Anti HCV activity and expression inhibition of HCC markers by protein extract from Iberis gibraltarica / Atividade anti-HCV e inibição da expressão de marcadores HCC por extrato de proteína de Iberis gibraltarica

Hepatitis C virus infection (HCV) is the foremost reason of progressive hepatic fibrosis and cirrhosis, with an elevated risk of hepatocellular carcinoma (HCC) development. Medicinal plants have been used for human health benefits for several years, but their therapeutic potential needs to be explored. The main objective of this study was to figure out the in vitro antiviral and anticancer characteristics of total crude protein of Iberis gibraltarica against HCV and HCC. Total crude protein of Iberis gibraltarica was isolated and quantified. The level of cytotoxicity was measured against the HepG2 cell line and it shows no significant cytotoxicity at the concentration of 504µg/ml. The anti-HCV effect was determined by absolute quantification via real time RT-PCR method and viral titer was reduced up to 66% in a dose dependent manner against the total protein of Iberis gibraltarica. The anticancer potential of Iberis gibraltarica was also examined through mRNA expression studies of AFP and GPC3 genes against the total protein of Iberis gibraltarica-treated HepG2 cells. The results show up to 90% of the down-regulation expression of AFP and GPC3. The obtained results indicate the therapeutic potential of total protein of Iberis gibraltarica against HCV and hepatocellular carcinoma in vitro.

A infecção pelo vírus da hepatite C (HCV) é a principal causa de fibrose hepática progressiva e cirrose, com risco elevado de desenvolvimento de carcinoma hepatocelular (HCC). As plantas medicinais vêm sendo utilizadas para benefícios à saúde humana há vários anos, mas seu potencial terapêutico precisa ser explorado. O principal objetivo deste estudo foi descobrir as características antivirais e anticancerígenas in vitro da proteína bruta total de Iberis gibraltarica contra HCV e HCC. A proteína bruta total de Iberis gibraltarica foi isolada e quantificada. O nível de citotoxicidade foi medido contra a linha celular HepG2 e não apresenta citotoxicidade significativa na concentração de 504µg/ml. O efeito anti-HCV foi determinado por quantificação absoluta através do método RT-PCR em tempo real e o título viral foi reduzido em até 66% de forma dose-dependente contra a proteína total de Iberis gibraltarica. O potencial anticancerígeno de Iberis gibraltarica também foi examinado através de estudos de expressão de mRNA dos genes AFP e GPC3 contra a proteína total de células HepG2 tratadas com Iberis gibraltarica. Os resultados mostram até 90% da expressão de regulação negativa de AFP e GPC3. Os resultados obtidos indicam o potencial terapêutico da proteína total de Iberis gibraltarica contra HCV e carcinoma hepatocelular in vitro.

Experiencia de downstaging versus criterios de Milán para trasplante hepático por carcinoma hepatocelular en una cohorte prospectiva / Experience with downstaging versus Milan criteria for liver transplantation in patients with hepatocellular carcinoma in a prospective cohort

Introducción. El acceso al trasplante hepático (TH) en pacientes con carcinoma hepatocelular (CHC) se basa en la aplicación de criterios morfológicos rigurosos estipulados desde 1996, co-nocidos como criterios de Milán. Una de las estrategias descritas para expandir estos criterios se conoce como downstaging (reducción del estadiaje tumoral mediante terapias locorregionales). El objetivo de este estudio fue describir el comportamiento postrasplante de pacientes con CHC que ingresaron dentro de los parámetros de Milán, comparado con el de aquellos pacientes llevados a terapia de downstaging en un centro colombiano. Metodología. Se incluyeron pacientes adultos con cirrosis hepática (CH) y CHC que fueron llevados a TH en el Hospital Pablo Tobón Uribe, entre julio de 2012 a septiembre de 2021. Como desenlace principal se definió recurrencia y tiempo de recurrencia de la enfermedad tumoral, muerte por todas las causas y tiempo al fallecimiento. Se evaluaron las características sociodemográficas y clínicas de cada grupo. Se incluyeron scores pronósticos de recurrencia de la enfermedad tumoral. Resultados. Se trasplantaron 68 pacientes con CH y CHC, 50 (73,5 %) eran hombres y la edad promedio fue 59 años; 51 pacientes (75 %) cumplían con los criterios de Milán y 17 (25 %) fueron llevados a terapia de downstaging previo al TH. No hubo diferencias significativas en la supervivencia global y supervivencia libre de trasplante entre los dos grupos evaluados, p=0,479 y p=0,385, respectivamente. Tampoco hubo diferencia significativa en la recurrencia de la enfermedad tumoral entre ambos grupos (p=0,81). En total hubo 7 casos de recurrencia tumoral (10,2 %) y 11 casos de muerte (16,2 %). Conclusiones. No se encontraron diferencias significativas en recurrencia y mortalidad entre los pacientes que cumplían los criterios de Milán y los trasplantados luego de la terapia de downstaging, en un tiempo de se-guimiento de 53 meses hasta el último control posterior al trasplante hepático. Esta sería la primera evaluación prospectiva de un protocolo de downstaging para CHC en Colombia.

Introduction. Access to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) is based on the application of rigorous morphological criteria stipulated since 1996, known as the Milan criteria. One of the strategies described to expand these criteria is known as downstaging (tu-mor staging reduction through locoregional therapies). The objective of this study was to describe the post-transplant performance of patients with HCC who were admitted within the Milan parameters, compared with those of patients taken to downstaging therapy, in a Colombian center. Methodolo-gy. Adult patients with cirrhosis and HCC that received LT between July 2012 and September 2021 at the Pablo Tobón Uribe Hospital were included. The main outcome was defined as recurrence and time to recurrence of the tumor disease, death from all causes, and time to death. The socio-demographic and clinical characteristics of each group were evaluated. Tumor disease recurrence prognostic scores were included. Results. Sixty-eight patients with cirrhosis and HCC received LT in the time frame, 50 (73.5%) were men and the mean age was 59 years. Fifty-one patients were trans-planted (75%) fulfilling Milan criteria, and 17 (25%) patients received downstaging therapies before LT. There were no significant differences in overall survival and transplant-free survival between the two groups, p=0.479 and p=0.385, respectively. There was also no significant difference in the recurrence of the tumor disease between both groups (p=0.81). In total there were 7 tumoral recurrences (10.2%) and 11 deaths (16.2%). Conclusions. There were no differences in recurrence and survival between patients transplanted fulfilling Milan criteria and those receiving downstaging therapies, following a mean time of 53 months after LT. This is the first prospective evaluation of the downstaging protocol in Colombia.

