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Consecutive Cirrhotic Patients (consecutive + cirrhotic_patient)
Selected AbstractsAscites improves upon plus serum sodium model for end-stage liver disease (MELD) for predicting mortality in patients with advanced liver diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009M. SOMSOUK Summary Background, The clinical impact of ascites has historically been well recognized; however, its value is unclear in the context of current prognostic models. Aim, To determine whether ascites can improve risk discrimination beyond model for end-stage liver disease (MELD) and serum sodium (MELDNa). Methods, Consecutive cirrhotic patients were evaluated for ascites on the basis of an outpatient CT along with concurrent MELD and Na values. Cox models were used to determine the added value of ascites for predicting 1-year mortality. Increases in the C-index, integrated discrimination improvement (IDI) and the net reclassification index (NRI) were used to assess improvements in discrimination after the addition of ascites. Results, A total of 1003 patients had Na and MELD scores available within 30 days of the CT scan. A total of 60 deaths occurred within 1 year, with mortality higher in patients with ascites (21.4% vs. 4.0%, HR 6.08, 95% CI 3.62,10.19, P < 0.0005). In the presence of ascites, the MELD and MELDNa scores underestimated mortality risk when the scores were less than 21. The addition of ascites to the MELDNa model substantially improved discrimination by the C-index (0.804 vs. 0.770, increase of 3.4%, 95% CI 0.2,9.9%), IDI (1.8%, P = 0.016) and NRI (15.8%, P = 0.0006). Conclusion, The incorporation of radiographic ascites significantly improves upon MELDNa for predicting 1-year mortality. The presence of ascites may help identify patients at increased risk for mortality, not otherwise captured by either MELD or MELDNa. [source] Propranolol plus placebo versus propranolol plus isosorbide-5-mononitrate in the prevention of a first variceal bleed: A double-blind RCTHEPATOLOGY, Issue 6 2003Juan Carlos García-Pagán M.D. Nonselective ,-blockers are very effective in preventing first variceal bleeding in patients with cirrhosis. Treatment with isosorbide-5-mononitrate (IS-MN) plus propranolol achieves a greater reduction in portal pressure than propranolol alone. The present multicenter, prospective, double-blind, randomized, controlled trial evaluated whether combined drug therapy could be more effective than propranolol alone in preventing variceal bleeding. A total of 349 consecutive cirrhotic patients with gastroesophageal varices were randomized to receive propranolol + placebo (n = 174) or propranolol + IS-MN (n = 175). There were no significant differences in the 1- and 2-year actuarial probability of variceal bleeding between the 2 groups (propranolol + placebo, 8.3% and 10.6%; propranolol + IS-MN, 5% and 12.5%). The only independent predictor of variceal bleeding was a variceal size greater than 5 mm. However, among patients with varices greater than 5 mm (n = 196), there were no significant differences in the incidence of variceal bleeding between the 2 groups. Survival was also similar. Adverse effects were significantly more frequent in the propranolol + IS-MN group due to a greater incidence of headache. There were no significant differences in the incidence of new-onset or worsening ascites or in impairment of renal function. In conclusion, propranolol effectively prevents variceal bleeding. Adding IS-MN does not further decrease the low residual risk of bleeding in patients receiving propranolol. However, the long-term use of this combination drug therapy is safe and may be an alternative in clinical conditions associated with a greater risk of bleeding. [source] Toll-like receptor 4 D299G polymorphism and the incidence of infections in cirrhotic patientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2010C. GUARNER-ARGENTE Aliment Pharmacol Ther,31, 1192,1199 Summary Background, Toll-like receptor (TLR) 4 genetic polymorphisms, mainly D299G, have been associated with increased predisposition to infection in several populations. Aim, To retrospectively analyse the relationship between the presence of the TLR4 D299G polymorphism and the incidence of bacterial infections in cirrhotic patients. Methods, We included 111 consecutive cirrhotic patients hospitalized with ascites and we determined the presence of the TLR4 D299G polymorphism by PCR,RFLP (polymerase chain reaction,restriction fragment length polymorphism) and its relationship with the incidence of previous bacterial infections. Results, Ten out of 111 (9%) cirrhotic patients presented with the TLR4 D299G polymorphism. The mean follow-up from first decompensation of cirrhosis until current admission was longer in D299G polymorphism patients than in wild-type patients (53.8 ± 40.7 vs. 35.4 ± 48.3 months, P = 0.03). D299G polymorphism patients showed a trend towards a higher incidence of history of previous infections (80% vs. 56.4%, P = 0.19), as well as a higher number of infections (2.8 ± 2.3 vs. 1.0 ± 1.3, P = 0.01) and bacteriaemias (0.4 ± 1.0 vs. 0.04 ± 0.2, P = 0.02) per patient than wild-type patients. Conclusions, Toll-like receptor 4 D299G polymorphism could influence not only the predisposition to bacterial infections but also the evolution of the disease in cirrhotic patients. Further prospective studies in larger series of patients are warranted. [source] Bone mineral density among cirrhotic patients awaiting liver transplantationLIVER TRANSPLANTATION, Issue 5 2004Rana Paramvir Sokhi Osteoporosis is an important and common complication in patients with chronic liver disease. The goal of this study was to determine the bone mineral density (BMD) in different subgroups among pretransplant cirrhotic patients. BMD of the lumbar vertebrae (L) and femoral neck (F) were obtained in 104 consecutive cirrhotic patients. Descriptive and inferential statistics were used to compare the BMD among various groups. The mean BMD in males (n = 54) and females (n = 50) at L were 1.28 ± 0.25 g/cm2 and 1.13 ± 0.20 g/cm2, respectively (P = .001); at F they were 1.03 ± 0.14 and 0.91 ± 0.17, respectively (P < .0001). Among males, BMD at L in Child-Turcotte-Pugh class B and C were 1.40 ± 0.21 and 1.13 ± 0.20, respectively (P = .001); at F they were 1.11 ± 0.10 and 0.93 ± 0.13, respectively (P < .0001). Among females, BMD at L in Child-Turcotte-Pugh class B and C were 1.27 ± 0.18 and 1.05 ± 0.16, respectively (P = .0003); at F they were 1.02 ± 0.16 and 0.83 ± 0.12, respectively (P = .001). The BMD in premenopausal females (n = 15) and postmenopausal females (n = 35) at L were 1.20 ± 0.19 and 1.11 ± 0.20, respectively (P = .15); at F they were 0.97 ± 0.17 and 0.88 ± 0.16, respectively (P = .12). The BMD in postmenopausal females on hormone replacement therapy (n = 19) and on no hormone replacement therapy (n = 16) at L were 1.07 ± 0.17 and 1.14 ± 0.23, respectively (P = .29); at F they were 0.85 ± 0.15 and 0.91 ± 0.18, respectively (P = .33). The BMD values between etiologic groups were not significantly different. The overall prevalence of osteopenia and osteoporosis were 34.6% and 11.5%, respectively, being significantly higher in females than in males. In conclusion, significant difference in BMD values exists between males and females, as well as between Child-Turcotte-Pugh class B and C patients with cirrhosis. In addition, there is no significant influence of menopausal status, hormone replacement therapy, and etiology of cirrhosis on BMD. (Liver Transpl 2004;10:648,653.) [source] | ||||||||||