Disfunção hepática em pacientes de unidade de terapia intensiva médica prevê desfecho desfavorável / Hepatic dysfunction in medical intensive careunit patients predicts poor outcome

ABSTRACT Background: A large number of patients admitted to the medical intensive care unit (MICU) have abnormal liver function tests (LFT). This includes patients with critical illness with or without preexisting liver disease and patients with acute primary liver injury. There are very few studies which have investigated the spectrum of liver disease, clinical profile and outcome in patients admitted to the MICU. Objective To evaluate the occurrence, etiology, clinical profile, laboratory profile and outcome of hepatic dysfunction in patients admitted to the MICU. To evaluate the utility of model for end-stage liver disease (MELD) score on admission as a predictor of adverse short term outcome in patients with hepatic dysfunction admitted in MICU. Methods: It was a prospective observational study, conducted from December 2017 to December 2018 in a tertiary care hospital. Two hundred and two patients admitted to the MICU with LFTs as per the inclusion criteria were analyzed and their short-term outcome at 7 days was studied in relation to various parameters. Results: LFT abnormalities were present in 202/1126 (17.9%) of the patients admitted to MICU. Critical illness associated liver dysfunction was found in 172 (85.2%) patients, chronic liver disease in 11 (5.4%) patients and acute viral hepatitis in 19 (9.4%) patients. Most common symptom was fever (68.3%) followed by vomiting (48.0%). Among LFT abnormalities, elevated transaminases, raised international normalized ratio and high MELD score on admission correlated with poor short-term outcome. Requirement for inotropes and mechanical ventilation correlated with poor short-term outcome. Mortality did not differ significantly between patients with chronic liver disease, patients with acute viral hepatitis and patients with critical illness associated hepatic dysfunction. Hepatic dysfunction in MICU was associated with poor outcome and a high short-term mortality of 56.4% (114/202). Conclusion: Liver function abnormality is common in patients who are admitted to the MICU and its presence is an indicator of poor short-term outcome.

RESUMO Contexto: Um grande número de pacientes internados na unidade de terapia intensiva (UTI) tem testes de função hepática anormais (TFH). Isso inclui pacientes com doença crítica com ou sem doença hepática pré-existente e pacientes com lesão hepática primária aguda. Há poucos estudos que têm investigado o espectro da doença hepática, perfil clínico e desfecho em pacientes admitidos em UTI. Objetivo Avaliar a ocorrência, etiologia, perfil clínico, perfil laboratorial e desfecho de disfunção hepática em pacientes internados na UTI médica. Avaliar a utilidade do modelo para doença hepática em estágio terminal (MELD). Escore na admissão como preditor de desfecho adverso a curto prazo em pacientes com disfunção hepática admitida em UTI. Métodos: Foi realizado um estudo observacional prospectivo, de dezembro de 2017 a dezembro de 2018 em um hospital de atenção terciária. Foram analisados 202 pacientes internados na UTI com TFH conforme os critérios de inclusão e seu desfecho a curto prazo de 7 dias foi estudado em relação a diversos parâmetros. Resultados: Anormalidades dos testes estiveram presentes em 202/1126 (17,9%) dos pacientes internados na UTI. Doença crítica associada à disfunção hepática foi encontrada em 172 (85,2%) pacientes, doença hepática crônica em 11 (5,4%) pacientes e hepatite viral aguda em 19 (9,4%) pacientes. O sintoma mais comum foi a febre (68,3%), seguido de vômito (48,0%) casos. Entre as anormalidades do TFH, transaminases elevadas, INR e escore MELD elevados na admissão correlacionaram-se com desfecho ruim de curto prazo. Exigência de inotrópicos e ventilação mecânica correlacionaram-se com desfecho de curto prazo ruim. A mortalidade não diferiu significativamente entre pacientes com doença hepática crônica, pacientes com hepatite viral aguda e pacientes com doença crítica associada à disfunção hepática. A disfunção hepática em UTI esteve associada a um desfecho ruim e à uma alta mortalidade a curto prazo de 114/202 (56,4%). Conclusão: A anormalidade da função hepática é comum em pacientes que são admitidos nas unidades de tratamento intensivo e sua presença é um indicador de desfecho de curto prazo ruim.