Uso de albúmina a largo plazo en el paciente cirrótico. Revisión sistemática / Long-term use of albumin in the cirrhotic patient. Systematic review

Introducción. La cirrosis constituye la etapa final de la enfermedad hepática crónica, con una alta mortalidad, y puede deberse a diferentes etiologías. La albúmina tiene tres indicaciones bien establecidas: la prevención de la disfunción circulatoria inducida por paracentesis, la peritonitis bacteriana espontánea y el síndrome hepatorrenal, sin embargo, su uso a largo plazo es controvertido. El objetivo de esta revisión fue identificar si el uso prolongado de la albúmina tiene efectos beneficiosos en el tratamiento de pacientes cirróticos. Metodología. Se realizaron búsquedas en la base de datos de PubMed, empleando los siguientes términos: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Se excluyeron los artículos que no cumplieron con la temática y aquellos que tenían más de 5 años de antigüedad, a excepción de aquellos relevantes para la revisión. Resultados. Se ha demos-trado en varios estudios realizados en los últimos 4 años, que la administración prolongada de albúmina reduce la mortalidad en el paciente cirrótico. Además, resulta en una disminución en ingresos hospitalarios por complicaciones de la cirrosis, disminución de la necesidad de para-centesis y menor uso de albúmina para otras indicaciones ya establecidas, lo que contrarresta los costos derivados de la terapia. Conclusión. Se concluye con base en la evidencia presenta-da, que el uso de albúmina a largo plazo podría resultar beneficioso en pacientes con cirrosis hepática descompensada. No obstante, es necesario abordar otros aspectos de la terapia en estudios posteriores

Introduction. Cirrhosis is the final stage of chronic liver disease, has a high mortality and can be due to different etiologies. Albumin has three well-established indications: prevention of circulatorydysfunction induced by paracentesis, spontaneous bacterial peritonitis, and hepatorenal syndrome, however, its long-term use is controversial. The objective of this review was to identify if the prolonged use of albumin has beneficial effects in the treatment of cirrhotic patients. Methodology. PubMed database was searched using the following terms: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Articles that did not meet the topic and those that were more than 5 years old were excluded, except for those relevant to the review. Results.It has been shown in several studies within the previous 4 years, that prolonged administration of albumin reduces mortality in cirrhotic patients. In addition, it results in a decrease in hospital ad-missions due to complications of cirrhosis, a decrease in the need for paracentesis and less use of albumin for other established indications, which offsets the costs derived from therapy. Conclusion. It is concluded based on the evidence presented, that the long-term use of albumin could be beneficial in patients with decompensated liver cirrhosis. However, other aspects of the therapy need to be addressed in further studies

Recaída en el consumo de alcohol después del trasplante de hígado por hepatopatía alcohólica / Alcohol relapse after liver transplantation for alcoholic liver disease

Introducción. La enfermedad hepática inducida por uso de alcohol se ha considerado una enferme-dad autoinfligida que limitaba el acceso al trasplante. Actualmente es una de las principales indicacio-nes de trasplante hepático en Colombia y el mundo, con excelente sobrevida. Metodología. Estudio descriptivo observacional donde se realizó una caracterización de los pacientes con trasplante hepá-tico por hepatopatía alcohólica en una institución de cuarto nivel, que incluyó un estudio cualitativo de la recaída en el consumo de alcohol postrasplante. Resultados. De 87 pacientes de una cohorte inicial de 96 pacientes trasplantados entre 2003 y 2021, se describieron características sociodemo-gráficas, comorbilidades previas y adquiridas posterior al trasplante, supervivencia del paciente y del injerto, y factores de riesgo asociados al consumo de alcohol. Adicionalmente, a 65 pacientes se les pudo realizar una entrevista estructurada para evaluar la recaída en el consumo de alcohol, 41,53 % volvieron a consumir alcohol; 23,07 % en patrón de riesgo de recaída y 18,46 % en patrón de slip (desliz). El antecedente de hepatitis alcohólica tuvo un RR de 3,273 (1,464­7,314) y p=0,007 para recaída en el consumo de alcohol, y la comorbilidad psiquiátrica un RR de 2,395 (1,002­5,722) y p=0,047. Finalmente, haber presentado al menos una recaída postrasplante tuvo un RR de 5,556 (1,499­20,588) con p=0,005 para rechazo del injerto. Conclusiones. La recaída en el consumo de alcohol fue frecuente, la hepatitis alcohólica previa y la comorbilidad psiquiátrica son factores de riesgo asociados. La recaída se asoció a rechazo del injerto sin afectar la sobrevida del paciente.

Introduction. Alcohol-induced liver disease has been considered a self-inflicted disease that limited access to transplantation. It is currently one of the main indications for liver transplantation in Colom-bia and the world, with excellent survival. Methodology. Observational descriptive study where a characterization of liver transplant patients due to alcoholic liver disease was carried out in a fourth level institution, which included a qualitative study of relapse in post-transplant alcohol consumption. Results. Of 87 patients from an initial cohort of 96 transplant patients between 2003 and 2021, sociodemographic characteristics, previous and acquired post-transplant comorbidities, patient and graft survival, and risk factors associated with alcohol consumption were described. Additionally, 65 patients were able to undergo a structured interview to assess relapse in alcohol consumption, 41.53% returned to alcohol consumption; 23.07% in risk relapse pattern, and 18.46% in slip pattern. The history of alcoholic hepatitis had a RR of 3.273 (1.464-7.314) and a p=0.007 for relapse in alcohol consumption, and psychiatric comorbidity a RR of 2.395 (1.002-5.722) and a p=0.047. Finally, having presented at least one post-transplant relapse had a RR of 5.556 (1.499-20.588) with ap=0.005 for graft rejection. Conclusions. Relapse in alcohol consumption was fre-quent, previous alcoholic hepatitis and psychiatric comorbidity were associated risk factors. Relapse was associated with graft rejection without affecting patient survival.

