Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis

BACKGROUND Liver cirrhosis patients admitted to intensive care unit(ICU)have a high mortality rate.AIM To establish and validate a nomogram for predicting in-hospital mortality of ICU patients with liver cirrhosis.METHODS We extracted demographic,etiological,vital sign,laboratory test,comorbidity,complication,treatment,and severity score data of liver cirrhosis patients from the Medical Information Mart for Intensive Care IV(MIMIC-IV)and electronic ICU(eICU)collaborative research database(eICU-CRD).Predictor selection and model building were based on the MIMIC-IV dataset.The variables selected through least absolute shrinkage and selection operator analysis were further screened through multivariate regression analysis to obtain final predictors.The final predictors were included in the multivariate logistic regression model,which was used to construct a nomogram.Finally,we conducted external validation using the eICU-CRD.The area under the receiver operating characteristic curve(AUC),decision curve,and calibration curve were used to assess the efficacy of the models.RESULTS Risk factors,including the mean respiratory rate,mean systolic blood pressure,mean heart rate,white blood cells,international normalized ratio,total bilirubin,age,invasive ventilation,vasopressor use,maximum stage of acute kidney injury,and sequential organ failure assessment score,were included in the multivariate logistic regression.The model achieved AUCs of 0.864 and 0.808 in the MIMIC-IV and eICU-CRD databases,respectively.The calibration curve also confirmed the predictive ability of the model,while the decision curve confirmed its clinical value.CONCLUSION The nomogram has high accuracy in predicting in-hospital mortality.Improving the included predictors may help improve the prognosis of patients.

sTREM-1 as promising prognostic biomarker for acute-on-chronic liver failure and mortality in patients with acute decompensation of cirrhosis

BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accurate identification of AD patients with high risk of development of ACLF and mortality.Soluble triggering receptor expressed on myeloid cells-1(sTREM-1)is released from activated innate immune cells and correlated with various inflammatory processes.AIM To explore the prognostic value of sTREM-1 in patients with AD of cirrhosis.METHODS A multicenter prospective cohort of 442 patients with cirrhosis hospitalized for AD was divided into a study cohort(n=309)and validation cohort(n=133).Demographic and clinical data were collected,and serum sTREM-1 was measured at admission.All enrolled patients were followed-up for at least 1 year.RESULTS In patients with AD and cirrhosis,serum sTREM-1 was an independent prognosis predictor for 1-year survival and correlated with liver,coagulation,cerebral and kidney failure.A new prognostic model of AD(P-AD)incorporating sTREM-1,blood urea nitrogen(BUN),total bilirubin(TBil),international normalized ratio(INR)and hepatic encephalopathy grades was established and performed better than the model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-consortium(CLIF-C)ACLF and CLIF-C AD scores.Additionally,sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d follow-up.The ACLF risk score incorporating serum sTREM-1,BUN,INR,TBil and aspartate aminotransferase levels was established and significantly superior to MELD,MELD-Na,CLIF-C ACLF,CLIF-C AD and P-AD in predicting risk of ACLF development.CONCLUSION Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.

Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study

BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.

Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy

AIM To compare the accuracy of the scoring systems ChildTurcotte-Pugh(CTP), Model for End-stage Liver Disease score(MELD), MELD-Na, and MELD to Serum Sodium ratio(MESO) to predict the mortality in decompensated liver cirrhosis.METHODS The PubMed, Web of Science, Cochrane Library, EMBASE, and Ovid databases were systematically searched from inception to September 2018 for relevant articles, and we evaluated the quality of the included studies. The accuracy of scoring systems was analyzed with Stata 12 and MetaDiSc 1.4.RESULTS Sixteen studies involving 2337 patients were included. The pooled areas under the summary receiver operating characteristic curves(AUROCs) of CTP, MELD, MELD-Na, and MESO to predict mortality were 0.81,0.78, 0.85, and 0.86, respectively. Within 3 mo, the AUROCs of CTP, MELD, and MELD-Na in predicting mortality were 0.78, 0.76, and 0.89, respectively. The AUROCs of CTP, MELD, and MELD-Na at 3 mo were 0.86, 0.78, and 0.86, respectively. The AUROCs of CTP, MELD, and MELD-Na at 6 mo were 0.91, 0.83, and 0.90, respectively. The AUROCs of CTP, MELD, and MELDNa at 12 mo were 0.72, 0.75 and 0.84, respectively. In cirrhotic patients with bleeding, the AUROCs of CTP and MELD were 0.76 and 0.88, respectively.CONCLUSION MESO has the highest AUROC in all assessed scoring systems. Considering the different time points, MELDNa has good accuracy in predicting the mortality of decompensated liver cirrhosis. Compared to CTP, MELD is better in predicting variceal bleeding.