The risk factors for and outcomes of preoperative hepatic dysfunction in patients who received surgical repair for acute DeBakey type I aortic dissection / 中华胸心血管外科杂志

Objective:To identify the risk factors for and outcomes of preoperative hepatic dysfunction (HD) in patients who underwent surgery for the treatment of acute DeBakey type I aortic dissection (ADIAD).Methods:A retrospective study including 810 consecutive patients between January 2014 and December 2019 in Nanjing Drum Tower Hospital was performed with emergency surgical repair. All patients were divided into non-HD and HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery and their clinical parameters and clinical outcomes were collected and compared. To determine independent predictors of preoperative HD, multivariate logistic regression analyses were performed using variables with P<0.5 in the univariate analyses. Kaplan-Meier survival analyses were conducted to analyze the association between preoperative HD and postoperative long-term survival. Results:The mean age of the patients was (52.4±12.5) years. 215 patients (26.5%) were identified as the preoperative HD group. In univariate analysis, significant difference was found with respect to the postoperative complications (98.6% vs. 94.5%, P=0.011) and 30-day mortality (20.0% vs. 8.4%, P<0.001) between the two groups. Multivariate logistic analysis showed that elevated serum troponin T levels upon admission( OR=1.921, P<0.001) and preoperative cardiac tamponade ( OR=2.158, P=0.002) were independent risk factors for preoperative HD. The long-term mortality rate was not significantly affected by preoperative HD. Conclusion:Early HD before surgery was commonly observed in patients with ADIAD and was associated with increased postoperative complications and 30-Day mortality. Elevated serum troponin T levels upon admission and preoperative cardiac tamponade were identified as risk factors for preoperative HD.

Hepatic Dysfunction in Children Suffering from Dengue Fever

Background: Dengue infections are associated with liver involvement leading to the occasional occurrence of liver failure ofsevere variety and even death. Dengue is almost endemic throughout India and it is much more serious and deleterious inchildren. We have, therefore, tried to estimate the prevalence of derangement of liver function in children affected with denguevirus infection.Materials and Methods: This study was done in admitted dengue patients in our medical college in the age group of1 month–12 years. Only 81 children of NS1 positive for dengue virus were included in the study. In all of these complete bloodcount and liver function tests were performed on the day of admission and every alternate date as long as they were admitted.Results: All the parameters that are serum glutamic-oxaloacetic transaminase (SGOT), serum glutamate-pyruvatetransaminase (SGPT), and gamma glutamyl transferase (GGT) raised throughout the whole period of dengue illness andthe serum albumin level were reduced. However, these changes were most marked on the 5th–6th days of fever after whichthey again slowly waned.Conclusion: Dengue fever causes hepatic injury in children, which is reflected by raised SGOT, SGPT, and GGT and reducedserum albumin. More the severity of the dengue infection more pronounced are the changes in liver derangement.

A study of clinical manifestations and complications of dengue fever in medical college hospital