Frequência de esteato-hepatite alcoólica em pacientes portadores do vírus de hepatite C / Frequency of alcoholic steatohepatitis in patients with hepatitis C virus

Introdução: o consumo de álcool é um fator de risco bem conhecido para induzir doença crônica do fígado. O álcool também é um cofator na patogênese induzida pelo vírus da hepatite C (VHC). A infecção crônica pelo VHC pode exacerbar a lesão hepática alcoólica por mecanismos que incluem aumento do estresse oxidativo. Portanto o VHC, concomitantemente com o consumo excessivo de álcool, induz diversos mecanismos fisiopatogênicos que contribuem para a diminuição da depuração viral e para a lesão hepática. Objetivos: 1 ­ avaliar a frequência de esteato-hepatite alcoólica em biópsias de pacientes portadores do vírus da hepatite C; 2 ­ estudar os estágios da fibrose hepática nesses pacientes versus pacientes com e sem ingestão de álcool; 3 ­ analisar os escores bioquímicos e antropométricos desses pacientes. Metodologia: estudo de corte transversal, com pacientes acompanhados no núcleo de hepatologia do Hospital Prof. Edgard Santos da Universidade Federal da Bahia, portadores de hepatite C, com laudos de biópsias disponíveis para avaliar presença de esteato-hepatite alcoólica comprovada pelo registro de consumo de gramas de álcool. Foram considerados etilistas homens que consumiam mais de 30 g por dia e mulheres com consumo maior do que 20 g por dia. As variáveis utilizadas basearam-se em critérios histológicos, epidemiológicos e clínicos aplicados a esses pacientes. Resultados: a amostra total de pacientes portadores de hepatite C analisados foi de 335, sendo 100 indivíduos considerados com ingestão elevada de álcool, e 28,9% dos casos da amostra. A presença de esteatose hepática sem esteato-hepatite foi em 34 indivíduos (10,15%), e os casos de esteato-hepatite aparecem em um total de 30 indivíduos (8,96%). A carga viral elevada dos pacientes, tendo como referência >800.000, esteve em n=102, com 30,4% dos casos de VHC. Conclusão: observou-se, na população de estudo, 43 % os portadores de VHC com uso excessivo de alcool, 8,9 6% tinham esteato-hepatiits e 10,15 % esteatose. Além disso, verificou-se que mais da metade desses pacientes (56,6%) apresentaram grau de fibrose moderada e 53,3%, atividade necroinflamatória leve. A comorbidade mais comum observada foi hipertensão arterial sistêmica (HAS), em 40% dos pacientes.

Introduction: alcohol consumption is a well-known risk factor for inducing chronic liver disease, alcohol is also a cofactor in the pathogenesis induced by Hepatitis C Virus (HCV). Chronic HCV infection can exacerbate alcoholic liver damage by mechanisms including increased oxidative stress. Therefore, HCV, concomitantly with excessive alcohol consumption, induces several pathophysiological mechanisms, which contribute to the decrease in viral clearance and liver damage. Objectives: 1 ­ to assess the frequency of alcoholic steatohepatitis in biopsies of patients with the hepatitis C virus, 2 ­ to study the stages of liver fibrosis in these patients versus in patients with or without alcohol intake, 3 ­ analyze biochemical and anthropometric scores of these patients. Methodology: cross-sectional study, with patients monitored at the hepatology center of Hospital Prof. Edgard Santos from the Federal University of Bahia, carriers of hepatitis C with biopsy reports available to assess the presence of alcoholic steatohepatitis proven by recording the consumption of grams of alcohol, considered an alcoholic being a man, who consumed more than 30 g per day and being woman more than 20g a day. The variables used were based on histological, epidemiological and clinical criteria applied to these patients. Results: the total sample of patients with hepatitis C analyzed was (n=335), with n=100 individuals considered to have high alcohol intake, and 28.9% of the cases in the sample. The presence of hepatic steatosis without steatohepatitis was in 34 individuals (10.15%), and cases of steatohepatitis appear in a total of n=30 individuals (8.96%).The high viral load of patients, with >800,000 as reference, was n=102, with 30.4% of cases of HCV. Conclusion: it was observed, in the study population, 43% of HCV carriers with excessive alcohol use, 8.96% had steatohepatitis and 10.15% steatosis. Furthermore, it was found that more than half of these patients (56.6%) had a moderate degree of fibrosis and 53.3% had mild necroinflammatory activity. The most common comorbidity observed was systemic arterial hypertension (SAH), in 40% of patients.

