AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and ev...AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE(OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.RESULTS A total of 366 patients(age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients(35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L(HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L(HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C(HR = 0.084, P < 0.001) and OHE history(HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.CONCLUSION CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.展开更多
BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duode...BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension(IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt(TIPS) plus embolization. CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leadingto duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation. CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.展开更多
BACKGROUND Acute 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 mortali...BACKGROUND Acute 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.AIM To identify risk factors for mortality and establish a nomogram for predicting the prognosis of these patients.METHODS Two 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.RESULTS The 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.CONCLUSION A 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.展开更多
基金Supported by Science and Technology Planning Project of Health and Family Planning Commission of Jiangxi Province,No.20171022National Natural Science Fund of China,No.81460122+2 种基金Project in the Science and Technology Pillar Program of Jiangxi Provincial Department of Science and Technology,No.20161BBG70166Jiangxi Provincial Outstanding Young Talent Program,No.20171BCB23085Natural Science Fund of Jiangxi Province For Young Scholars,No.20171BAB215008
文摘AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE(OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.RESULTS A total of 366 patients(age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients(35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L(HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L(HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C(HR = 0.084, P < 0.001) and OHE history(HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.CONCLUSION CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.
基金Supported by National Natural Science Foundation of China under Grant No.81503437
文摘BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension(IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt(TIPS) plus embolization. CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leadingto duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation. CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.
基金Supported by the National Natural Science Foundation of China,No.81960120 and No.82160115.
文摘BACKGROUND Acute 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.AIM To identify risk factors for mortality and establish a nomogram for predicting the prognosis of these patients.METHODS Two 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.RESULTS The 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.CONCLUSION A 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.
