Aplicabilidad del índice de fragilidad hepática en pacientes cirróticos evaluados para trasplante / Applicability of the liver frailty index in cirrhotic patients evaluated for transplantation

Introducción. En las últimas décadas se han desarrollado diferentes scores y modelos para predecir el pronóstico en pacientes con enfermedad hepática crónica avanzada. Los más reconocidos y utilizados son el sistema de estadificación de Child-Pugh (CP) y el score de MELD, pero estos carecen de herramientas para evaluar objetivamente otros factores pronósticos. Por este motivo, se ha incorporado el concepto de fragilidad a la hepatología clínica. El objetivo de este artículo es examinar la aplicabilidad del índice de fragilidad hepática (IFH) en pacientes con cirrosis evaluados para trasplante hepático en Uruguay. Metodología. Estudio observacional, descriptivo y retrospectivo en el Servicio de Enfermedades Hepáticas del Hospital Central de las Fuerzas Armadas (HCFFAA) de enero de 2018 a diciembre de 2021. Resultados. Se evaluaron un total de 78 pacientes, excluyéndose 19 de estos, culminando con una muestra final de 59 pacientes. La edad media fue de 52 años, siendo el 66 % hombres. La principal etiología de la cirrosis fue la alcohólica, y la comorbilidad más frecuente fue el sobrepeso/obesidad (66 %). La media de IFH fue de 4,03 ± 0,45. El 90 % de los pacientes eran prefrágiles, el 10 % frágiles y ningún paciente fue clasificado como no frágil. El 76 % presentaba un estadio avanzado de la enfermedad al momento de la evaluación 42 % CP estadio B, 34 % CP C, 24 % CP A, con una media de MELD-Na de 17,8 ± 7,6. El 17 % tuvo complicaciones infecciosas. La mortalidad global (n=78) fue del 12 %, y la de los pacientes con IFH calculado fue del 22 %. Conclusiones. El cálculo del IFH es realizable en cirróticos como herramienta objetiva que brinda una mirada integral del paciente. A mayor severidad de la cirrosis, mayor es el IFH. Sin embargo, este índice no parece ser un predictor de la eventual realización del trasplante hepático, ni de muerte en lista de espera en nuestros pacientes.

Introduction. In recent decades, several scores and models have been proposed to predict prognosis in patients with advanced chronic liver disease. The most recognized and used are the Child-Pugh (CP) and the Model for End-stage Liver Disease (MELD) scores, but they lack tools to objectively evaluate other prognostic factors. For this reason, the concept of fragility has been incorporated into clinical hepatology. The objective of this study was to evaluate the applicability of the liver frailty index (LFI) in patients with cirrhosis evaluated for liver transplantation in Uruguay. Methodology. Observational, descriptive and retrospective study at the Hospital Central de las Fuerzas Armadas (HCFFAA) Liver Disease Service from January 2018 to December 2021. Results. A total of 78 patients were evaluated, 19 were excluded, culminating in a final sample of 59 patients. The mean age was 52 years, with 66% being men. The main etiology of cirrhosis was alcoholic and the most frequent comorbidity was overweight/obesity (66%). The mean LFI was 4.03 ± 0.45. 90% of patients were pre-fragile, 10% were fragile, and no patient was classified as non-fragile. 76% had an advanced stage of the disease at the time of evaluation: 42% CP stage B, 34% CP C, 24% CP A, with a mean MELD-Na of 17.8 ± 7.6. 17% had infectious complications. Overall mortality (n=78) was 12%, and that of patients with calculated LFI was 22%. Conclusions. The LFI can be calculated in cirrhotic patients, and it is an objective tool that provides a comprehensive view of the patient. LFI depends on the severity of the cirrhosis. However, this index is not a predictor of liver transplantation or death on the waiting list in our patients.