Tecnossocialidade no cotidiano da pessoa com cirrose hepática: Revisão integrativa / Tecnosocialidad en la vida diaria de las personas con cirrosis hepática: Revisión integrativa / Technosociality in the daily life of a person with liver cirrhosis: Integrative review

Objetivo: identificar e refletir o uso da tecnossocialidade no cotidiano das pessoas com cirrose hepática para a promoção da saúde.Método:revisão integrativa desenvolvida de junho a dezembro de 2021 .A busca pelos estudos foi atemporal realizada nas bases da PUBMED, Scopus e Biblioteca Virtual em Saúde,a partir dos descritores Rede Social, Internet e Cirrose Hepática. Os estudos foram selecionados seguindo o fluxograma PRISMA.Resultados: foram inclusos 13 estudos divididos em duas categorias: 1. Tecnossocialidade: alfabetização e letramento digital, necessidade de avaliação da propriedade e proficiência tecnológica ;2. Tecnossocialidade: uso de aplicativos como ferramenta terapêutica para a promoção da saúde, estratégia de monitoramento remoto para o gerenciamento e cuidado da pessoa com cirrose. Conclusão:a tecnologia está no cotidiano das pessoas com cirrose. A alfabetização digital e o uso deaplicativos são estratégias importantespara a promoção da saúde da pessoa com cirrose hepática.(AU)

Objective: to identify and reflect on the use of technosociality in the daily lives of people with liver cirrhosis for health promotion. Method: integrative review developed from June to December 2021. The search was conducted with no time limitin the databases PUBMED, Scopus and Virtual Health Library using the descriptors Social Network, Internet and Liver Cirrhosis. The studies were selected following the PRISMA flowchart. Results: 13 studies were included divided into two categories: 1. Technosociality: digital literacy, emphasizing the need for assessment of ownership and technological proficiency; 2. Technosociality: use of applications as a therapeutic tool for health promotion, remote monitoring strategy for the management and care of the person with cirrhosis. Conclusion: technology is in the daily life of people with cirrhosis. Digital literacy and the use of applications are important strategies for health promotion of people with liver cirrhosis.(AU)

Objective: to identify and reflect on the use of technosociality in the daily lives of people with liver cirrhosis for health promotion. Method: integrative review developed from June to December 2021. The search was conducted with no time limitin the databases PUBMED, Scopus and Virtual Health Library using the descriptors Social Network, Internet and Liver Cirrhosis. The studies were selected following the PRISMA flowchart. Results: 13 studies were included divided into two categories: 1. Technosociality: digital literacy, emphasizing the need for assessment of ownership and technological proficiency; 2. Technosociality: use of applications as a therapeutic tool for health promotion, remote monitoring strategy for the management and care of the person with cirrhosis. Conclusion: technology is in the daily life of people with cirrhosis. Digital literacy and the use of applications are important strategies for health promotion of people with liver cirrhosis.(AU)

Objetivo: identificar y reflexionar sobre el uso de latecnosocialidadenla vida cotidiana de las personas concirrosis hepática para lapromoción de lasalud. Método:revisión integradora desarrollada de junio a diciembre de 2021. La búsqueda se realizo sinlímite de tiempoenlas bases PUBMED, Scopus y Virtual Health Library a partir de losdescriptoresRed Social, Internet y Cirrosis Hepática. Los estudios se seleccionaronsiguiendoel diagrama de flujo PRISMA. Resultados:incluyeron 13 estudios, divididos en dos categorías: 1. Tecnosocialidad: alfabetizacióndigital,evaluarlapropiedadtecnológica; 2. Tecnosocialidad: uso de aplicaciones como herramientaterapéutica para lapromoción de lasalud, estrategia de monitorización remota para lagestión y el cuidado. Conclusión:latecnología está enla vida cotidiana de las personas concirrosis. La alfabetización digital y el uso de aplicacionessonestrategiasparalapromoción de lasalud.(AU)

Nonalcoholic steatohepatitis: An emerging cause of cirrhosis in Colombia / La esteatohepatitis no alcohólica: una causa emergente de cirrosis en Colombia

Abstract Introduction: Cirrhosis of the liver is a significant cause of morbidity and mortality in Latin America; the increased prevalence of metabolic syndrome in our population could be changing the epidemiological profile of patients with advanced chronic liver disease. Aim: To characterize a group of patients with cirrhosis of the liver at an outpatient hepatology care center in Cartagena de Indias, Colombia, and determine the contribution of nonalcoholic steatohepatitis (NASH) as an etiological factor in this population. Materials and methods: Retrospective, cross-sectional, analytical study. All patients who attended the hepatology follow-up with a diagnosis of cirrhosis of the liver were in the six-monthly follow-up protocol that included screening for hepatocellular carcinoma (HCC) and esophageal varices. Results: 346 patients were included, most were women (54.3 %). The first and second causes of cirrhosis were cryptogenic (35 %) and NASH (30.9 %), respectively, followed by viral hepatitis (17 %) and autoimmune diseases (9 %). Of these patients, 87.4 % were within categories A and B of the Child-Turcotte-Pugh score, and only 12.5 % (33 patients) were in stage C. Also, 60 % had at least one clinical decompensation, 38 % a history of variceal hemorrhage, and 4 % a diagnosis of HCC; 80.6 % of patients with NASH cirrhosis had diabetes, and 46.7 % were overweight. Conclusion: NASH cirrhosis is an emerging cause of advanced chronic liver disease in Colombia.

Resumen Introducción: la cirrosis hepática es una importante causa de morbimortalidad en América Latina; el incremento de la prevalencia del síndrome metabólico en nuestra población podría estar cambiando el perfil epidemiológico de los pacientes con enfermedad hepática crónica avanzada. Objetivos: caracterizar un grupo de pacientes con cirrosis hepática y determinar la contribución de la esteatohepatitis no alcohólica (NASH) como factor etiológico de esta población en la ciudad de Cartagena de Indias, Colombia, en un centro de atención ambulatoria de hepatología. Métodos: estudio retrospectivo, transversal, analítico. Se incluyeron todos los pacientes que acudieron al seguimiento de hepatología con diagnóstico de cirrosis hepática que se encontraban en el protocolo de seguimiento semestral que incluía el cribado de hepatocarcinoma y várices esofágicas. Resultados: se incluyeron 346 pacientes. La mayoría fueron mujeres (54,3 %). La primera y segunda causa de cirrosis fue la criptogénica (35 %) y la NASH (30,9 %), respectivamente; seguidas de las hepatitis virales (17 %) y enfermedades autoinmunes (9 %). De estos pacientes, el 87,4 % se encontraba dentro de las categorías A y B de la escala pronóstica de Child-Turcotte-Pugh, y solo el 12,5 % (33 pacientes) en estadio C. El 60 % había presentado al menos una descompensación clínica, 38 % tenía antecedentes de hemorragia por várices y 4 %, diagnóstico de hepatocarcinoma. El 80,6 % de los pacientes con cirrosis NASH era diabético y el 46,7 % tenía exceso de peso. Conclusión: La cirrosis NASH es una causa emergente de enfermedad hepática crónica avanzada en Colombia.

