In patients with cirrhosis, anemia is common and is likely to be multifactorial, including decreased erythrocyte production,sequestration due to hypersplenism, hemolysis, and increased blood loss from gastrointestinal...In patients with cirrhosis, anemia is common and is likely to be multifactorial, including decreased erythrocyte production,sequestration due to hypersplenism, hemolysis, and increased blood loss from gastrointestinal bleeding. Renal dysfunction is also common in liver disease and this may also cause anemia.However, an association between anemia and renal dysfunction has not been reported in patients with cirrhosis. Our objective was to determine whether anemia in cirrhotic patients is independently related to renal dysfunction. We conducted a retrospective chart review of patients in our institution listed for liver transplantation. We collected simultaneous data on age,hemoglobin, creatinine, albumin, liver enzymes, prothrombin time, and bilirubin. We excluded patients who were hospitalized or deceased to avoid confounding variables. Two hundred eighty-six (female n = 130) patients with a mean age of 52.8± 9.7(range,18-73) years were studied. Renal dysfunction(creatinine >1.2 mg/dL) was present in 55(19% ) patients, andanemia (hemoglobin<12 g/dL)was seen in 115 (40% ) patients.Anemia was more common in patients with renal dysfunction(64 versus 34% ;P< 0.001) compared to those with normal renal function. Creatinine, prothrombin time, and bilirubin showed an inverse relationship (all P s < 0.001) with hemoglobin, and albumin showed a positive correlation with hemoglobin (P < 0.001). Multivariate analysis showed that creatinine (OR, 2.4;95% CI, 1.05-5.3; P =0.038), prothrombin time (P=0.026),bilirubin (P=0.035), and albumin(P=0.001) were independent predictors of anemia. Renal dysfunction is an important cause of anemia in patients with cirrhosis. The role of erythropoietin in the management of anemia in patients with cirrhosis and renal dysfunction should be explored in prospective studies.展开更多
Autonomic neuropathy (AN) is common in patients with chronic liver disease. For hitherto unknown reasons, in longitudinal studies, the presence of AN has been found to be an independent predictor of mortality in patie...Autonomic neuropathy (AN) is common in patients with chronic liver disease. For hitherto unknown reasons, in longitudinal studies, the presence of AN has been found to be an independent predictor of mortality in patients with cirrhosis. We hypothesized that patients with AN are more likely to develop hepatic encephalopathy (HE) due to prolonged intestinal transit time. In this study, we examined the incidence of newonset HE in patients with and without AN. Seventy two patients (Child A/B/C = 35/31/6) without evidence of HE at the time of autonomic function testing (AFT) were followed for 39.5 ±27.3 months. The end point of the study was the development of new onset HE. Patients were followed until death or liver transplantation. Of the 72 patients, 42 (58%) patients did not develop HE (group A) while 30 (42%) developed HE (group B) during the follow up. Both groups had similar baseline demographics. AN was more common in group B (27/30; 90%) compared to group A (28/42; 67%) (P = 0.02). Kaplan Meier analysis showed a trend toward a higher incidence of HE in patients with AN. Mortality was higher in group B (12/30; 40%) compared to group A (8/42; 19%) (P=0.04). Patients with AN were more likely to develop new onset HE. Although an independent effect of AN on HE was not established in this study, we speculate that delayed intestinal transit secondary to AN may explain the higher incidence of HE in patients with AN.展开更多
文摘In patients with cirrhosis, anemia is common and is likely to be multifactorial, including decreased erythrocyte production,sequestration due to hypersplenism, hemolysis, and increased blood loss from gastrointestinal bleeding. Renal dysfunction is also common in liver disease and this may also cause anemia.However, an association between anemia and renal dysfunction has not been reported in patients with cirrhosis. Our objective was to determine whether anemia in cirrhotic patients is independently related to renal dysfunction. We conducted a retrospective chart review of patients in our institution listed for liver transplantation. We collected simultaneous data on age,hemoglobin, creatinine, albumin, liver enzymes, prothrombin time, and bilirubin. We excluded patients who were hospitalized or deceased to avoid confounding variables. Two hundred eighty-six (female n = 130) patients with a mean age of 52.8± 9.7(range,18-73) years were studied. Renal dysfunction(creatinine >1.2 mg/dL) was present in 55(19% ) patients, andanemia (hemoglobin<12 g/dL)was seen in 115 (40% ) patients.Anemia was more common in patients with renal dysfunction(64 versus 34% ;P< 0.001) compared to those with normal renal function. Creatinine, prothrombin time, and bilirubin showed an inverse relationship (all P s < 0.001) with hemoglobin, and albumin showed a positive correlation with hemoglobin (P < 0.001). Multivariate analysis showed that creatinine (OR, 2.4;95% CI, 1.05-5.3; P =0.038), prothrombin time (P=0.026),bilirubin (P=0.035), and albumin(P=0.001) were independent predictors of anemia. Renal dysfunction is an important cause of anemia in patients with cirrhosis. The role of erythropoietin in the management of anemia in patients with cirrhosis and renal dysfunction should be explored in prospective studies.
文摘Autonomic neuropathy (AN) is common in patients with chronic liver disease. For hitherto unknown reasons, in longitudinal studies, the presence of AN has been found to be an independent predictor of mortality in patients with cirrhosis. We hypothesized that patients with AN are more likely to develop hepatic encephalopathy (HE) due to prolonged intestinal transit time. In this study, we examined the incidence of newonset HE in patients with and without AN. Seventy two patients (Child A/B/C = 35/31/6) without evidence of HE at the time of autonomic function testing (AFT) were followed for 39.5 ±27.3 months. The end point of the study was the development of new onset HE. Patients were followed until death or liver transplantation. Of the 72 patients, 42 (58%) patients did not develop HE (group A) while 30 (42%) developed HE (group B) during the follow up. Both groups had similar baseline demographics. AN was more common in group B (27/30; 90%) compared to group A (28/42; 67%) (P = 0.02). Kaplan Meier analysis showed a trend toward a higher incidence of HE in patients with AN. Mortality was higher in group B (12/30; 40%) compared to group A (8/42; 19%) (P=0.04). Patients with AN were more likely to develop new onset HE. Although an independent effect of AN on HE was not established in this study, we speculate that delayed intestinal transit secondary to AN may explain the higher incidence of HE in patients with AN.
