Fecal cytolysin does not predict disease severity in acutely decompensated cirrhosis and acute-on-chronic liver failure

Background:Cirrhosis with acute decompensation(AD)and acute-on-chronic liver failure(ACLF)are characterized by high morbidity and mortality.Cytolysin,a toxin from Enterococcus faecalis(E.faecalis),is associated with mortality in alcohol-associated hepatitis(AH).It is unclear whether cytolysin also contributes to disease severity in AD and ACLF.Methods:We studied the role of fecal cytolysin in 78 cirrhotic patients with AD/ACLF.Bacterial DNA from fecal samples was extracted and real-time quantitative polymerase chain reaction(PCR)was performed.The association between fecal cytolysin and liver disease severity in cirrhosis with AD or ACLF was analyzed.Results:Fecal cytolysin and E.faecalis abundance did not predict chronic liver failure(CLIF-C)AD and ACLF scores.Presence of fecal cytolysin was not associated with other liver disease markers,including Fibrosis-4(FIB-4)index,‘Age,serum Bilirubin,INR,and serum Creatinine(ABIC)’score,Child-Pugh score,model for end-stage liver disease(MELD)nor MELD-Na scores in AD or ACLF patients.Conclusions:Fecal cytolysin does not predict disease severity in AD and ACLF patients.The predictive value of fecal cytolysin positivity for mortality appears to be restricted to AH.

肝硬化患者门静脉血栓形成

门静脉血栓形成(PVT)在肝硬化患者中较为常见,尽管PVT相关的严重并发症(如肠系膜缺血)很罕见,但一旦出现足以危胁生命。目前PVT的临床意义、诊断和治疗仍未明确,尚处于探讨中。本文对PVT的分级、临床表现地域差异、诊断标准、病理生理及危险因素进行了阐述,对各种治疗方案和预防措施进行了评价,重点分析了各种方案/措施的缺陷。此外,我们还对PVT对预后的影响这一争议问题进行了探讨,着重考虑了肝移植和未来展望。