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratorial

Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method (AU)

Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado (AU)

Utilidad del índice de fibrosis hepática (IFH) medido durante la ultrasonografía endoscópica en la evaluación del parénquima pancreático / Usefulness of the Liver Fibrosis Index (LFI) Measured during Endoscopic Ultrasonography in Evaluating the Pancreatic Parenchyma

El ultrasonido endoscópico ha cambiado la evaluación de las enfermedades pancreáticas y ha logrado un diagnóstico histopatológico (cuando se asocia con la punción); sin embargo, este procedimiento requiere de entrenamiento, no está libre de complicaciones y alrededor de 25% de los pacientes puede tener falsos negativos. Por esto se ha implementado el uso de la elastografía cuantitativa con el strain ratio, el cual permite diferenciar las masas benignas de las malignas. Existe evidencia creciente, pero aún no conclusiva, dada la heterogeneidad de los resultados (sin consenso para su realización), por lo que es necesario desarrollar otros métodos, que permitan una mayor certeza diagnóstica, como el índice de fibrosis hepática (IFH) medido por ultrasonografía endoscópica, el cual tienen como base la inteligencia artificial, validado para el diagnóstico y el seguimiento de la fibrosis hepática. Nuestro grupo considera que se podría usar de la misma forma para valorar el parénquima pancreático. Objetivo: evaluar si el IFH puede diferenciar tres tipos diferentes de tejidos pancreáticos: páncreas normal, páncreas graso y cáncer de páncreas. Metodología: estudio prospectivo de corte transversal en un solo centro. Se incluyeron 66 pacientes mayores de 18 años, con indicación de ultrasonografía endoscópica. El grupo 1 fue de pacientes con indicación diferente a la enfermedad biliopancreática (55 pacientes). En este grupo se aplicó la escala de clasificación de páncreas graso por ultrasonografía endoscópica (USE), utilizando como referencia la ecogenicidad del bazo (previamente validada); este grupo se subdividió en uno con parénquima pancreático normal y en otro con páncreas graso. En el grupo 2 (11 pacientes) se incluyeron los pacientes llevados para el estudio de lesión sólida pancreática, con diagnóstico citológico positivo para carcinoma de páncreas. Como herramienta de recolección de datos se utilizó un formulario virtual de Google Drive, disponible con dirección acortada: shorturl.at/pIMWX, diligenciado antes y después del procedimiento por fellows de Gastroenterología, previamente entrenados para este fin. El IFH se tomó en el páncreas en tiempo real mediante un software suministrado por el fabricante (Hitachi-Noblus), en un período comprendido entre enero de 2019 y enero 2020. A todos los pacientes se les realizó una ecoendoscopia biliopancreática completa, con un ecoendoscopio Pentax lineal y procesador Hitachi-Noblus; luego se efectuó una elastografía cualitativa y una cuantitativa, la cual incluyó la medición del IFH. Resultados: en total se incluyeron 66 pacientes: 11 pacientes con diagnóstico confirmado por citología de cáncer de páncreas y 55 pacientes que se enviaron para ecoendoscopia por evaluación de otras patologías diferentes a la biliopancreática. El rango de edad fue de 23-89, media de 56,75 años. El antecedente más frecuente fue la esteatosis o esteatohepatitis (n = 14) (25,45%). La indicación para la realización del procedimiento más frecuente fue la lesión subepitelial (n = 29) (52,73 %). Los porcentajes de pacientes según los grados de ecogenicidad del páncreas fueron de grado I (n = 29) (52,73 %); grado II (n = 5) (9,09 %); grado III (n = 18) (32,73 %); grado IV (n = 3) (5,45 %). Se tomaron los grados I y II como páncreas normal, y los grado III y IV como páncreas graso. Estos se dividieron en n = 34 pacientes (61,82 %) para páncreas normal y n = 21 (38 %) para páncreas graso; es decir, que de acuerdo con la escala utilizada hay una prevalencia para páncreas graso de 38,18 %. Se realizó el IFH en los tres subgrupos diferentes: los considerados como ecoendoscópicamente normales, los clasificados como páncreas graso y los pacientes con diagnóstico de cáncer de páncreas confirmado por citología, tomado en el páncreas. El IFH para los tres diferentes grupos fueron, respectivamente, normal: IFH 2,60, rango 0,97-3,47 (IC 95 % 2,17-3,02); páncreas graso: IFH 3,87, rango 2-5,5 (IC 95 % 3,44-4,29); cáncer de páncreas: IFH 6,35, rango 5,8-7,8 (IC 95 % 5,92-6,77). Conclusiones: este es el primer estudio piloto que usa el IFH aplicado al parénquima pancreático, y se sugiere su utilidad para diferenciar, de manera no invasiva, el páncreas normal, el graso y el carcinoma de páncreas. Este hallazgo se debe confirmar en poblaciones más amplias y heterogéneas, con el fin de ser validado.