Background: Dengue, the most common arboviral disease worldwide is usually endemic but several epidemics have been recorded. Global incidence of dengue has grown dramatically in recent decades; about half of the world's population is now at risk. The situation in India is reflected by occurrence of major disease outbreaks from time to time over the last few decades. Objectives: The objective of the present study was to observe the various clinical manifestations and complications of dengue fever. Materials and Methods: Study included 100 patients admitted to medicine ward in medical college hospital for a period of 6 months with symptoms and signs suggestive of dengue fever and those positive for NS1Ag, IgM and IgG dengue antibodies using Rapid strip test. Results: Among 100 patients observed, majority cases were dengue fever (92%) with no mortality, 5% were dengue hemorrhagic fever (DHF) with mortality 20% and 3% were dengue shock syndrome (DSS) with mortality 67%. 71 were males and 29 were females with sex ratio 2.5:1. Maximum patients were in the age group of 18-30years. Most common clinical manifestations were fever (100%), headache (90%), abdominal pain (72%), arthralgia (65%), myalgia (64%), hepatomegaly (52%) and splenomegaly (41%). Thrombocytopenia (84%) is the most common hematological abnormality observed. Among serology positivity, majority were positive for NS1 antigen (81%), followed by IgM antibodies (7%) and mixed positivity (12%). Most common complication observed was hepatic dysfunction (33%). Conclusion: Dengue infection is common viral infection with varying clinical manifestations from region to region and epidemic to epidemic. Even though no specific treatment available for dengue fever but early diagnosis and timely intervention will prevent complications and mortality from dengue hemorrhagic fever and dengue shock syndrome.

A prospective study of pattern of hepatic dysfunction in dengue fever patient in coastal Andhra Pradesh, India

Background: DENV (dengue viral infection) is a non-hepatotropic RNA virus, but hepatic involvement is common. High level of viremia is associated with involvement liver and other organs. Present study is a prospective study which is aimed to know about the, pattern of hepatic involvement in dengue patients admitted in General Medicine Dept Konaseema Institute of Medical Science.Methods: This is a prospective hospital-based study conducted in the Department of General Medicine Konaseema Institute of Medical Science Amalapuram Andhra Pradesh, from December 2015 to December 2017. During two year of study period 126 clinically and serologically positive patients of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome, classified as per the, definition of national vector borne disease control programme Govt. of India.Results: Mean value of total bilirubin was 0.8 mg/dl in DF patients, 0.96mg/dl in DHF patients and 1.08mg/dl in DSS patients. Mean value of AST was 77.44(IU/L) in DF group, 112.32 IU/L in DHF group and 486.28 in DSS group. In DF group mean ALT in DHF group was 94.36 (IU/L) and it was 386.42 IU/L in DSS group. Mean value of serum albumin was 3.97 gm/dl in DF group, 3.65 gm/dl in DHF group and 3.49 gm/dl in DSS group. Serum globulin mean value was 2.98mg/dl in DF group, 2.86 gm/dl in DHF group and 2.69 gm/dl in DSS group. Serum alkaline phosphate level was also increased in all the groups, mean value of ALP was 118.46 IU/L in DF group, 164.32 IU/L in DF group, 164.32 IU/L in DHF patients and 342.42 IU/L in DSS group.Conclusions: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme.

Síndrome de hipersensibilidad a los anticonvulsivos: reporte de un caso / Anticonvulsant Hypersensitivity Syndrome: A Case Report

El síndrome de reacción cutánea con eosinofilia y síntomas sistémicos (DRESS) es una reacción idiosincrásica a medicamentos que se caracteriza por erupción cutánea, fiebre, linfadenopatía y disfunción de órganos internos. Se revisa el caso de una paciente con trastorno afectivo bipolar (TAB) que sufrió una respuesta inflamatoria sistémica asociada al uso de ácido valproico y, además, tuvo una importante reactivación de los síntomas al usar otros medicamentos cuyos mecanismos de acción farmacológicos son diferentes. El diagnóstico de DRESS es principalmente de exclusión, por lo que puede tardarse en detectarlo y terminar en una entidad potencialmente mortal.

DRESS syndrome (skin reaction with eosinophilia and systemic symptoms) is an idiosyncratic drug reaction characterized by rash, fever, lymphadenopathy, and internal organ dysfunction. This case report is on a patient with bipolar affective disorder who presented with a systemic inflammatory response associated with the use of valproic acid, and an important activation of symptoms when used with other drugs with a different pharmacological action mechanism. The diagnosis of DRESS syndrome is primarily by exclusion, and its detection may be difficult, which could potentially become fatal for the patient.