Clinical significance of Golgi protein 73 in liver cirrhosis and its relationship with radiological parameters / 中国辐射卫生

Objective To explore the clinical significance of serum Golgi protein 73 (GP73) in liver cirrhosis and its association with radiological parameters. Methods We included 177 patients with liver cirrhosis and 61 patients with chronic hepatitis admitted to The First Hospital of Jilin University from January 2016 to December 2018, with 70 healthy subjects who underwent physical examination during the same period as the control. We compared GP73, alanine transaminase (ALT), aspartate transaminase (AST), albumin (ALB), total bilirubin (TBIL), prothrombin time (PT), and main portal vein diameter between the patients with liver cirrhosis, patients with chronic hepatitis, and healthy subjects. The GP73 level was further compared between liver cirrhosis subgroups by various classification methods. The correlation between GP73 and ALT, AST, ALB, TBIL, PT, and main portal vein diameter was analyzed. Results The GP73 level was significantly higher in the liver cirrhosis group than in the chronic hepatitis group and the healthy control group (P < 0.001). Patients with decompensated cirrhosis had a significantly higher serum GP73 level than those with compensated cirrhosis (P < 0.001). The serum GP73 levels in the Child-Pugh B and C cirrhosis subgroups were significantly higher than that in the Child-Pugh A cirrhosis subgroup (P < 0.05). In the liver cirrhosis group, the GP73 level was positively correlated with AST, ALT, TBIL, PT, and main portal vein diameter, while negatively correlated with ALB. Conclusion Serum GP73 is significantly increased in patients with liver cirrhosis, which is closely related to liver injury indicators. Serum GP73 shows important clinical value for the early diagnosis and prognosis assessment of liver cirrhosis.

The value of Fib4 and APRI in predicting liver failure after hepatectomy in patients with hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To evaluate the value of preoperative aspartate aminotransferaseto platelet ratio index (APRI) and fibrosis index 4 (Fib4) in predicting posthepatectomy liver failure (PHLF) of primary hepatocellular carcinoma.Methods:The data of 587 patients with hepatocellular carcinoma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2020 were retrospectively collected and analyzed, including 412 males and 175 females, aged (56.8±11.2) years. Univariate and multivariate logistic regression were used to analyze the influencing factors of PHLF. The ability of Child-Pugh score, model for end-stage liver diseas (MELD) score, APRI and Fib4 to predict PHLF was evaluated through the receiver operating characteristic (ROC) curve of subjects.Results:Among 587 patients, 186 (31.7%) had liver failure after hepatectomy. In multivariate logistic regression analysis, APRI ( OR=2.660, 95% CI: 1.314-5.384, P=0.007) and Fib4 ( OR=1.322, 95% CI: 1.157-1.511, P<0.001) were risk factors for PHLF in patients with hepatocellular carcinoma. The higher the number, the greater the risk of PHLF. The predicted area under the ROC curve of PHLF in patients with hepatocellular carcinoma was Fib4(0.719)>APRI(0.686)>MELD score(0.618)>Child-Pugh score(0.565). Conclusion:APRI and Fib4 were risk factors of PHLF in patients with hepatocellular carcinoma. They predict the occurrence of PHLF better than Child-Pugh score and MELD score.

Research status and progress on surgical treatment of postoperative recurrence of hepatocellular carcinoma / 器官移植

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. At present, hepatectomy is one of the most frequent therapeutic options, whereas the high postoperative recurrence rate severely affects the long-term survival of HCC patients. Therefore, it is urgent to choose appropriate therapeutic regime to treat the recurrence of HCC to improve the long-term survival of HCC patients. Surgical treatment is an efficacious treatment for recurrent HCC, including re-hepatectomy, salvage liver transplantation and radiofrequency ablation. Currently, individualized treatment is recommended for postoperative recurrence of HCC. The selection of treatment should be conducted based on the tumor conditions after the first hepatectomy, the characteristics of recurrent tumors, baseline data of patients and recurrence time, etc., aiming to formulate appropriate treatment regimes for patients. In this article, these surgical regimes were reviewed and compared to explore appropriate surgical schemes for postoperative recurrence of HCC, aiming to provide reference for prolonging the survival of HCC patients.