Abstract Endoscopic ultrasound has changed the evaluation of pancreatic diseases and has achieved a histopathological diagnosis (when associated with a puncture); however, this procedure requires training, is not free of complications, and around 25 % of patients may have false negatives. Therefore, quantitative elastography with the strain ratio has been implemented to differentiate benign masses from malignant ones. There is growing but not yet conclusive evidence, given the heterogeneity of the results (without consensus on its performance). It is necessary to develop other methods that allow for greater diagnostic certainty, such as the liver fibrosis index (LFI) measured by endoscopic ultrasonography. This method is based on artificial intelligence and validated for diagnosing and monitoring liver fibrosis. Our group considers that it could also be used to assess the pancreatic parenchyma. Aim: To evaluate whether the LFI can differentiate three types of pancreatic tissues: normal pancreas, fatty pancreas, and pancreatic cancer. Materials and methods: Prospective cross-sectional single-center study. We included sixty-six patients over 18 years of age with an indication for endoscopic ultrasonography. Group 1 consisted of patients with an indication other than the biliopancreatic disease (55 patients). The endoscopic ultrasonography (EUS) fatty pancreas classification scale was applied to this group, taking the echogenicity of the spleen (previously validated) as a reference; this group was subdivided into normal pancreatic parenchyma and fatty pancreas. Group 2 (11 patients) included those examined for solid pancreatic lesions with a positive cytological diagnosis of pancreatic carcinoma. We used a Google Form as a data collection tool, available with a shortened address (shorturl.at/pIMWX). It was filled out before and after the procedure by Gastroenterology fellows, previously trained for this purpose. The LFI was measured in the pancreas in real-time using software supplied by the manufacturer (Hitachi Noblus) between January 2019 and January 2020. All patients underwent a complete biliopancreatic echoendoscopy, with a linear Pentax echoendoscope and Hitachi Noblus processor. Then, qualitative and quantitative elastography was performed, including LFI measurement. Results: We included a total of 66 patients: 11 with a diagnosis of pancreatic cancer confirmed by cytology and 55 sent for ultrasound endoscopy due to pathologies other than the biliopancreatic disease. The age range was 23-89, with a mean of 56.75 years. The most frequent history was steatosis or steatohepatitis (n = 14) (25.45 %). The most frequent indication for performing the procedure was subepithelial lesion (n = 29) (52.73 %). The percentages of patients according to pancreatic echogenicity were Grade I (n = 29) (52.73 %); Grade II (n = 5) (9.09 %); Grade III (n = 18) (32.73 %); Grade IV (n = 3) (5.45 %). Grades I and II were taken as a normal pancreas and Grades III and IV as a fatty pancreas, divided into n = 34 patients (61.82 %) for a normal pancreas and n = 21 (38 %) for a fatty pancreas. According to the scale used, there is a fatty pancreas prevalence of 38.18 %. The LFI was measured in three subgroups: those considered endoscopically normal, those classified as fatty pancreas, and patients diagnosed with pancreatic cancer confirmed by cytology taken from the pancreas. The LFI for these groups were, respectively, normal pancreas: LFI 2.60, range 0.97-3.47 (95 % CI 2.17-3.02); fatty pancreas: LFI 3.87, range 2-5.5 (95 % CI 3.44-4.29); pancreatic cancer: LFI 6.35, range 5.8-7.8 (95 % CI 5.92-6.77). Conclusions: This is the first pilot study that applies the LFI to the pancreatic parenchyma. It is useful in differentiating a normal pancreas, a fatty pancreas, and pancreatic carcinoma non-invasively. This finding must be validated in larger and more heterogeneous populations.

Remisión a largo plazo de la hipertensión portopulmonar mediante trasplante hepático en paciente con cirrosis asociada a hepatitis autoinmune / Long term remission of portopulmonary hypertension with liver transplantation in a patient with cirrhosis associated to autoimmune hepatitis

La hipertensión portopulmonar (HTPP) es una complicación infrecuente de la hipertensión portal, que sigue un curso progresivo con un pronóstico sombrío. Los reportes en pacientes pediátricos son escasos y con períodos de seguimiento cortos. Se describe una paciente con cirrosis descompensada que desarrolló HTPP resuelta mediante trasplante hepático, que permanece asintomática tras diez años de seguimiento.

Portopulmonary hypertension is an uncommon complication of portal hypertension, running a progressive course with a negative prognosis. Reports in pediatric patients are scarce with short follow up. We describe the case of decompensated cirrhosis who developed PoPH and resolved with liver transplantation, remaining asymptomatic after ten years of follow up.

Guías para el diagnóstico y seguimiento de niños y adolescentes portadores de hipertensión portal / Guidelines for diagnosis and follow-up of children and adolescents with portal hypertension

La hipertensión portal es un síndrome complejo producido por un aumento de la resistencia al flujo venoso esplácnico a nivel de la vena porta o sus ramas, con una circulación sistémica hiperdinámica caracterizada por vasodilatación periférica y aumento del gasto cardíaco. El sitio de obstrucción al flujo portal puede ser prehepático (hígado normal), intrahepático (como en la cirrosis) o posthepático (síndrome de BuddChiari). En los pacientes pediátricos, las causas prehepáticas e intrahepáticas se reparten en proporciones casi iguales (aproximadamente el 50 % cada una). La expresión clínica y el impacto individual son muy variados, pero en todos los casos expresan un deterioro en la salud de los pacientes y la necesidad de corregir el problema, tanto en sus consecuencias como, idealmente, en sus causas.

Portal hypertension is a complex syndrome caused by increased resistance to the splachnic venous flow at the portal vein level, with a hyperdynamic systemic circulation characterized by peripheral vasodilation and high cardiac output. Portal flow can be obstructed at prehepatic (¨normal liver¨), intrahepatic (as in cirrhosis), or post-hepatic level (as in Budd-Chiari syndrome). In pediatric patients, prehepatic and intrahepatic causes are almost equally distributed (nearly 50% each). Clinical presentation and individual impact are heterogeneous, but in each case, it is the expression of a worsening condition and the need to solve the problem, either by treating its consequences or (ideally) its causes.

Guía para el seguimiento de pacientes pediátricos con enfermedad hepática crónica / Guidelines for the follow-up of pediatric patients with chronic liver disease

La historia natural de la enfermedad hepática crónica (EHC) se caracteriza por una fase de cirrosis compensada asintomática seguida de una fase descompensada, que se acompaña de signos clínicos evidentes, de los cuales los más frecuentes son la ascitis, las hemorragias, la encefalopatía y la ictericia. Esta guía actualizada sobre el manejo de pacientes con EHC en la edad pediátrica fue confeccionada con el propósito de mejorar la práctica clínica de estos pacientes complejos y darle herramientas al pediatra de cabecera para un seguimiento adecuado. Para ello, un grupo de expertos subrayó la importancia del inicio temprano del tratamiento etiológico en cualquier grado de enfermedad hepática y ampliaron su labor jerarquizando las complicaciones de la cirrosis: ascitis, hemorragia digestiva, infecciones, malnutrición; aspectos endocrinológicos, neurológicos, oftalmológicos y gastrointestinales; y complicaciones vasculares pulmonares y renales. Se incluyeron, además, aspectos psicosociales, así como el cuidado del adolescente en su transición a la vida adulta.

