Contributory roles of sarcopenia and myosteatosis in development of overt hepatic encephalopathy and mortality after transjugular intrahepatic portosystemic shunt

BACKGROUND Skeletal muscle abnormalities,such as muscle mass depletion(sarcopenia)and fatty infiltration of the muscle(myosteatosis),are frequent complications in cirrhotic patients scheduled for transjugular intrahepatic portosystemic shunt(TIPS).AIM To investigate the association and predictive value of sarcopenia and myosteatosis for overt hepatic encephalopathy(HE)and mortality after TIPS.METHODS The records of cirrhotic patients who underwent the TIPS procedure at our hospital between January 2020 and June 2021 were retrospectively retrieved.The transversal psoas muscle thickness(TPMT)and psoas muscle attenuation(PMA)measured from the unenhanced abdominal computed tomography(CT)at the level of the third lumbar vertebrae were used to analyze the sarcopenia and myosteatosis,respectively.The area under curve(AUC)was used to evaluate the discriminative power of TPMT,PMA,and relevant clinical parameters.Furthermore,log-rank test was performed to compare the incidence of overt HE and survival between the different groups,and the association of risk factors with overt HE and mortality was analyzed using Cox proportional hazards regression models.RESULTS A total of 108 patients were collected.Among these patients,45.4%of patients developed overt HE after TIPS treatment.Furthermore,32.4%and 28.7%of these patients were identified to have myosteatosis and sarcopenia,respectively.Myosteatosis(51.0%vs 16.9%,P<0.001)and sarcopenia(40.8 vs 18.6%,P=0.011)were found to be more frequent in patients with overt HE,when compared to patients without overt HE.The receiver operating characteristics analysis indicated that the predictive power of TPMT and PMA in overt HE(AUC=0.713 and 0.778,respectively)was higher when compared to the neutrophil lymphocyte ratio(AUC=0.636).The cumulative incidence of overt HE was the highest in patients with concomitant sarcopenia and myosteatosis,followed by patients with myosteatosis or sarcopenia,while this was the lowest in patients without sarcopenia and myosteatosis.In addition,sarcopenia and myosteatosis were independently associated with overt HE and mortality after adjusting for confounding factors in post-TIPS patients.CONCLUSION CT-based estimations for sarcopenia and myosteatosis can be used as reliable predictors for the risk of developing overt HE and mortality in cirrhotic patients after TIPS.

Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome

BACKGROUND Treatments for hepatic sinusoidal obstruction syndrome(HSOS)are limited.AIM To evaluate transjugular intrahepatic portosystemic shunting(TIPS)as a treatment for pyrrolidine alkaloid-related HSOS(PA-HSOS).METHODS This retrospective analysis included patients with PA-HSOS admitted to the First Affiliated Hospital of the University of Science and Technology of China(June 2015 to January 2019).Baseline clinical characteristics and follow-up data were extracted from the medical records.All patients included in this study experienced failure of initial therapy.Patients were divided into the TIPS and conservative treatment groups according to the therapy they received.Liver function,maximal ascites depth,imaging characteristics,pathology findings,and survival were compared between groups.RESULTS The TIPS group included 37 patients(28 males),and the conservative treatment group included 17 patients(11 males).Baseline characteristics were similar between groups.There were two deaths in the TIPS group and seven deaths in the conservative treatment group during follow-up(3-48 mo).The 3-,6-,12-and 24-mo survival rates were 94.6%,94.6%,94.6%and 94.6%,respectively,in the TIPS group and 70.6%,57.8%,57.8%and 57.8%,respectively,in the conservative treatment group.Kaplan-Meier analysis revealed significantly longer survival for the TIPS group than for the conservative treatment group(P=0.001).Compared with the pre-treatment value,maximal ascites depth was significantly lower at 1 wk,2 wk,1 mo,and 3 mo for the TIPS group(all P<0.05)but not in the conservative treatment group.Contrast-enhanced computed tomography demonstrated the disappearance of patchy liver enhancement after TIPS.Pathology showed that liver congestion and hepatocyte swelling improved with time after TIPS placement.CONCLUSION TIPS may achieve better outcomes than conventional symptomatic treatment in patients with PA-HSOS.

Novel roles of lipopolysaccharide and TLR4/NF-κB signaling pathway in inflammatory response to liver injury in Budd-Chiari syndrome

BACKGROUND Budd-Chiari syndrome(BCS)is an uncommon disorder characterized by obstruction of hepatic venous outflow.To date,the exact mechanism underlying hepatic injury derived from the hepatic venous outflow obstruction in BCS remains largely unknown.AIM To assess the role of NF-κB-mediated inflammation in BCS-induced liver injury in humans and rats.METHODS A total of 180 rats were randomly assigned into nine groups,including four BCS model groups(1,3,6 and 12 wk),four sham-operated groups(1,3,6 and 12 wk),and a control group.Lipopolysaccharide(LPS)levels in each group were detected by the Tachypleus Amebocyte Lysate assay.The mRNA and protein levels of TLR4,NF-κB,tumor necrosis factor(TNF)-α,interleukin(IL)-2 and interferon(IFN)-γwere quantified.In addition,60 patients with BCS and 30 healthy controls were enrolled,and their blood samples were analyzed.RESULTS Hepatic and plasma LPS levels were significantly increased in rats.The mRNA and protein expression levels of TLR4,NF-κB and inflammatory cytokines(TNF-α,IL-2 and IFN-γ)in liver tissues were significantly higher in the BCS model groups compared with the other two groups.In addition,the model groups(1,3,6 and 12 wk after BCS induction)showed significant differences in the levels of LPS,TLR4,NF-κB,TNF-α,IL-2 and IFN-γ.Notably,there was a significant correlation between the LPS concentrations and mRNA and protein levels of TLR4,NF-κB and inflammatory cytokines.Importantly,it was revealed that the levels of LPS,TLR4,NF-κB and inflammatory cytokines were significantly greater in chronic BCS patients than healthy controls and acute BCS patients.CONCLUSION LPS level is markedly elevated in BCS,in turn activating the TLR4/NF-κB signaling pathway,leading to induction of inflammatory cytokines(TNF-α,IL-2 and IFN-γ)in response to BCS-induced liver injury.

Differential diagnosis of coronavirus disease 2019 from community-acquired-pneumonia by computed tomography scan and follow-up

Objective Coronavirus disease 2019(COVID-19)is currently the most serious infectious disease in the world.An accurate diagnosis of this disease in the clinic is very important.This study aims to improve the differential ability of computed tomography(CT)to diagnose COVID-19 and other community-acquired pneumonias(CAPs)and evaluate the short-term prognosis of these patients.Methods The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province,China from January 21 to February 28,2020 were retrospectively analysed.The CT manifestations of the two groups were recorded and compared.A correlation analysis was used to examine the relationship between COVID-19 and age,size of lung lesions,number of involved lobes,and CT findings of patients.The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity.Results The typical CT findings of COVID-19 are simple ground-glass opacities(GGO),GGO with consolidation or grid-like changes.The sensitivity and specificity of the combination of age,white blood cell count,and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%,respectively.Pulmonary consolidation,fibrous cords,and bronchial wall thickening were used as indicators to exclude COVID-19.The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%,respectively.The follow-up results showed that 67.8%(112/165)of COVID-19 patients had abnormal changes in their lung parameters,and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age.Conclusions Age,white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP.Patients aged over 60 years with COVID-19 have a poor prognosis.This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.