Estudio descriptivo de pacientes con cirrosis hepática de etiología viral, en la provincia de Matanzas / Descriptive study of patients with viral-etiology liver cirrhosis in the province of Matanzas

RESUMEN Introducción: la cirrosis hepática de etiología viral representa un impactante problema de salud a nivel mundial, no solo por su elevada tasa de prevalencia, sino por los costos generados en la atención médica. Objetivos: determinar el comportamiento de los pacientes cirróticos, de etiología viral, en la provincia de Matanzas. Materiales y métodos: se realizó un estudio descriptivo-retrospectivo en 47 pacientes con cirrosis hepática de etiología viral, atendidos en el Servicio de Gastroenterología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, de enero de 2016 a enero de 2018. Los resultados de las variables analizadas se expusieron en tablas de doble entrada. Resultados: el 68,1 % de los pacientes correspondió a cirrosis por virus C. Predominaron los mayores de 50 años, con carga viral entre 4-6,9 log10, y atendidos en régimen ambulatorio. En el 57,4 % se detectaron signos endoscópicos de hipertensión portal, que se corroboraron en el doppler hepático. La ascitis asociada a diferentes sepsis fueron las complicaciones más registradas. El 55,4 % fue clasificado como Child-Pugh A, y el 76,6 % en etapa clínica compensada. Conclusiones: el diagnóstico y seguimiento de la cirrosis hepática viral sigue siendo un verdadero reto para la comunidad médica. De ahí los esfuerzos que han de realizarse para su control desde las fases compensadas, para retardar la aparición de complicaciones (AU).

ABSTRACT Introduction: viral etiology liver cirrhosis is an impacting health problem around the world, not only because of its high prevalence rate but also because of the costs generated by its medical care. Objective: to determine the behavior of the patients with viral etiology liver cirrhosis in the province of Matanzas. Materials and methods: a descriptive-retrospective study was carried out in 47 patients with viral etiology liver cirrhosis treated in the service of Gastroenterology of the Hospital "Comandante Faustino Perez" of Matanzas, from January 2016 to January 2018. The results of the analyzed variables were shown in double-entry tables. Results: 68.1% of the patients presented cirrhosis caused by C virus, Patients elder 50 years old predominated, with 4-6.9 log10, treated in ambulatory regimen. Endoscopic signs of portal hypertension were found in 57.4%. It was corroborated with liver Doppler. Ascites associated to different sepsis were the most frequently registered complications. 55.4% were classified as Child-Pugh A, and 76.6% were in compensated clinical stage. Conclusions: viral liver cirrhosis diagnosis and follow-up is still a true challenge for the medical community, and hence the efforts that should be made to control it from the compensated stages to delay the appearance of complications (AU).

Patient counseling for chronic liver disease patients with anxiety and depression: A cross-sectional study

Anxiety and depression were interlinked with the severity of liver diseases. Patients should know the true severity ofthe disease and patient counseling helps them. This was a cross-sectional study carried out on 100 patients sufferingfrom chronic liver disease. Child Turcotte Pugh score was used to calculate the severity of the disease. HospitalAnxiety and Depression Scale was used to calculate the anxiety and depression of patients. Non-parametric tests areused to find out the association. The level of significance was p < 0.05. The mean age group of patients was 47.29± 13.17 years. The three most presenting clinical signs and symptoms according to their occurrence was abdominalpain (74%), edema (58%), and ascites (51%). The median Child Turcotte Pugh score was 9 corresponds to class B.We observed highly significant association (p < 0.01) between total bilirubin (p < 0.0001), albumin (p < 0.0001),and the severity and prognosis of the disease. We observed a higher percentage of patients with borderline abnormalanxiety (61%) and depression (51%) in our study. High-risk patients were made aware of the severity of the diseaseand consequences thereafter, provided with patient counseling along with a list of deaddiction centers. Integrating apsychologist can benefit patients struggling with deaddiction of alcohol.