The natural history of chronic liver disease (CLD) is characterized by a phase of asymptomatic compensated cirrhosis followed by a decompensated phase, accompanied by the development of evident clinical signs, the most frequent being ascites, hemorrhages, encephalopathy and jaundice. This updated guideline on the management of pediatric patients with CLD was developed with the purpose of improving the clinical practice of these complex patients and to provide the pediatrician with tools for an adequate follow-up. To this end, a group of experts, after stressing the importance of early initiation of etiologic treatment in any degree of liver disease, expanded their work to include a hierarchy of complications of cirrhosis: ascites, gastrointestinal bleeding, infections, malnutrition, endocrinological, neurological, ophthalmological, gastrointestinal, pulmonary vascular and renal complications. Psychosocial aspects including the care of the adolescent in their transition to adult life were also included.

Autonomic dysfunction is common in liver cirrhosis and is associated with cardiac dysfunction and mortality: prospective observational study

ABSTRACT BACKGROUND: Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis. OBJECTIVE: To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality. DESIGN AND SETTING: Prospective observational study conducted in the Federal University of São Paulo. METHOD: A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters. RESULTS: The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100. CONCLUSION: Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.

Trastornos de la coagulación en cirrosis hepática: artículo de revisión / Coagulation disorders in liver cirrhosis: a review article

Los eventos fisiopatológicos de la cirrosis hepática alteran drásticamente los procesos de hemostasia primaria, secundaria y fibrinólisis. Antiguamente se conceptuaba que dichas alteraciones predisponían exclusivamente a un estado de hipocoagulabilidad, debido a la baja producción hepática de factores procoagulantes y a la trombocitopenia característica. Actualmente existe evidencia de mecanismos de compensación que llevan a un reequilibrio hemostático, que es inestable y fácilmente desregulado ante comorbilidades, complicaciones y progresión de la enfermedad, conduciendo a fenómenos prohemorrágicos o protrombóticos, como trombosis venosa portal, tromboembolismo venoso, etc. Para determinar eficazmente si un paciente cirrótico tiene riesgo de sangrado, no son de utilidad las pruebas de coagulación convencionales. El tratamiento dependerá del estado hipo o hipercoagulable del paciente. Para ello desarrollamos una revisión de los fenómenos hemostáticos en la cirrosis, con el fin de dar a conocer sus características, el método de diagnóstico más eficaz y los tratamientos disponibles.

The pathophysiological events of liver cirrhosis drastically alter the processes of primary and secondary hemostasis and fibrinolysis. Previously, it was conceptualized that these alterations exclusively predisposed to hypocoagulation, due to the low hepatic production of procoagulant factors and the characteristic thrombocytopenia. Currently, there is evidence of compensation mechanisms that lead to a hemostatic rebalancing, which is unstable and easily dysregulated in the presence of comorbidities, complications and progression of the disease, leading to prohemorrhagic or prothrombotic phenomena, such as portal vein thrombosis, venous thromboembolism, etc. To effectively determine whether a cirrhotic patient is at risk for bleeding, conventional coagulation tests are not helpful. Treatment will depend on the hypo or hypercoagulable state of the patient. In this manuscript, we review the hemostatic phenomena in cirrhosis, to reveal its characteristics, effective diagnostic methods and treatment.

Falla hepática aguda sobre crónica: análisis de una serie de casos y revisión de la literatura / Acute-on-chronic liver failure: analysis of a case series and review of the literature

Introducción. La cirrosis hepática continúa siendo una enfermedad frecuente en nuestro medio, con una mortalidad elevada. Su descompensación se puede asociar a la falla de uno o más órganos, llevando a una falla hepática aguda sobre crónica (ACLF), confiriéndoles a estos pacientes un pronóstico diferente asociado a una alta mortalidad. El objetivo de este artículo es reportar las características clínicas y epidemiológicas de los pacientes que cursaron con ACLF en un hospital de alta complejidad, así como realizar una revisión de la literatura de acuerdo con las definiciones actuales, sobre las diferentes escalas para la evaluación de su pronóstico. Metodología. Estudio descriptivo tipo retrospectivo de series de casos. La población estuvo constituida por la totalidad de los pacientes atendidos en el periodo entre diciembre del 2005 a enero del 2020, mayores de 18 años, y con diagnóstico de cirrosis hepática en el Hospital Pablo Tobón Uribe, que cumplieran los criterios diagnósticos para ACLF. Resultados. Se incluyó una serie de casos de 19 pacientes con diagnóstico de ACLF, el 47,36% correspondía a hombres con una mediana de edad de 53 años, la clasificación de la cirrosis fue Child C para todos, la etiología fue de origen alcohólico en el 42,10%, autoinmune en el 21,05%, virus de la hepatitis B en el 10,52%, y virus de la hepatitis C, esteatohepatitis no alcohólica y cirrosis biliar primaria en el 5,26% de los casos. Los precipitantes de la ACLF fueron alcoholismo activo en el 42,10% de los casos, no se identificó evento en el 26,31%, y las infecciones y sangrado variceal se presentaron en el 15,78%. Ladistribución de la clasificación fue ACLF 1 15,78%, ACLF 2 26,31% y ACLF 3 36,84%. La supervivencia acumulada en los pacientes que recibieron trasplante hepático fue mayor en relación a los que no, 80% versus 33,3%. Conclusión. La ACLF es un proceso dinámico y potencialmente reversible con una mortalidad elevada a corto plazo. En nuestra serie encontramos una mayor supervivencia en los pacientes trasplantados, lo que confiere una mejoría en la sobrevida a corto y largo plazo, por lo que este continúa siendo el tratamiento óptimo en la actualidad.