A review of literature on modern parenteral nutrition.

Appropriate nutritional support is the standard of care for hospitalized patients. Total parenteral nutrition has evolved as a distinct therapeutic reality within the past decade for patients with appropriate indications including but not limited to non/dysfunction of the gastrointestinal tract. Starvation/malnutrition historically associated with prolonged hospital stay and protracted illness course can be somewhat addressed successfully. Though it is a well-established fact that current TPN techniques can be both safe and effective if used with due caution, the prevention and awareness of potential complications must be considered. Changes in technique are to be anticipated as advancement of knowledge and improvement and innovation in materials ensues. The current effectiveness and safety of TPN, particularly in comparison to enteral feeding and the clinical situations most appropriate for nutrition support have been the topic of ongoing discussion. Innovative strategies such as supplementation of TPN with medium-chain triglycerides, glutamine or branched-chain amino acids have been compared with standard treatments. Increasing efforts are being made to mitigate the adverse effects associated with TPN such as hyperglycaemia, central venous catheter infection, and hepatic dysfunction. This review focuses on these issues as addressed by the recent literature.

Hypersomnia as Presenting Symptom in Wilson's Disease

Wilson's disease shows considerably various symptoms that sometimes timely diagnosis is delayed when patient shows vague clinical presentation. We present a female patient whose initial symptom was hypersomnia and severe fatigue. She was initially diagnosed as depression. Because initial hepatic function test was unremarkable, it was not easy to come to think about relationship between hepatic function and hypersomnia. Her final diagnosis was Wilson's disease. This case suggested that hypersomnia otherwise unexplained could be the presenting symptom of Wilson's disease.

Parenteral Nutrition Associated Cholestasis Is Earlier, More Prolonged and Severe in Small for Gestational Age Compared with Appropriate for Gestational Age Very Low Birth Weight Infants

PURPOSE: We hypothesized that parenteral nutrition associated cholestasis (PNAC) would be more severe in small for gestational age (SGA) compared with appropriate for gestational age (AGA) very low birth weight (VLBW) infants. MATERIALS AND METHODS: Sixty-one VLBW infants were diagnosed as PNAC with exposure to parenteral nutrition with elevation of direct bilirubin > or =2 mg/dL for > or =14 days. Twenty-one SGA infants and 40 AGA infants matched for gestation were compared. RESULTS: Compared with AGA infants, PNAC in SGA infants was diagnosed earlier (25+/-7 days vs. 35+/-14 days, p=0.002) and persisted longer (62+/-36 days vs. 46+/-27 days, p=0.048). Severe PNAC, defined as persistent elevation of direct bilirubin > or =4 mg/dL for more than 1 month with elevation of liver enzymes, was more frequent in SGA than in AGA infants (61% vs. 35%, p=0.018). The serum total bilirubin and direct bilirubin levels during the 13 weeks of life were significantly different in SGA compared with AGA infants. SGA infants had more frequent (76% vs. 50%, p=0.046), and persistent elevation of alanine aminotransferase. CONCLUSION: The clinical course of PNAC is more persistent and severe in SGA infants. Careful monitoring and treatment are required for SGA infants.

Total glucosides of paeony can affect hepatic dysfunction of patients with moderate or severe liver damage caused by methotrexate and leflunomide in rheumatoid arthritis patients / 中华风湿病学杂志