Correlation Study of Coagulation Profile in Spectrum of Liver Diseases.

Liver plays a central role in the maintenance of haemostasis. Impairment of liver parenchymal cell function disturbs haemostasis resulting in the development of multiple coagulation abnormalities. We wanted to study the coagulation profile and haemostatic dysfunction in liver disease patients so as to prevent bleeding related complications and evaluate the relationship between bleeding tendencies and coagulation profile abnormalities in such patients.METHODSThis was a cross sectional study conducted in the Department of Pathology, JNMC, A.V.B.R.H, Sawangi, Wardha, from August, 2017 to July 2019 among 102 patients of liver diseases. PT, D-dimer, and platelet count were assessed in different liver diseases. Data was entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A p value of <0.05 was considered statistically significant.RESULTSA total of 102 patients were included in the study. Mean age of the patients was 40.07 ± 15.21 years. 69.61% patients were males. Fever with abdominal distension was the most common complaint. Mean with SD of Child Pugh score was 8.31±2.3 and Mean with SD of MELD score was 13.1±8.24. For predicting cirrhosis and other chronic liver disorders, out of all coagulation parameters, D-Dimer showed the best diagnostic accuracy.CONCLUSIONSPresent study showed an overall good diagnostic power of coagulation parameters in assessing different liver diseases and also showed that D-dimer may be regarded as a stable and good predictor for chronic liver diseases.

Evaluation of Non-endoscopic Parameters for the Detection of Esophageal Varices in Patients of Liver Cirrhosis, Confirmed by Endoscopy

Introduction: Esophageal varices are generally the mostcommon clinical manifestation of portal hypertension inPatients of liver cirrhosis. Most common causes of deathin liver cirrhosis are hemorrhage from esophageal varices.The present study has been carried out to identify clinical,biochemical and ultrasonographic parameters which mightnon‑invasively predict the existence and the risk of varicealbleed.Material and Methods: The present prospective observationalstudy was conducted in 2 years among 100 patients sufferingfrom liver cirrhosis above 18 years of age. Detailed history,clinical examination, investigations to fulfill the inclusionand exclusion criteria of all patients was taken. Different nonendoscopic parameters were taken Plateletcount, Coagulationprofile, Ultrasonography whole abdomen, Child-PughTorcotte (CPT) Score, AST to platelet ratio index (APRI) forthe detection of esophageal varices and its grading in livercirrhosis patients which was confirmed by endoscopy.Results: There was significant association of presence ofesophageal varices in liver cirrhosis patients with presence oficterus, presence of ascites,presence of splenomegaly, gradeof Child Pugh Score, AST to Platelet rationdex (APRI score)Prothrombin Time and International Normalized Ratio(PT/INR), mean TB (mg/dl), mean spleen size.Conclusions: The result of present study concluded thatsome parameters are strongly associated with grades ofvarices and could be useful for early detection and subsequentmanagement of varices.

Correlation between APRI Index, MELD Score and Child Pugh Score in cirrhosis of liver

Background: Liver cirrhosis is the end result of chronic liver injury and is one of the most common cause of morbidity and mortality. Several scorings are available to predict the severity and prognosis of liver cirrhosis. This study aims to calculate APRI index, MELD score and child Pugh score in cirrhosis patients and to find the correlation between them.Methods: This is the Cross-sectional study on 100 patients confirmed with cirrhosis of liver. Cirrhosis due to alcohol, Hepatitis B and C, autoimmune, Cryptogenic, NAFLD, were included in the study. APRI Index, MELD Score and Child Pugh Score were calculated, and the correlation was obtained.Results: This study found out the relationship between APRI index, MELD Score and Child Pugh Score with significant p value. The study also showed that all the three scores were raised with patients who had complication of cirrhosis like encephalopathy, refractory ascites. Among those who had complication like grade 3 or 4 encephalopathy, APRI index had a mean value of 3.4, Child Pugh had a mean score of 13.2, and MELD had a mean score of 36.08 with standard deviation of 2.0, 1.5, 6.0 respectively.Conclusions: APRI index is an independent predictor of morbidity and mortality. The prognostic performance of all 3 was comparable, Hence APRI index can be used as an alternative scoring which is cost effective and objective method in predicting the severity and prognosis in cirrhosis of liver.