Introduction. Liver cirrhosis continues to be a common disease in our setting, with high mortality. Its decompensation can be associated with the failure of one or more organs, leading to acute-onchronic liver failure (ACLF), giving these patients a different prognosis associated with higher mortality. The objective of this article is to report the clinical and epidemiological characteristics of patients with ACLF in a high-complexity hospital, as well as to carry out a review of the literature about the different scores for evaluating their prognosis. Methodology. This is a descriptive, retrospective case series study. The population included all the patients during December 2005 to January 2020, over 18 years old, with a diagnosis of liver cirrhosis at the Pablo Tobón Uribe Hospital, who met the diagnostic criteria for ACLF. Results. We included a case series of 19 patients with a diagnosis of ACLF, 47.36% were men with a median age of 53 years, all of them with Child C cirrhosis, the etiology was alcoholic in 42.10%, autoimmune in 21.05%, hepatitis B virus in 10.52%, and hepatitis C virus, non-alcoholic steatohepatitis and primary biliary cirrhosis in 5.26% of the cases. The precipitants of ACLF were active alcoholism in 42.10% of the cases, no event was identified in 26.31%, and variceal infections and bleeding occurred in 15.78%. Classification was ACLF 1 in 15.78%, ACLF 2 in 26.31% and ACLF 3 in 36.84%. Cumulative survival in patients who received liver transplantation was higher in relation to those who did not, 80% versus 33.3%. Conclusion. ACLF is a dynamic and potentially reversible process with high short-term mortality. In our series, we found a longer survival in transplant patients, which improves survival rates at short and long term, so as of today, this continues to be the optimal treatment.

The Gamma-glutamyl Transpeptidase to Platelet Ratio (GPR) Predict Significant Liver Fibrosis and Cirrhosis in Chronic Egyptian HCV Patients

Non- invasive parameters of liver fibrosis are being widely incorporated and adopted in clinical practice, of them, 2 ratios APRI and FIB-4 were proposed and applied. The gamma-glutamyl transferase -to platelet ratio (GPR) was developed and investigated as available test that is useful in predicting liver fibrosis stages in chronic HBV patients. We aimed to estimate the diagnostic performance of GPR compared to APRI in assessing different fibrosis stages estimated by ultrasound based Transient Elastography in chronic HCV Egyptian patients

Prevalence of Hepatitis B and C Virus Infection among Pregnant Women in Sharkia Governorate, Egypt

Viral infections is the cause of liver inflammation, cirrhosis and even liver hepatocellular carcinoma (HCC). Despite the availability of HBV vaccine and antiviral treatment for HBV and HCV both remain a major health problem. The aim of this study To determine the seroprevalence of HBV and HCV infection among pregnant women in Sharkia governorate, Egypt.

Indirect serum biomarkers perform sub optimally in screening for significant liver fibrosis among HIV-infected and uninfected adults in Uganda

ntroduction: Indirect serum biomarkers present an acceptable noninvasive and cheap alternative for screening of significant liver fibrosis (SLF). Evaluation of their use in resource limited settings is important to determine their utility. Methods: We conducted a cross sectional study among 520 HIV infected and HIV uninfected adults attending care clinics in Kampala Uganda. Presence of SLF was determined using Fibroscan® liver stiffness measurement of ≥7.2KPa. The diagnostic value of indirect serum biomarkers for diagnosis of SLF was evaluated using the area under the receiver operating characteristics curve (AUROC) using Fibroscan® as gold standard. Results: Overall AUROC values for Age Platelet Index (API), Aspartate to Alanine Ratio (AAR), AST-to-Platelet Ratio Index (APRI), Fibrosis Index based on 4 Factors (FIB-4) and Gamma glutamyl transferase to Platelet Ratio Index (GPR) were 0.52, 0.49, 0.55, 0.55 and 0.54 respectively. Among HIV-infected participants AUROC values were slightly improved at predicting presence of SLF but still under 70%. Conclusion: Despite APRI and FIB-4 being more likely to identify participants with SLF, the overall diagnostic value of all serum biomarkers was poor with and without stratification by HIV status. We recommend the use of Fibroscan® technology as more accurate non-invasive diagnostic method for screening of SLF

Sociodemographic and medical characteristics of liver cirrhosis deaths in a Ghanaian tertiary hospita

Objective: Cirrhosis is common in Ghana because of its high risk factors prevalence. However, information on cirrhosis in Ghana is lacking. This study aimed to study the clinical, and laboratory characteristics of cirrhotic patients in a tertiary hospital in Ghana. Design: This was a retrospective study of sociodemographic characteristics, symptoms and signs, biochemical and fibrotic indices, treatments, and complications data of 247 patients with cirrhosis who died on admission. Setting: This study was carried out at the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Ghana, Results: Two-thirds (68.0%) of the patients were within 30 to 60 years, with more than half (73.7%) being males. The most common aetiological factors among the patients were Hepatitis B virus infection (53.8%), alcohol use (31.6%) and Hepatitis C virus infection (4.9%). More than half (55.0%) of the patients reported late for admission, and 67.2% died within the first two weeks of admission. The most common clinical feature was abdominal distension (61.1% of patients), and the least was upper-abdominal mass (14.2%). The levels of most liver test parameters were elevated, fibrotic indices were high, and haemoglobin and albumin levels were reduced. More than half (53.8%) of the patients were in Child Pugh class B. The most common complication was hepatic encephalopathy; the least was hepato-renal syndrome. Definite treatment for complications of cirrhosis was lacking. Conclusion: Deaths from cirrhosis at the hospital were mostly of young males with chronic hepatitis B infection. Implementation of hepatitis B prevention and treatment guidelines can help reduce cirrhosis deaths.