Prognostic utility of systemic inflammatory markers and chronic hepatitis C virus infection status in hepatocellular carcinoma patients treated with local ablation.

BACKGROUND: Hepatocellular carcinoma (HCC) has high incidence and mortality worldwide. Local ablation using radiofrequency ablation (RFA) or microwave ablation (MWA) is potentially curative for early-stage HCC with outcomes comparable to surgical resection. We explored the influence of demographic, clinical, and laboratory factors on outcomes of HCC patients receiving ablation. METHODS: This retrospective cohort study included 221 HCC patients receiving local ablation at Mayo Clinic between January 2000 and October 2018, comprising 140 RFA and 81 MWA. Prognostic factors determining overall survival (OS) and disease-free survival (DFS) were identified using multivariate analysis. RESULTS: There was no clinically significant difference in OS or DFS between RFA and MWA. In multivariate analysis of OS, pre-ablation lymphocyte-monocyte ratio [Hazard ratio (HR) 0.7, 95% confidence interval (CI) 0.58-0.84, P = 0.0001], MELD score [HR 1.12, 95%CI 1.068-1.17, P <  0.0001], tumor number [HR 1.23, 95%CI 1.041-1.46, P = 0.015] and tumor size [HR 1.18, 95%CI 1.015-1.37, P = 0.031] were clinically-significant prognostic factors. Among HCC patients with chronic hepatitis C (HCV) infection, positive HCV PCR at HCC diagnosis was associated with 1.4-fold higher hazard of death, with 5-year survival of 32.8% vs 53.6% in HCV PCR-negative patients. Regarding DFS, pre-ablation lymphocyte-monocyte ratio [HR 0.77, 95%CI 0.66-0.9, P = 0.001], MELD score [HR 1.06, 95%CI 1.022-1.11, P = 0.002], Log2 AFP [HR 1.11, 95%CI 1.033-1.2, P = 0.005], tumor number [HR 1.29, 95%CI 1.078-1.53, P = 0.005] and tumor size [HR 1.25, 95%CI 1.043-1.51 P = 0.016] were independently prognostic. CONCLUSIONS: Pre-ablation systemic inflammation represented by lymphocyte-monocyte ratio is significantly associated with OS and DFS in HCC patients treated with local ablation. HCV viremia is associated with poor OS. Tumor biology represented by tumor number and size are strongly prognostic for OS and DFS while AFP is significantly associated with DFS only.

Spontaneous bacterial empyema in patients with liver cirrhosis in Upper Egypt: prevalence and causative organisms.

BACKGROUND: Spontaneous bacterial empyema (SBEM) is a complication in cirrhotic patients, in which a preexisting pleural effusion becomes infected. PURPOSE: The purpose was to determine the prevalence and causative organisms of SBEM among cirrhotic patients with hydrothorax. MATERIALS AND METHODS: This descriptive, cross-sectional study included 901 cirrhotic patients. All patients underwent clinical evaluation, liver function tests, chest X-ray, abdominal and chest ultrasonography, and pleural and peritoneal fluids study (when detected) including polymorphonuclear (PMN) leukocyte count, biochemical analysis, and culture by two methods: conventional and modified (inoculation of 10 mL of pleural or peritoneal fluid into a blood culture bottle). Diagnostic criteria for SBEM included positive pleural fluid culture and a PMN count of >250 cells/mm(3) or, if a negative culture, a pleural fluid PMN count of >500 cells/mm(3) and the absence of pneumonia on chest radiography. RESULTS: Of 901 cirrhotic patients, 16 cases of SBEM were diagnosed. The prevalence of SBEM was 1.8 % in cirrhotic patients and 26.2 % in patients with cirrhosis and hydrothorax. Pleural fluid culture was found to be positive by the conventional method in four (25 %) cases and by modified methods in 11 (68.8 %) cases. Escherichia coli was the most frequently isolated pathogen (six cases). The mortality rate of SBEM was 25 %. CONCLUSIONS: SBEM is a frequent complication in cirrhotic patients with hydrothorax. E. coli is the most frequent organism responsible for SBEM. The modified method of pleural fluid culture is more sensitive than the conventional method for diagnosis of SBEM.

Hepatobiliary disorders among naïve patients with ulcerative colitis in Upper Egypt.

BACKGROUND AND STUDY AIMS: Association of ulcerative colitis (UC) with hepatobiliary disorders is well recognised. The most common hepatobiliary complications of inflammatory bowel disease (IBD) are fatty liver infiltration and cholelithiasis. The prevalence of liver dysfunction in IBD remains unclear. The aim of the study is to try to identify the frequency and risk factors of hepatobiliary disorders among patients with UC in Upper Egypt. PATIENTS AND METHODS: We prospectively analysed 33 patients with newly diagnosed UC of Tropical Medicine and Gastroenterology Department, Assiut University Hospital. For all participants, the following were conducted: clinical evaluation, abdominal ultrasonography (US) examination and laboratory investigations. Risk factors of hepatobiliary disorders were identified using univariate, then multivariate analysis. RESULTS: The frequency of hepatic disorders (fatty liver and elevated liver chemistry) was 75.8% in study patients while the frequency of biliary disorders (gallbladder stones and gallbladder wall thickening) was 54.5%. A higher risk of hepatic disorders was observed with older age (odds ratio (OR) 14, 95% confidence interval (CI) 2-124). A higher risk of biliary disorders was observed with UC severe activity index (OR 27, 95% CI 3-292). CONCLUSIONS: The frequency of hepatobiliary disorders in patients with UC exceeded what was previously reported. High frequency of hepatic disorders was related to older age, while that of biliary disorders was related to UC activity.