Hepatitis C-related liver cirrhosis-strategies for the prevention of hepatic decompensation,hepatocarcinogenesis,and mortality

Liver cirrhosis (LC) is a critical stage of chronic liver disease, including that caused by hepatitis C virus (HCV). In the absence of antiviral therapy, 67%-91% of patients with HCV-related LC patients die of liver-related causes, including hepatocellular carcinoma (HCC) and liver failure. Among the therapeutic strategies used to prevent liver-related complications in these patients is standard therapy with pegylated interferon and ribavirin, which induces a sustained virological response (SVR) in 25% of HCV genotype 1-infected patients and in 69% of patients infected with genotypes 2 and 3. SVR in patients with HCV-related LC has been associated with reduced rates of hepatic decompensation, HCC, and mortality. More recently developed direct-acting antiviral agents have shown excellent antiviral efficacy, with preliminary data demonstrating that an interferon-free regimen that includes these direct-acting antiviral agents achieved SVR in more than 50% of patients with HCV genotype 1 LC. Branched-chain amino acid supplementation, improvement of insulin resistance, and the use of &#x003b2;-blockers for portal hypertension may also reduce liver-related complications. Here, we review advances in antiviral and adjunctive therapies for improved outcomes in patients with HCV-associated LC.

Influence of antibiotic-regimens on intensive-care unit-mortality and liver-cirrhosis as risk factor

AIM: To assess the rate of infection, appropriateness of antimicrobial-therapy and mortality on intensive care unit(ICU). Special focus was drawn on patients with liver cirrhosis.METHODS: The study was approved by the local ethical committee. All patients admitted to the Internal Medicine-ICU between April 1, 2007 and December 31, 2009 were included. Data were extracted retrospectively from all patients using patient charts and electronic documentations on infection, microbiological laboratory reports, diagnosis and therapy. Due to the large hepatology department and liver transplantation center, special interest was on the subgroup of patients with liver cirrhosis. The primary statistical-endpoint was the evaluation of the influence of appropriate versusinappropriate antimicrobial-therapy on in-hospitalmortality.RESULTS: Charts of 1979 patients were available. The overall infection-rate was 53%. Multiresistantbacteria were present in 23% of patients with infection and were associated with increased mortality(p < 0.000001). patients with infection had significantly increased in-hospital-mortality(34% vs 17%, p < 0.000001). Only 9% of patients with infection received inappropriate initial antimicrobial-therapy, no influence on mortality was observed. Independent risk-factors for in-hospital-mortality were the presence of septicshock, prior chemotherapy for malignoma and infection with pseudomonas spp. Infection and mortality-rate among 175 patients with liver-cirrhosis was significantly higher than in patients without liver-cirrhosis. Infection increased mortality 2.24-fold in patients with cirrhosis. patients with liver cirrhosis were at an increased risk to receive inappropriate initial antimicrobial therapy.CONCLUSION: The results of the present study report the successful implementation of early-goal-directed therapy. Liver cirrhosis patients are at increased risk of infection, mortality and to receive inappropriate therapy. Increasing burden are multiresistant-bacteria.

Proton pump inhibitor use increases mortality and hepatic decompensation in liver cirrhosis

BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermore,PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017.PPI users were defined as cumulative defined daily dose(cDDD)≥28 within a landmark period,after hospitalisation for hepatic decompensation.Cox regression analysis for comparison was done after propensity score adjustment.Further risk of hepatic decompensation was analysed by Poisson regression.RESULTS Among 295 decompensated cirrhosis patients,238 were PPI users and 57 were non-users.PPI users had higher mortality compared to non-users[adjusted HR=2.10,(1.20-3.67);P=0.009].Longer PPI use with cDDD>90 was associated with higher mortality,compared to non-users[aHR=2.27,(1.10-5.14);P=0.038].PPI users had a higher incidence of hospitalization for hepatic decompensation[aRR=1.61,(1.30-2.11);P<0.001].CONCLUSION PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation.Longer PPI exposure with cDDD>90 increases the risk of mortality.