Cardiovascular dysfunction in patients of cirrhosis of liver

Background: Cirrhosis of liver refers to a progressive condition that disrupts the normal architecture of the liver. It is increasingly recognized that cirrhosis per se can cause cardiac dysfunction. The aim was to assess cardiovascular dysfunction electrocardiographically and echocardiographically in patients with cirrhosis of liver and to find the correlation between cardiovascular dysfunction and severity of liver cirrhosis as per child-PUGH score.Methods: Total 90 patients of cirrhosis of liver of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. The severity of liver cirrhosis was assessed as per Child Pugh Score. QTc interval was calculated by Bazett抯 formula. Systolic and Diastolic dysfunction was seen on 2D-echocardiography.Results: QTc interval increased linearly with the severity of liver cirrhosis. Mean values of QTc in Child Pugh Class A=425.00(�.97), Class B=437.35(�.60), Class C=479.71(�.48) with p value of 0.04 which is significant. Diastolic dysfunction was also related with the severity of liver cirrhosis. In Child Pugh Class A= 2(33%) patients had grade 1 diastolic dysfunction, Class B=23(59%) patients had grade 1 diastolic dysfunction while in Child Pugh Class C=3(7%) had grade 1 diastolic dysfunction, 33(73%) patients had grade 2 diastolic dysfunction and 1(2%) patients had grade 3 diastolic dysfunction with p value of 0.04 which is significant. Systolic function was found normal in all the patients.Conclusions: Diastolic dysfunction and QTc interval prolongation are both related with the severity of liver cirrhosis and are major criteria of cirrhotic cardiomyopathy.

Diastolic dysfunction in patients with liver cirrhosis: A short-term, observational study at a Malaysian hospital

@#Cirrhotic cardiomyopathy is a recognised complication of liver cirrhosis and predicts poor outcomes. Detection of diastolic dysfunction, an early indicator of left ventricular dysfunction can help identify those patients at risk of disease progression. In our study we showed that there was a high prevalence of diastolic dysfunction amongst patients with liver cirrhosis at our outpatient clinic, with the majority being Child-Pugh A/low MELD score. Multiple regression analysis indicated that age and sodium levels were significantly associated with the presence of diastolic dysfunction. This further reinforces the importance of dietary sodium restriction amongst patients with liver cirrhosis.

Difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation / 器官移植

Objective To compare the difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation (LDLT). Methods Clinical data of 272 donors and recipients undergoing LDLT were retrospectively analyzed. According to different patterns of hepatic artery reconstruction, all recipients were divided into the magnifying glass group (n=189) and microscope group (n=83). The operation time, intraoperative blood loss, hepatic artery reconstruction site, diameter of anastomosis, incidence of postoperative complications and survival rate of recipients were statistically compared between two groups. Results Compared with the microscope group, the operation time, hepatic artery reconstruction time and intraoperative blood loss were significantly less in the magnifying glass group (all P < 0.001). The most common site of hepatic artery reconstruction was the right hepatic artery in two groups, and the diameter of anastomosis was (2.1±0.9) mm in the magnifying glass group and (2.1±0.8) mm in the microscope group, with no statistical significance between two groups (P > 0.05). The 1-, 2- and 3-year survival rates of recipients in the magnifying glass group were 88%, 86% and 85%, which did not significantly differ from 89%, 87% and 86% in the microscope group (all P > 0.05). The incidence of postoperative complications did not significantly differ between two groups (all P > 0.05). Conclusions The efficacy and safety of hepatic artery reconstruction in LDLT under surgical magnifying glass are equivalent to those under surgical microscope, with less operation workload and intraoperative blood loss. For experienced transplantation surgeons, it is recommended to perform hepatic artery reconstruction assisted by surgical magnifying glass.

