Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis?

BACKGROUND/AIMS: Cellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis. METHODS: Six hundred twenty consecutive HCV-related cirrhotic patients were evaluated for cellulitis. Demographic and clinical data were evaluated, along with blood and skin cultures. Severity of cirrhosis was assessed using Child-Pugh score. In-hospital mortality was assessed. RESULTS: Seventy-seven (12.4%) cirrhotic patients had cellulitis (25 with compensated and 52 with decompensated disease). Smoking and venous insufficiency were risk factors of cellulitis in compensated cirrhosis. Leg edema, ascites, hyperbilrubinemia and hypoalbuminemia were risk factors in decompensated cirrhosis. Gram-positive bacteria (Staphylococcus spp. and Streptococcus pyogenes) were the infective organisms in compensated patients, while gram negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were the predominant organisms in decompensated cirrhosis. Fungi (Candida albicans and Aspergillus niger) were detected in 3 decompensated cases. In-hospital mortality in patients with cellulitis was 27.3%, approaching 100% in decompensated patients with gram-negative cellulitis. Prolonged hospitalization, higher model for end-stage liver disease (MELD)-Na score, septic shock, local complication, and recurrent cellulitis were predictors of mortality. CONCLUSIONS: Cellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. Cellulitis has a poor prognosis, with mortality rates approaching 100% in decompensated patients with gram-negative cellulitis. Stratifying patients according to severity of cirrhosis is important to identify the proper empirical antibiotic and to decide the proper means of care.

Novel prognostic biomarkers for HCC progression in Egyptian patients

Objectives: To evaluate values of Cyclin D and Cdk4 in HCC, chronic hepatitis C, HCV related liver cirrhosis and healthy controls, their clinico-radiological correlations and prognosis of HCC

Methods: Group 1: Fifty patients with HCC, Group 2.Fifty patients with chronic hepatitis C with or without cirrhosis and Group 3: Thirty healthy controls were enrolled. All patients were positive for hepatitis C virus [HCV] antibody and confirmed by HCV RNA. Calculation of Barcelona-Clinic Liver Cancer [BCLC] staging system, MELD and Child-Pugh scores. mRNA for cyclin Dl and Cdk4 were analyzed by quantitative RT-PCR

Results: The mean Cyclin Dl and Cdk4 values were higher in HCC group compared with the other two groups [p value= 0.001]. In HCC group, the mean Cdk4 and cyclin Dlvalues were significantly higher among HCC patients with multiple hepatic focal lesion [HFL] [p value= 0. 0001, and003 respectively] compared with those with single lesion. A significant correlation between size of [HFL], alpha-Fetoprotein[AFP] and mean Cdk4 value [p value= 0.028, 0.0001 respectively]

Conclusions: Significant values of cyclin Dl and Cdk4 were found in HCC, compared to normal and chronic hepatitis C and correlated to the number, size of HFL and AFP level. Thus, the assessment of cyclin Dl and Cdk4 may provide a novel strategy for prognostication and targeted therapy of HCC