKI were scarce.AIMTo identify risk factors for mortality and establish a nomogram for predicting the prognosis of these patients.METHODSTwo hundred fifty consecutive patients with cirrhosis and AKI were recruited and randomly divided into training cohort (n = 173) and validation cohort (n = 77). In the training cohort, potential risk factors for death were identified by performing a Cox regression analysis, and a nomogram was established. The predictive performance of the nomogram was internally and externally validated by calculating the area under the receiver operating characteristic curve (AUROC), constructing a calibration curve and performing decision curve analysis.RESULTSThe serum sodium level, international normalized ratio, peak serum creatinine level > 1.5 mg/dL, the presence of hepatic encephalopathy and diabetes were potential risk factors for mortality of cirrhotic patients with AKI in the training dataset. A prognostic nomogram incorporating these variables was established for predicting the overall survival of these patients. Compared with Child-Turcotte-Pugh, the model for end-stage liver disease (MELD) and the MELD-Na scores, the nomogram in predicting 90- and 180-d mortality exhibited better discriminatory power with AUROCs of 0.792 and 0.801 for the training dataset and 0.817 and 0.862 for the validation dataset, respectively. With a nomogram score of 98, patients were divided into low- and high-risk groups, and high-risk patients had a higher mortality rate.CONCLUSIONA prognostic nomogram displayed good performance for predicting the overall survival of cirrhotic patients with AKI, and will assist clinicians in evaluating the prognosis of these patients.

FRI488 - A simple model for predicting survival in cirrhotic patients undergoing portosystemic shunt embolization

FRI488 - A simple model for predicting survival in cirrhotic patients undergoing portosystemic shunt embolization