Objective To investigate the effect of total glucosides of paeony(TGP) on hepatic dysfunction caused by Methotrexate (MTX) and Leflunomide (LEF) in patients with moderate or severe rheumatoid arthritis (RA).Methods From July 2010 to February 2011,204 cases with definite-diagnosed rheumatoid arthritis were included in three hospitals in Anhui province.All these patients suffered from moderate or severe rheumatoid arthritis and they were divided randomly into two groups,the therapeutic groups were treated with TGP combined with MTX and LEF and the control group were treated without TGP.The incidence of hepatic dysfunction was observed.Statistical anylysis was carried out by using t test and x2 test.Results One hundred and ninty-four patients had completed observation for at least 12 weeks.In the therapeutic group,only 10 of 105 patients had hepatic dysfunction compared to 31 of 89 patients in the control group.The incidence of hepatic dysfunction of the therapeutic group was significantly lower than the control group.After 12 weeks treatment with TGP,the effective respohse rates of the therapeutic group was 81.9％,which was higher than 74.6％ in the control group.The good response rate in the therapeutic group was 21.6％,which was better than 11.7％ in the control group.Although the difference between the two groups was not statistically significant,we could observed the tendency of increasing in effectiveness and the good response rate in the therapeutic group when compared with the control group.Conclusion TGP can decrease the incidence of hepatic dysfunction during the treatment with MTX and LEF,and it may improve the therapeutic effecacy of patients with RA.

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study / Avaliação das alterações clínicas e hepáticas em pacientes adultos com dengue: estudo prospectivo em um período de dois meses

INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

INTRODUÇÃO: Analisar prospectivamente a disfunção hepática e a evolução dos sinais e sintomas em pacientes adultos com dengue durante um período de dois meses. MÉTODOS: Realizamos um estudo prospectivo em Campos dos Goytacazes, Rio de Janeiro, Brasil, de janeiro a julho de 2008. Foi avaliada a evolução das manifestações clínicas e laboratoriais em 90 pacientes adultos com dengue, em um período de dois meses. Vinte controles foram arrolados para análise da função hepática. Em ambos os grupos foram realizadas coletas de dados e sangue nos primeiros cinco dias da doença, e aos 8, 15, 30 e 60 dias após o início da doença. Foram excluídos pacientes com hepatite B, hepatite C, gestantes e aqueles sabidamente soropositivos para HIV. RESULTADOS: No final do segundo mês do início da dengue, 33,3% (30/90) dos pacientes apresentaram persistência de pelo menos um sinal ou sintoma. Estavam presentes no final do segundo mês 57,7% (15/26) dos sinais ou sintomas. Os maiores percentuais de persistência foram: artralgia, adinamia, fraqueza, fadiga, anorexia, alteração do paladar e queda de cabelo. A infecção prévia pelo vírus da dengue (DENV) não predispôs a uma maior duração dos sintomas. Da função hepática, observamos alterações relevantes somente nos níveis das transaminases, que em alguns casos permaneceram elevados até o final do segundo mês. Os níveis de ALT ultrapassaram os de AST na convalescença. Homens apresentaram níveis mais elevados de transaminases quando comparados aos de mulheres. CONCLUSÕES: Dengue apresenta grande número de sintomas e transaminases elevadas no final do segundo mês de doença.

Compromiso hepático por Dengue en niños del Huila, Colombia / Dengue-related hepatic compromise in children from the Huila department of Colombia

Objetivo Determinar la frecuencia y severidad del compromiso hepático en niños con Dengue. Métodos Estudio descriptivo que incluyó a 108 niños menores de 13 años con diagnóstico de infección por virus de Dengue, confirmada por detección plasmática de NS1 e IgM dengue-específica, que consultaron al Hospital Universitario de Neiva, en el período de junio de 2009 a mayo de 2010.El grado de daño hepático fue evaluado por criterios clínicos y bioquímicos que incluyeron transaminasas y albúmina. El diagnóstico de infección con Leptospira o Hepatitis A fue realizado por detección de IgM plasmática específica medida en fase aguda y convaleciente. Resultados De los casos incluidos, 98 y 10 casos fueron clasificados como dengue con signos de alarma y Dengue grave, respectivamente. Dos de cada tres pacientes con Dengue presentaron signos de alarma y todos los pacientes con Dengue grave presentaron algún grado de compromiso hapático evidenciado clínica y bioquímicamente. Independientemente de la clasificación clínica, la hepatomegalia fue el signo clínico cardinal del compromiso hepático y se presentó en el 85 % del total de niños incluidos. De resaltar, 5 de los pacientes presentaron probable coinfección de dengue y leptospira, siendo la primera descripción en Colombia. En ninguno de los casos analizados se presentó enfermedad aguda por Hepatitis A. Conclusión El compromiso hepático es muy frecuente en la infección por virus Dengue. Enfermedades como la leptospirosis deben ser tenidas en cuenta no sólo en el diagnóstico diferencial del paciente pediátrico febril con compromiso hepático, sino como causa de coinfección en el niño con Dengue en el sur de Colombia.

