BACKGROUND High venous ammonia(VA)values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis(LC)as well as acute hepatitis.Moreover,VA has been associated with poo...BACKGROUND High venous ammonia(VA)values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis(LC)as well as acute hepatitis.Moreover,VA has been associated with poor prognosis and high mortality in these clinical settings.However,the role of ammonia in acuteon-chronic liver failure(ACLF)has not yet been clearly established.AIM To assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care center.METHODS We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites,hepatic encephalopathy(HE),upper gastrointestinal bleeding,or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver(APASL)criteria for ACLF.The study was conducted in“St.Spiridon”University Hospital,Iasi,Romania,a tertiary care center,between January 2017 and January 2019.The APASL ACLF Research Consortium(AARC)score was calculated and ACLF grade was established accordingly.West-haven classification was used for HE.Statistical analysis was performed using IBM SPSS version 22.0.RESULTS Four hundred and forty-six patients were included,aged 59(50-65)years,57.4%men.Child-Pugh,model for end-stage liver disease(MELD)and AARC scores were 11(10-12),19.13±6.79,and 7(6-8),respectively.66.4%had ACLF grade I,31.2%ACLF grade II,and 2.5%ACLF grade III.HE was diagnosed in 83.9%,34%grade I,37.2%grade II,23.5%grade III,and 5.3%grade IV.Overall mortality was 7.8%.VA was 103(78-148)μmol/L.Receiver operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score[Area under the curve(AUC)=0.886],MELD score(AUC=0.816),VA(AUC=0.812)and a fair accuracy for the Child-Pugh score(AUC=0.799).Subsequently,a cut-off value for the prediction of mortality was identified for VA(152.5μmol/L,sensitivity=0.706,1-specificity=0.190).Univariate analysis found acute kidney injury,severe HE(grade III or IV),VA≥152.5μmol/L,MELD score≥22.5,Child-Pugh score≥12.5,and AARC score≥8.5 to be associated with inhospital mortality.Multivariate analysis identified AARC score≥8.5 and venous ammonia≥152μmol/L to be independent predictors of in-hospital mortality.CONCLUSION VA could be used as an inexpensive predictor of in-hospital mortality in patients with ACLF.Patients with both ACLF and VA>152.5μmol/L have a high risk for a poor outcome.展开更多
2017年2月15日-19日,第26届亚太肝病学会(Asian Pacific Association for the Study of the Liver,APASL)年会在上海隆重召开,本届APASL以“Action for Cure”为主题,号召大家“行动起来,治愈肝病”。目前,全口服直接抗病毒药物...2017年2月15日-19日,第26届亚太肝病学会(Asian Pacific Association for the Study of the Liver,APASL)年会在上海隆重召开,本届APASL以“Action for Cure”为主题,号召大家“行动起来,治愈肝病”。目前,全口服直接抗病毒药物(direct-acting antiviral agems,DAAs)的出现使90%以上的丙型肝炎患者在治疗3~6个月后可得到完全治愈。本文就此次会议中有关丙型肝炎的相关研究报道进行总结。展开更多
2015年亚太肝病学会(Asian Pacific Association for the Study of the Liver,APASL)组织亚太各国专家对乙型肝炎指南进行了修订,形成了APASL乙肝指南草案,并于今年3月在伊斯坦布尔举行的第24届APASL年会上由印度学者Shiv K.Sarin教授...2015年亚太肝病学会(Asian Pacific Association for the Study of the Liver,APASL)组织亚太各国专家对乙型肝炎指南进行了修订,形成了APASL乙肝指南草案,并于今年3月在伊斯坦布尔举行的第24届APASL年会上由印度学者Shiv K.Sarin教授逐条进行了解读,同时进行了充分讨论。本文将根据大会发表的资料,对指南与临床密切结合的内容,包括基本概念、诊断、治疗及患者管理等方面进行系统解读和总结,供临床医生在实际中参考和应用。展开更多
文摘BACKGROUND High venous ammonia(VA)values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis(LC)as well as acute hepatitis.Moreover,VA has been associated with poor prognosis and high mortality in these clinical settings.However,the role of ammonia in acuteon-chronic liver failure(ACLF)has not yet been clearly established.AIM To assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care center.METHODS We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites,hepatic encephalopathy(HE),upper gastrointestinal bleeding,or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver(APASL)criteria for ACLF.The study was conducted in“St.Spiridon”University Hospital,Iasi,Romania,a tertiary care center,between January 2017 and January 2019.The APASL ACLF Research Consortium(AARC)score was calculated and ACLF grade was established accordingly.West-haven classification was used for HE.Statistical analysis was performed using IBM SPSS version 22.0.RESULTS Four hundred and forty-six patients were included,aged 59(50-65)years,57.4%men.Child-Pugh,model for end-stage liver disease(MELD)and AARC scores were 11(10-12),19.13±6.79,and 7(6-8),respectively.66.4%had ACLF grade I,31.2%ACLF grade II,and 2.5%ACLF grade III.HE was diagnosed in 83.9%,34%grade I,37.2%grade II,23.5%grade III,and 5.3%grade IV.Overall mortality was 7.8%.VA was 103(78-148)μmol/L.Receiver operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score[Area under the curve(AUC)=0.886],MELD score(AUC=0.816),VA(AUC=0.812)and a fair accuracy for the Child-Pugh score(AUC=0.799).Subsequently,a cut-off value for the prediction of mortality was identified for VA(152.5μmol/L,sensitivity=0.706,1-specificity=0.190).Univariate analysis found acute kidney injury,severe HE(grade III or IV),VA≥152.5μmol/L,MELD score≥22.5,Child-Pugh score≥12.5,and AARC score≥8.5 to be associated with inhospital mortality.Multivariate analysis identified AARC score≥8.5 and venous ammonia≥152μmol/L to be independent predictors of in-hospital mortality.CONCLUSION VA could be used as an inexpensive predictor of in-hospital mortality in patients with ACLF.Patients with both ACLF and VA>152.5μmol/L have a high risk for a poor outcome.
文摘2017年2月15日-19日,第26届亚太肝病学会(Asian Pacific Association for the Study of the Liver,APASL)年会在上海隆重召开,本届APASL以“Action for Cure”为主题,号召大家“行动起来,治愈肝病”。目前,全口服直接抗病毒药物(direct-acting antiviral agems,DAAs)的出现使90%以上的丙型肝炎患者在治疗3~6个月后可得到完全治愈。本文就此次会议中有关丙型肝炎的相关研究报道进行总结。
文摘2015年亚太肝病学会(Asian Pacific Association for the Study of the Liver,APASL)组织亚太各国专家对乙型肝炎指南进行了修订,形成了APASL乙肝指南草案,并于今年3月在伊斯坦布尔举行的第24届APASL年会上由印度学者Shiv K.Sarin教授逐条进行了解读,同时进行了充分讨论。本文将根据大会发表的资料,对指南与临床密切结合的内容,包括基本概念、诊断、治疗及患者管理等方面进行系统解读和总结,供临床医生在实际中参考和应用。