Influence of unrecorded alcohol consumption on liver cirrhosis mortality

Unrecorded alcohol includes illegally distributed alcohol as well as homemade or surrogate alcohol which is unintended for consumption by humans(e.g.,cosmetics containing alcohol).The highest unrecorded alcohol consumption occurs in Eastern Europe and some of these countries have an over proportional liver cirrhosis mortality.Compounds besides ethanol have been hypothesized as being responsible for this observation.On the other hand,chemical investigations were unable to prove that unrecorded alcohol regularly contains contaminants above toxicological thresholds.However,illegally produced spirits regularly contain higher percentages of alcohol(above 45%by volume),but for considerably less costs compared with licit beverages,potentially causing more problematic patterns of drinking.In this review,it is investigated whether patterns of drinking rather than product composition can explain the liver cirrhosis mortality rates.Statistical examination of World Health Organization country data shows that the originally detected correlation of the percentage of unrecorded alcohol consumption and liver cirrhosis mortality rates disappears when the data is adjusted for the prevalence of heavy episodic drinking.It may be concluded that there is currently a lack of data to demonstrate causality between the composition of illicit spirits(e.g.,higher levels of certain contaminants in home-produced products)and liver toxicity on a population scale.Exceptions may be cases of poisoning with antiseptic liquids containing compounds such as polyhexamethyleneguanidine,which were reported to be consumed as surrogate alcohol in Russia,leading to an outbreak of acute cholestatic liver injury,histologically different from conventional alcoholic liver disease.

Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review

BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intraabdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhosis, defined as fungal infection of ascitic fluid in the presence of ascitic neutrophil count of greater than 250 cells/mL. AIM To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients. METHODS Studies were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases until February 2019. Inclusion criteria included intervention trials and observation studies describing the association between SFP and cirrhosis. The primary outcome was in-hospital, 1-mo, and 6- mo mortality rates of SFP in cirrhotic patients. Secondary outcomes were fungal microorganisms identified and in hospital management by anti-fungal medications. The National Heart, Lung and Blood Institute quality assessment tools were used to assess internal validity and risk of bias for each included study. RESULTS Six observational studies were included in this systematic review. The overall quality of included studies was good. A meta-analysis of results could not be performed because of differences in reporting of outcomes and heterogeneity of the included studies. There were 82 patients with SFP described across all the included studies. Candida species, predominantly Candida albicans was the fungal pathogen in majority of the cases (48%-81.8%) followed by Candida krusei (15%- 25%) and Candida glabrata (6.66%-20%). Cryptococcus neoformans (53.3%) was the other major fungal pathogen. Antifungal therapy in SFP patients was utilized in 33.3% to 81.8% cases. The prevalence of in hospital mortality ranged from 33.3% to 100%, whereas 1-mo mortality ranged between 50% to 73.3%. CONCLUSION This systematic review suggests that SFP in end stage liver disease patient is associated with high mortality both in the hospital and at 1-mo, and that antifungal therapy is currently underutilized.

Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis

AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. METHODSThis is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of RESULTSA total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value P value P value P value P value P value P value CONCLUSIONThe 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.

Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis

BACKGROUND Atrial fibrillation(AF)is the most common cardiac arrhythmia encountered in clinical practice.However,the outcomes associated with AF in hospitalized patients with liver cirrhosis are unknown.AIM To determine the outcomes of hospitalized patients with liver cirrhosis and AF.METHODS In this study,we examined morbidity and mortality of patients with concomitant AF and liver cirrhosis from the National Inpatient Sample database,the largest publicly available inpatient healthcare database in the United States.RESULTS A total of 696937 patients with liver cirrhosis were included,45745 of whom had concomitant AF(6.6%).Liver cirrhosis patients with AF had higher rates of inhospital mortality(12.6%vs 10.3%,P<0.001),clinical stroke(1.6%vs 1.1%,P<0.001),and acute kidney injury(28.2%vs 25.1%,P<0.001),and less gastrointestinal bleeding(4.4%vs 5.1%,P<0.001)and blood transfusion(22.5%vs 23.8%,P<0.001)compared with those who did not have the arrhythmia.In addition,they had a longer length of stay(8±10 d vs 7±8 d,P<0.001)and higher hospitalization costs(20720±33210$vs 16272±24166$,P<0.001).CONCLUSION In subjects with liver cirrhosis,AF is associated with higher rates of inpatient mortality,stroke,and acute kidney injury compared to those who do not have the cardiac arrhythmia.