Objective Dengue is the most important arthropod-borne viral disease in the world; it can be life-threatening because of liver involvement. Aim Determining liver involvement frequency and severity in dengue-infected children. Methods This was a descriptive case series study which involved studying 108 dengue-infected children aged less than 13 years old whose infection had been confirmed by the detection of dengue-specific IgM and NS1 in plasma. Clinical and biochemical parameters were used for evaluating liver involvement, including transaminases and albumin. Hepatitis A and leptospira infection were also evaluated by using ELISA to detect pathogen-specific IgM in plasma during acute and convalescence phases. The study was carried out at a teaching hospital in Neiva from June 2009 to May 2010. Results Ninety-eight of the aforementioned cases were clinically classified as dengue with warning signs (DWS) and 10 as severe dengue (SD). Two out of three DWS patients and all SD patients had some degree of liver involvement, shown clinically and biochemically. Regardless of the clinical classification, hepatomegaly was the main clinical sign of liver involvement and was present in 85% of all the children in the study. It is worth noting that 5 patients had probable dengue and leptospirosis co-infection, this being the first instance of this in Colombia. None of the cases analyzed here had acute hepatitis A. Conclusions Liver compromise should be considered in confirmed cases of dengue as shown in this series of children. Leptospirosis must be considered as differential diagnosis and also as causing co-infection in a febrile child.

Síndrome hepatorrenal: diagnóstico y tratamiento / Hepatorenal syndrome: diagnosis and treatment

El síndrome hepatorrenal es potencialmente reversible, se presenta en pacientes con cirrosis, ascitis, insuficiencia hepática aguda o hepatitis alcohólica y se caracteriza por deterioro de la función renal, alteraciones de la función cardiovascular e hiperactividad de sistemas como el nervioso simpático y el renina-angiotensina. Han sido innumerables las investigaciones realizadas sobre la coexistencia de la disfunción hepática y renal y su impacto en la morbilidad y mortalidad en las unidades de atención al paciente en estado crítico. El objetivo del presente artículo es proporcionar una revisión bibliográfica actualizada acerca del tema y facilitar la actuación médica ante los afectados con el mencionado síndrome.

The hepatorenal syndrome is potentially reversible, it is presented in patients with cirrhosis, ascites, acute hepatic failure or alcoholic hepatitis and it is characterized by deterioration of the renal function, changes of the cardiovascular function and hyperactivity of systems as the sympathetic nervous one and the renin-angiotensin system. The investigations carried out on the coexistence of the hepatic and renal disorders and their impact in the mobility and mortality in the institutions for critically ill patient have been countless. The objective of the present work is to provide an updated literature review about the topic and to facilitate the medical performance in those cases with the mentioned syndrome.