Application of acoustic radiation force impulse elastography combined with serum markers in Child-Pugh grading

OBJECTIVES: Acoustic radiation force impulse (ARFI) elastography, the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 (FIB-4) index are widely used to assess liver fibrosis. However, efficacies of these methods in the evaluation of hepatic functional reserve remain unclear. In this study, we investigated the relationship between ARFI elastography combined with either AAR, APRI, or FIB-4 index and Child-Pugh (CP) class for the evaluation of hepatic functional reserve in patients with chronic hepatitis B (CHB)-related cirrhosis. METHODS: The shear wave velocities of 104 patients with clinically confirmed CHB-related cirrhosis were determined using the ARFI; and clinical serum markers (e.g. ALT, AST, PLT) were used to calculate the AAR, APRI, and FIB-4 index. Cirrhosis patients were scored according to their CP class. The ARFI, AAR, APRI, and FIB-4 index were compared with the CP class. The efficacy of each indicator in diagnosis was analyzed using the receiver operating characteristic (ROC) curve and the ARFI combined with either the AAR, APRI, or FIB-4 index, which is used to predict decompensated cirrhosis. RESULTS: No significant differences were observed in gender and age among CP classes A, B, and C patients (p>0.05). The ARFI values and the AAR, APRI, and FIB-4 index of patients with CP classes A, B, and C were significantly different (p<0.05). With an increasing CP class, the ARFI, AAR, APRI, and FIB-4 values increased. The correlation between the ARFI and the CP class was stronger than that between the AAR, APRI, and FIB-4 index and the CP class. The area under the ROC curve for the diagnosis of decompensated cirrhosis using the ARFI was 0.841, which was higher than that for the AAR, APRI, and FIB-4 index. According to the area under the curve results, no significant differences were found when the ARFI was combined with either the AAR, APRI, or FIB-4 index and when the ARFI alone was used. CONCLUSIONS: The ARFI value has a strong correlation with the CP class. Therefore, ARFI elastography complements CP class in the assessment of the hepatic functional reserve in patients with CHB-related cirrhosis.

Utility of MELD Score as Prognostic Indicator in Patients of Liver Cirrhosis and its Correlation with Child-Pugh Score

Introduction: The model for end-stage liver disease (MELD)score is a useful tool to assess prognosis in critically illcirrhotic patients. Therefore present study’s aim is to evaluateprognostic value of MELD score in patients with cirrhosis andto find out the correlation of MELD score with Child-PughScore.Material and Methods: Present study was carried out ina large public hospital in Mumbai from October 2003 toNovember 2004 on liver cirrhosis patients. Seventy sixpatients of cirrhosis of liver who had attended gastroenterologyoutpatient department of the hospital were included in thestudy. Thirty age and sex matched healthy controls wereincluded in the study. MELD score was calculated at Mayoclinic calculator site.Results: Mean age of cases of cirrhosis was 46.97 + 12.96years with range of 15-74 years. There was no significantdifference in the age or sex distribution of cases in the survivalor expired category (p>0.05). Our study showed significantdifference in mortality between the three Child Pugh grades(p<0.05). Present study showed significant correlationbetween MELD score and Child-Pugh Score. Mean MELDscore was significantly more in expired cases (22.0+7.74)than in survived cases (14.87+6.42) during six monthlyfollow up period (p<0.05).Cases with MELD scores ≥30 hadsignificantly high mortality rate.Conclusion: Therefore MELD score can be used as significantshort term prognostic factor in patients with cirrhosis.