Characteristics of alcoholic liver disease and predictive factors for mortality of patients with alcoholic cirrhosis

BACKGROUND:Alcoholic liver disease is one of the major chronic liver diseases worldwide.The aim of the study was to describe the clinical characteristics of alcoholic liver disease and to compare the predictive values of biochemical parameters,complications,Child-Turcotte-Pugh score,model for end-stage liver disease(MELD)score and discriminant function score for the mortality of in-hospital or 3-month after discharge of patients with alcoholic cirrhosis(AC).METHODS:A retrospective record review and statistical analysis were performed on 205 consecutive patients with the discharge diagnosis of alcoholic liver disease.Three models were used to predict the mortality of patients with AC.The number of variceal hemorrhage,infection,hepatic encephalopathy and hepatocellular carcinoma was analyzed as"numbers of complications".Model 1 consisted of creatinine,white blood cell count,international normalized ratio and"numbers of complications".Model 2 consisted of MELD score.Model 3included"numbers of complications"and MELD score.RESULTS:The risk of developing AC was significant for patients with alcohol consumption of higher than 80 g/d(OR=2.807,P【0.050)and drinking duration of longer than 10 years(OR=3.429,P【0.028).The area under curve for predicting inhospital mortality of models 1,2 and 3 was 0.950,0.886 and 0.911(all P【0.001),respectively.The area under curve for predicting the 3-month mortality of models 1,2 and 3 was 0.867,0.878 and0.893(all P【0.001),respectively.CONCLUSIONS:There is a dose-dependent relationship between alcohol consumption and the risk of developing AC.MELD score has a better predictive value than Child-TurcottePugh or discriminant function score for patients with AC,and model 1 or 3 is better than model 2.

Cardiac surgery in patients with liver cirrhosis:Risk factors for predicting mortality

AIM:To evaluate the results of cardiac surgery in cirrhotic patients and to find the predictors of early and late mortality.METHODS:We included 55 consecutive cirrhotic patients undergoing cardiac surgery between 1993 and2012.Child-Turcotte-Pugh(Child)classification and Model for End-Stage Liver Disease(MELD)score were used to assess the severity of liver cirrhosis.The online EuroSCORE II calculator was used to calculate the logistic EuroSCORE in each patient.Stepwise logistic regression analysis was used to identify the risk factors for mortality at different times after surgery.Multivariate Cox proportional hazard models were applied to estimate the hazard ratios(HR)of predictors for mortality.The Kaplan-Meier method was used to generate survival curves,and the survival rates between groups were compared using the log-rank test.RESULTS:There were 30 patients in Child class A,20in Child B,and five in Child C.The hospital mortality rate was 16.4%.The actuarial survival rates were 70%,64%,56%,and 44%at 1,2,3,and 5 years after surgery,respectively.There were no significant differences in major postoperative complications,and early and late mortality between patients with mild and advanced cirrhosis.Multivariate logistic regression showed preoperative serum bilirubin,the EuroSCORE and coronary artery bypass grafting(CABG)were associated with early and late mortality;however,Child class and MELD score were not.Cox regression analysis identified male gender(HR=0.319;P=0.009),preoperative serum bilirubin(HR=1.244;P=0.044),the EuroSCORE(HR=1.415;P=0.001),and CABG(HR=3.344;P=0.01)as independent risk factors for overall mortality.CONCLUSION:Advanced liver cirrhosis should not preclude patients from cardiac surgery.Preoperative serum bilirubin,the EuroSCORE,and CABG are major predictors of early and late mortality.

Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on the prognosis and complications of liver cirrhosis is not fully clarified.AIM To clarify the mortality and related risk factors as well as complications in cirrhotic patients with T2DM.METHODS We searched PubMed,EMBASE,and the Cochrane Library from their inception to December 1,2020 for cohort studies comparing liver transplant-free mortality,hepatocellular carcinoma(HCC),ascites,spontaneous bacterial peritonitis(SBP),variceal bleeding,and hepatic encephalopathy(HE)in cirrhotic patients with vs without T2DM.Odds ratios(ORs)were combined by using fixed-effects or random-effects models with RevMan software.RESULTS The database search generated a total of 17 cohort studies that met the inclusion criteria.Among these studies,eight reported the risk of mortality,and eight reported the risk of HCC.Three studies provided SBP rates,and two documented ascites rates.Four articles focused on HE rates,and three focused on variceal bleeding rates.Meta-analysis indicated that T2DM was significantly associated with an increased risk of liver transplant-free mortality[OR:1.28,95%confidence intervals(CI):1.16-1.41,P<0.0001]and HCC incidence(OR:1.82,95%CI:1.32-2.51,P=0.003).The risk of SBP was not significantly increased(OR:1.1695%CI:0.86-1.57,P=0.34).Additionally,T2DM did not significantly increase HE(OR:1.3195%CI:0.97-1.77,P=0.08),ascites(OR:1.1195%CI:0.84-1.46,P=0.46),and variceal bleeding(OR:1.34,95%CI:0.99-1.82,P=0.06).CONCLUSION The findings suggest that cirrhotic patients with T2DM have a poor prognosis and high risk of HCC.T2DM may not be associated with an increased risk of SBP,variceal bleeding,ascites,or HE in cirrhotic patients with T2DM.

Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis

BACKGROUND Acute decompensation(AD)of cirrhosis is related to systemic inflammation and elevated circulating cytokines.In this context,biomarkers of inflammation,such as calprotectin,may be of prognostic value.AIM To evaluate serum calprotectin levels in patients hospitalized for complications of cirrhosis.METHODS This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis,20 outpatients with stable cirrhosis,and 20 healthy controls.Serum calprotectin was measured by enzyme-linked immunosorbant assay.RESULTS Calprotectin levels were higher among groups with cirrhosis when compared to healthy controls.Higher median calprotectin was related to Child-Pugh C,ascites,and hepatic encephalopathy.Higher calprotectin was related to acute-on-chronic liver failure(ACLF)and infection in the bivariate,but not in multivariate analysis.Calprotectin was not associated with survival among patients with ACLF;however,in patients with AD without ACLF,higher calprotectin was associated with a lower 30-d survival,even after adjustment for chronic liver failure-consortium(CLIF-C)AD score.A high-risk group(CLIF-C AD score≥60 and calprotectin≥580 ng/mL)was identified,which had a 30-d survival(27.3%)similar to that of patients with grade 3 ACLF(23.3%).CONCLUSION Serum calprotectin is associated with prognosis in patients with AD without ACLF and may be useful in clinical practice to early identify patients with a very low short-term survival.

From liver to hormones:The endocrine consequences of cirrhosis

Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption.Despite its importance,assessing endocrine issues in cirrhotic patients is frequently neglected.This article provides a comprehensive review of the epidemiology,pathophysiology,diagnosis,and treatment of endocrine disturbances in liver cirrhosis.The review was conducted using the PubMed/Medline,EMBASE,and Scielo databases,encompassing 172 articles.Liver cirrhosis is associated with endocrine disturbances,including diabetes,hypoglycemia,sarcopenia,thyroid dysfunction,hypogonadotropic hypogonadism,bone disease,adrenal insufficiency,growth hormone dysfunction,and secondary hyperaldosteronism.The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system,respectively.Sarcopenia can be assessed through imaging and functional tests,while other endocrine disorders are evaluated using hormonal assays and imaging studies.Treatment options include metformin,glucagon-like peptide-1 analogs,sodium-glucose co-transporter-2 inhibitors,and insulin,which are effective and safe for diabetes control.Established standards are followed for managing hypoglycemia,and hormone replacement therapy is often necessary for other endocrine dysfunctions.Liver transplantation can address some of these problems.

Fat necrosis of liver in a patient with mixed type liver cirrhosis

To the Editor: Fatty liver diseases, including nonalcoholic fatty liver disease and alcohol related fatty liver disease, have become a major public health concern [ 1, 2 ]. Fatty liver diseases have been shown to progress through various stages, from steatosis or necrosis with inflammation and hepatocyte damage to the development of fibrosis and eventual cirrhosis with an increased risk of carcinoma [ 2, 3 ].