Etiology and clinical features of hepatic dysfunction in patients after allogeneic hematopoietic stem cell transplantation / 白血病·淋巴瘤

Objective To summarize and evaluate the incidence,etiology,diagnostic and therapeutic method of hepatic dysfunction after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods 83 blood disease patients who undergoing allo-HSCT from 2006 to 2010 in the affiliated cancer hospital of Zhengzhou university.Among those who suffered from Ⅱ-Ⅳ grade hepatic dysfunction,the incidence,the ratio of different causes,clinical feature and diagnostic method were evaluated.The difference of causes of hepatic dysfunction in different period,the therapeutic method and curative effect were also analysed.Results Among 83 patients undergoing allo-HSCT,45 patients suffered from Ⅱ-Ⅳ grade hepatic dysfunction,the ratio was 54.2 ％.For etiology,7 were preconditioning,9 were cyclosporine (CsA),2 were hepatic venoocclusive disease (HVOD),24 were hepatic graft versus host disease (GVHD),2 was hepatic B virus (HBV)reactivation,1 was mutiple organ failure.20 cases (44.4 ％) occurred in one month after allo-HSCT with the main etiology of drug hepatotoxicity.13 cases (28.9 ％) occurred from one month to 100 days after allo-HSCT,while 12 cases (26.7 ％) occurred from 101 days to one year with the main etiology of both hepatic GVHD.27 cases were cured and 10 were improved after treatment.2 cases were not cured and 6 cases died from relapse of the primary disease,or else from the complication of allo-HSCT.Conclusion Hepatic dysfunction is an common complication after allo-HSCT,drug hepatotoxicity and hepatic GVHD are the major causes.The relativity between hepatic dysfunction and period after allo-HSCT is a important reference for diagnosis.It will produce desired result to choose proper therapeutic method based on etiology.

Risk factors and clinical analysis on acute hepatic dysfunction induced by sepsis / 中华急诊医学杂志

Objective To study the incidence,risk factors and clinical features of patients with acute hepatic dysfunction induced by sepsis. Methods One hundred and sixty patients with sepsis were assigned to two groups according to liver function: sepsis group and acute hepatic dysfunction group. Logistic regression analysis was used to study the risk factors.The comparison of plasma endothelin-1 ( ET-1 ) and sepsis-related organ failure assessment (SOFA) score between two groups was carried out.Results Of 160sepsis patients,25 (15.6％) patients were subjected to acute hepatic dysfunction induced by sepsis.Logistic regression analysis showed that long-term indulgence in wine drunk (OR =4.102,95％ CI 1.288 -13.063 ),history of cardiac insufficiency ( OR =4.109,95％ CI 1.352 - 12.493) and hypotension ( OR =5.833,95％ CI:1.712 - 19.868 ) were the significant risk factors.Though oxygenation index ( PaO2/FiO2),platelet (PLA) and Glasgow coma scale (GCS) were not different between two groups,the total bilirubin (Tbil),direct bilirubin (Dbil),creatitine (Cre),range of blood glucose variation (Rglu),lactic acid (Lac),plasma ET-1and SOFA score in acute hepatic dysfunction group were higher than those in sepsis group. Mortality rate in acute hepatic dysfunction group was higher than that in sepsis group.Conclusions Long-term drunk,history of cardiac insufficiency and hypotension are the risk factors in acute hepatic dysfunction induced by sepsis.Elevated arterial Lac and plasma ET-1 levels,and higher SOFA score in acute hepatic dysfunction group suggest poor prognosis.

Ictericia y hepatopatía en el paciente con malaria / Jaundice and hepatopathy in patients with malaria

La ictericia es un hallazgo frecuente en el paciente con malaria. Según la Organización Mundial de la Salud, se considera un signo de peligro cuando se acompaña de aumento importante de las bilirrubinas y comúnmente se relaciona con disfunción hepática y lesión de otros sistemas. La lesión hepática en estos pacientes es frecuente, está asociada a otras complicaciones, y es reversible si se identifica y se trata a tiempo. Con este trabajo se pretende revisar el valor semiológico de la ictericia como indicador de malaria complicada, explicar su patogénesis y los mecanismos de daño hepático; además, hacer un enfoque del paciente con hepatopatía palúdica, diferenciando la disfunción hepática de la falla y la encefalopatía hepáticas.