Serum Uric Acid Level and Its Association with Child Pugh Score in Chronic Liver Disease

Introduction: Chronic liver disease is a disorder in whichprogressive destruction of liver parenchyma leads to fibrosisand lead to cirrhosis. Increased level of serum uric acid may because insulin resistance, metabolic syndrome and oxidativestress which are the risk factors for progression of liverdisease.Objective: To estimate the levels of uric acid and evaluate itsassociation with the severity of liver disease.Methods: One hundred fifty patients diagnosed with Chronicliver disease, age between 20 to 65 years, either gender, wereenrolled in the study. Patients were grouped as classes A, Band C on the basis of Child Pugh score. Serum uric acid wasestimated and compared among the three groups.Result: Analysis of Variance (ANOVA) was applied and it wasobserved that there was a significant elevation of serum uricacid level with the progression of disease (P = <0.001). Apositive association of uric acid on applying Spearman’scorrelation, with progression of Child Pugh score was alsoobserved (r = 0.293; P = <0.001)

To Study the Prevalence of QTc Interval Prolongation in Cirrhosis of Liver And Its Relationship with the Severity of Disease

Background: Cirrhosis of liver is considered as chronicdisease of liver characterised by the triad of parenchymalinflammation, necrosis and regeneration with diffuse increasein fibrosis and formation of nodules around regenerating liverparenchyma. A retrospective study of 90 patients of livercirrhosis visiting OPD/Indoor of SGRDIMSR, Vallah, SriAmritsar were included in the study conducted from Jan 2017to Aug 2018 to assess QTc interval in patients with cirrhosis ofliver due to any etiology and to find the correlation betweenQTc interval and severity of liver cirrhosis as per Child-PughScore.Methods: The severity of liver cirrhosis was assessed andaccording to the Child Pugh Score, divided into Class A, ClassB and Class C of 30 patients each. QT interval was noted in allthe patients. QTc was calculated by Bazett’s formula. Fromabove parameters we try to find out whether there is anycorrelation between QTc and severity of disease.Results: The mean value of calculated QTc interval in: ClassA=0.474; Class B=0.490 and Class C=0.583. The QTc intervalincreased linearly with the severity of the disease and the pvalue was less than 0.001 which is highly significant.Conclusion: In our study we concluded that the prolongationof QTc interval is co-related with liver function and itsprevalence increases with the severity of liver dysfunction.Prolongation of the QTc interval was statistically confirmed inChild-Pugh C and B. The prolonged Q-T interval predictssevere arrhythmias and sudden death, and they are the idealcandidates for liver transplantation.

Clinical value of preoperative aspartate aminotransferase-to-platelet ratio index in predicting liver failure after hepatectomy for primary liver cancer / 第二军医大学学报

Objective To explore the predictive value of preoperative aspartate aminotransferase-to-platelet ratio index (APRI) for post-hepatectomy liver failure (PHLF) after hepatectomy in the patients with primary liver cancer (PLC). Methods A retrospective study was conducted on the data from the PLC patients who underwent first hepatectomy in Tumor Hospital Affiliated to Guangxi Medical University between Sep. 2013 and Dec. 2016. The logistic regression model and receiver operating characteristic (ROC) curve were performed to determine the predicting values of APRI, Child-Pugh score, model for end-stage liver disease (MELD) score and albumin-bilirubin (ALBI) score for PHLF. Results A total of 1 108 PLC patients were included in this study, and PHLF occurred in 217 (19.58%) patients. The logistic regression analysis showed that Child-Pugh score, MELD score, ALBI score and APRI were predicting factors for PHLF (all P0.05). The ROC curve analysis showed that preoperative APRI (area under curve [AUC]: 0.745, 95% confidence interval [CI] 0.709-0.781, P0.001) was significantly better for predicting PHLF compared with Child-Pugh score (AUC 0.561, 95% CI 0.516-0.605, P＝0.005), MELD score (AUC 0.650, 95% CI 0.610-0.691, P0.001) and ALBI score (AUC 0.662, 95% CI 0.621-0.703, P0.001). Based on Youden index, the best cut-off value of preoperative APRI was 0.55 for predicting PHLF in PLC patients, with a sensitivity of 71.9% and a specificity of 68.5%, and the patients with APRI0.55 had significantly higher overall incidence of PHLF, and higher incidence of PHLF A, B and C compared with ones with APRI≤0.55 (all P0.05). Conclusion Preoperative APRI is more accurate for predicting PHLF after hepatectomy in PLC patients versus the Child-Pugh, MELD and ALBI scores, providing guiding significance for clinical treatment of PLC.