Clinical study on the relationship between liver cirrhosis,ascites,and hyponatremia

BACKGROUND Cirrhosis is a common liver disease,and ascites is one of the common clinical conditions.However,the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied.AIM To explore the clinical manifestations,prognostic factors,and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies.METHODS In this study,we retrospectively analyzed the clinical data of 150 patients diagnosed with cirrhosis and ascites between 2017 and 2022.Patients were divided into two groups:ascites combined with hyponatremia group and ascites group.We compared the general characteristics,degree of hyponatremia,complications,treatment,and prognosis between the two groups.RESULTS In the study results,patients in the ascites combined with hyponatremia group showed an older average age(58.2±8.9 years),64.4%were male,and had a significantly longer hospitalization time(12.7±5.3 d).Hyponatremia was more severe in this group,with a mean serum sodium concentration of 128.5±4.3 mmol/L,which was significantly different from the ascites group of 137.6±2.1 mmol/L.Patients with ascites and hyponatremia were more likely to develop hepatic encephalopathy(56.2%vs 39.0%),renal impairment(45.2%vs 28.6%)and infection(37.0%vs 23.4%).Regarding treatment,this group more frequently used diuretics(80.8%vs 62.3%)and salt supplements(60.3%vs 38.9%).Multiple logistic regression analysis identified older age[Odds ratio(OR)=1.06,P=0.025]and male gender(OR=1.72,P=0.020)as risk factors for hyponatremia combined with ascites.Overall,patients with ascites and hyponatremia present a clear high-risk status,accompanied by severe complications and poor prognosis.CONCLUSION In patients with cirrhosis,ascites with hyponatremia is a high-risk condition that is often associated with severe complications.

Effects of Lactobacillus paracasei N1115 on gut microbial imbalance and liver function in patients with hepatitis B-related cirrhosis

BACKGROUND Hepatitis B cirrhosis(HBC)is a chronic disease characterized by irreversible diffuse liver damage and aggravated by intestinal microbial imbalance and metabolic dysfunction.Although the relationship between certain single probiotics and HBC has been explored,the impact of the complex ready-to-eat Lactobacillus paracasei N1115(LP N1115)supplement on patients with HBC has not been determined.AIM To compare the changes in the microbiota,inflammatory factor levels,and liver function before and after probiotic treatment in HBC patients.METHODS This study included 160 HBC patients diagnosed at the General Hospital of Ningxia Medical University between October 2018 and December 2020.Patients were randomly divided into an intervention group that received LP N1115 supplementation and routine treatment and a control group that received routine treatment only.Fecal samples were collected at the onset and conclusion of the 12-wk intervention period.The structure of the intestinal microbiota and the levels of serological indicators,such as liver function and inflammatory factors,were assessed.RESULTS Following LP N1115 intervention,the intestinal microbial diversity significantly increased in the intervention group(P<0.05),and the structure of the intestinal microbiota was characterized by an increase in the proportions of probiotic microbes and a reduction in harmful bacteria.Additionally,the intervention group demonstrated notable improvements in liver function indices and significantly lower levels of inflammatory factors(P<0.05).CONCLUSION LP N1115 is a promising treatment for ameliorating intestinal microbial imbalance in HBC patients by modulating the structure of the intestinal microbiota,improving liver function,and reducing inflammatory factor levels.

Clinical Efficacy Observation of Pangfu Wan Yao Medicine in Treating Ascites of Liver Cirrhosis

Objective: To treat ascites in patients with grade 3 liver cirrhosis using traditional Chinese medicine, evaluate effectiveness and safety by observing improvements in physical and mental symptoms, explore optimal treatment measures, and benefit clinical practice. Methods: 40 patients with ascites of liver cirrhosis admitted to our department from October 2020 to October 2022 were selected. According to a random number table, all patients were divided into an observation group treated with Yao Medicine and a control group treated with conventional Western medicine, with 20 cases in each group. The improvement of adverse emotions was evaluated before and after treatment using the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS). The changes in liver function indicators were observed to judge the efficacy and safety. Results: The effective rate in the observation group was 95.00%, and in the control group was 90.00%. The comparison between the two groups showed a significant increase in the effective rate in the observation group, with a statistically significant difference (P P P > 0.05). After treatment, compared with the control group, the observation group showed a significant decrease in SDS and SAS scores, with a statistically significant difference (P < 0.05). Conclusion: Yao Medicine can effectively improve the physical and mental symptoms of patients with ascites of liver cirrhosis, with good effectiveness and high safety.