Jaundice is a common finding in malaria patients. According to the World Health Organization, it is considered a sign of danger when accompanied by an important increase of bilirubin and it is frequently related to hepatic dysfunction and injury to other organs. Liver injury in these patients is common and it is associated with other complications. If it is identified and treated early, it is reversible. This paper reviews the semiological value of jaundice as an indicator of complicated malaria; it explains its pathogenesis and the mechanisms of liver damage. It also focuses on the patient with hepathopathy, distinguishing hepatic dysfunction, hepatic failure and hepatic encephalopathy.

Cholestatic Jaundice Induced by Duloxetine in a Patient with Major Depressive Disorder

Duloxetine is a balanced and potent serotonin and noradrenaline reuptake inhibitor (SNRI) and has adverse effects that are commonly associated with such drugs, including nausea, dry mouth, constipation, insomnia, and dizziness. Recently, duloxetine-induced liver injury has also been observed in patients with preexisting liver disease or chronic alcohol use. We investigated the effects of duloxetine in a healthy young adult with major depressive disorder (MDD) but no risk factors, and found that his total bilirubin level increased to 3.3 mg/dL and he developed jaundice after 5 months of duloxetine treatment. Discontinuation of duloxetine treatment saw his total bilirubin level decrease to 1.8 mg/dL. Thus, the administration of duloxetine might induce liver injury in a patient with MDD. However, the limitations of this single case report must be acknowledged. Although the cause of hepatic dysfunction in this case remains to be elucidated, clinicians should monitor liver function carefully after duloxetine treatment. Further investigations with a larger sample are needed.

Clinical Analysis of 7 Children with Fatal Virus Encephalopathy / 实用儿科临床杂志

Objective To explore clinic manifestations and laboratory investgation of virus encephalopathy.Methods The clinical course,cerebrospinal fluid(CSF),hepatic dysfunction,computerized tomography of 7 cases treated in our hospital from October 1999 to March 2005 were retrospectively reviewed.Results Seven cases of virus encephalopathy were typically associated with a suddent onset of high fever,severe convulsion,rapidly progressive coma,marked elevations of alanine aminotransferase(AST) and aspartate transaminase(ALT).Four cases died,3 cases had severe sequelae.Blood ammonemia was normal,brain CT scans revealed peripheral or basal nuclei low-density areas.Conclusion Children with a sudden onset of high fever,severe convulsions,rapidly progressive coma may have a poor prognosis.

A Case of Postoperative Acute Hepatic Dysfunction after Sevoflurane Anesthesia: A case report / 대한마취과학회지

We report a case of a suspected acute hepatic dysfunction after general anesthesia with sevoflurane. A 71 year old female underwent a laparoscopic appendectomy under O2-N2O-sevoflurane anesthesia. She had no history of anesthesia, allergy, hypertension, diabetes or hepatitis. Four hours after surgery, she developed a conscious disturbance and became comatose. There was a marked increase in the serum aspartate aminotransferase, alanine aminotransferase, activated partial thromboplastin time and prothrombin time level, but the platelet and eosinophil counts were within the normal range. Her hepatic dysfunction improved after conservative therapy. She recovered gradually and was discharged after 24 days of hospitalization. Sevoflurane is believed to be the possible cause of the acute hepatic dysfunction in this case.

Delayed Recovery after Continuous Infusion of Midazolam in Hepatic Dysfunction: A case report / 대한마취과학회지

Benzodiazepines are frequently administered for sedation to surgical intensive care unit patients who require postoperative intubation and mechanical ventilation. Midazolam is the most commonly used drug, which is water soluble, short-acting benzodiazepine and rapidly metabolized by the liver. Continuous intravenous infusion of midazolam was administered to the man who was 40 years old for mechanical ventilation in the intensive care unit for 58 hours. After discontinued midazolam, patient who had acute hepatic dysfunction had been sedated with endotracheal intubation for 5 days. Even flumazenil was tried twice to reverse the effect of midazolam, the response was limited by the time. Finally he awaked as recovery of his hepatic function.