Effect of different liver function Child-Pugh classification on clinical prognosis of hepatocellular carcinoma recipients after liver transplantation / 器官移植

Objective To evaluate the effect of the different Child-Pugh classification on the recurrence and survival of hepatocellular carcinoma (HCC) recipients after liver transplantation. Methods Clinical data of 125 HCC recipients undergoing liver transplantation were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival curve. The independent risk factors probably affecting the recurrence and survival of HCC recipients after liver transplantation were identified by using Cox's proportional hazards regression model. Results The median follow-up time was 25.6 months. The 3-year DFS and OS rates were 68.4% and 65.7% for all patients. The 3-year DFS and OS rates in 113 patients with Child-Pugh class A/B HCC were 68.6% and 66.2%, whereas 66.7% and 65.6% for 12 patients with Child-Pugh class C HCC with no statistical significance (all P>0.05). Cox's proportional hazards regression model demonstrated that vascular invasion (P=0.001)and the number of tumors>3 (P=0.025) were the independent risk factors for the postoperative recurrence of HCC in recipients undergoing liver transplantation. Alpha fetoprotein (AFP)>400μg/L (P=0.035), vascular invasion (P=0.031) and number of tumors>3 (P=0.008) were the independent risk factors affecting the survival of HCC patients. Conclusions The postoperative prognosis does not significantly differ between Child-Pugh class C and A/B HCC patients after liver transplantation. AFP, vascular invasion and number of tumors are the risk factors affecting the clinical prognosis of HCC patients after liver transplantation. Liver transplantation is an efficacious treatment for HCC patients with Child-Pugh class C.

Correlation between serum CA125 level and severity of liver dysfunction in patients with liver cirrhosis: A Meta-analysis / 临床肝胆病杂志

ObjectiveTo investigate the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis. MethodsWanfang Data, CNKI, CBM, and VIP were searched for Chinese articles on the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis published from January, 2008 to October, 2018, with a liver cirrhosis group and a normal control group in each article. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for quality assessment. The mean and standard deviation of CA125 in liver cirrhosis group, healthy control group, and liver cirrhosis groups with different Child-Pugh classes were analyzed. Meta-Analyst software was used to calculate the standardized mean deviation (SMD) of CA125 in each group and perform the meta-analysis. A heterogeneity analysis was performed for the studies included in this study; a random effects model was used in case of significant heterogeneity, while a fixed effect model was used in case of insignificant heterogeneity. A one-way analysis of variance was used for comparison of continuous data between multiple groups. ResultsA total of 15 articles were included in this study. The meta-analysis showed that the liver cirrhosis group had a significantly higher serum CA125 level than the healthy control group (181.18±110.76 U/ml vs 15.10±7.15 U/ml, SMD=2.28, 95% confidence interval: 1.81-2.76, P＜0.001). The level of CA125 increased significantly with the increase in Child-Pugh class (F=15.704, P＜0.001). ConclusionSerum CA125 level is correlated with the severity of liver dysfunction in patients with liver cirrhosis and thus has a certain value in evaluating the severity of liver dysfunction and predicting prognosis.

Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. MATERIALS AND METHODS: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy₁₀ (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy₁₀ (median, 56.0 Gy₁₀). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.