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Vaishnav M, Elhence A, Kumar R, Mohta S, Palle C, Kumar P, Ranjan M, Vajpai T, Prasad S, Yegurla J, Dhooria A, Banyal V, Agarwal S, Bansal R, Bhattacharjee S, Aggarwal R, Soni KD, Rudravaram S, Singh AK, Altaf I, Choudekar A, Mahapatra SJ, Gunjan D, Kedia S, Makharia G, Trikha A, Garg P, Saraya A. Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding. J Clin Exp Hepatol 2021; 11:327-333. [PMID: 33519132 PMCID: PMC7833290 DOI: 10.1016/j.jceh.2020.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/OBJECTIVE There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease -2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. METHODS In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included. RESULTS The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. CONCLUSION Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.
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Key Words
- AD, Acute decompensation
- AIH, Autoimmune hepatitis
- AIMS65, Albumin, international normalized ratio, mental status, systolic blood pressure, age > 65
- CLD, Chronic liver disease
- COVID-19, Coronavirus disease −2019
- CRS, Clinical Rockall Score
- Carvedilol
- Endoscopy
- FFP, Fresh frozen plasma
- GAVE, Gastric antral vascular ectasia
- GBS, Glasgow-Blatchford bleeding score
- GI, Gastrointestinal
- HE, Hepatic encephalopathy
- HVPG, Hepatic venous pressure gradient
- INR, International normalized ratio
- LGI, Lower gastrointestinal
- Liver transplant
- MOHFW, Ministry of Health and Family Welfare
- NSAIDs, Non-steroidal anti-inflammatory drugs
- PPE, Personal protective equipment
- PRBC, Packed red blood cells
- Prognosis
- Proton pump inhibitors
- RR, Respiratory rate
- RT-PCR, Reverse transcriptase polymerase chain reaction
- SARS-CoV2, Severe acute respiratory syndrome Coronavirus 2
- UGI, Upper gastrointestinal
- Variceal bleeding
- mGBS, Modified Glasgow-Blatchford bleeding score
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Affiliation(s)
- Manas Vaishnav
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Srikant Mohta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Palle
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Peeyush Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Ranjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanmay Vajpai
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Prasad
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Jatin Yegurla
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anugrah Dhooria
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Banyal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajat Bansal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Kapil D Soni
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Swetha Rudravaram
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Ashutosh K Singh
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Irfan Altaf
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Avinash Choudekar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya J Mahapatra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Shalimar D, Vaishnav M, Elhence A, Kumar R, Mohta S, Palle C, Kumar P, Ranjan M, Vajpai T, Prasad S, Yegurla J, Dhooria A, Banyal V, Agarwal S, Bansal R, Bhattacharjee S, Aggarwal R, Soni KD, Rudravaram S, Singh AK, Altaf I, Choudekar A, Mahapatra SJ, Gunjan D, Kedia S, Makharia G, Trikha A, Garg P, Saraya A. Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding.. [DOI: 10.1101/2020.08.06.20169813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractBackground/ObjectiveThere is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19.
MethodsIn this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22 April to 22 July 2020, were included.ResultsThe mean age of patients was 45.8±12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis-21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay.ConclusionConservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient’s condition, response to treatment, resources and the risks involved, on a case to case basis.
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Wilhoit CB, Holman ND, Rockey DC. Blood transfusion practices in upper gastrointestinal bleeding: response to a landmark study. J Investig Med 2020; 68:882-887. [PMID: 32098831 DOI: 10.1136/jim-2019-001199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Lack of clear evidence in red blood cell (RBC) transfusion during gastrointestinal bleeding has led to varied recommendations over the years. However, studies in broad areas of medicine have provided evidence about appropriate RBC transfusion thresholds, and a 'landmark' study published in 2013 provided evidence in patients with upper gastrointestinal (UGI) bleeding. We hypothesized that the response to the evidence would lead to improved RBC transfusion practice. Our aim was to determine the response in RBC transfusion practices at our institution. DESIGN We examined RBC transfusion practices in patients with UGI bleeding who presented to the Medical University of South Carolina from January 2010 through December 2013. We abstracted extensive clinical data including demographic, medical history (comorbidities), medications, physical examination findings, laboratory data, endoscopic data, and RBC transfusion practices. We considered appropriate RBC transfusion to have occurred when performed for a hemoglobin level of <70 g/L. RESULTS 270 patients hospitalized with UGI bleeding had 606 RBC transfusions; 355 transfusions in 107 patients were appropriate, and 251 transfusions in 163 were inappropriate. In 2010, 2011, and 2012, the rates of appropriate RBC transfusions were 61/124 (49%), 92/172 (53%), and 84/142 (59%), respectively. There was a statistically significant difference in appropriate transfusions in 2013 (118/168 (70%)) compared with 2012 (84/142 (59%), p=0.003), as well as during 2010-2012 (237/438 (54%), p≤0.003). CONCLUSIONS The data suggest that there was an improvement in RBC transfusion practices after a landmark study. However, the data also highlight that RBC transfusion practices in UGI bleeding remain imperfect.
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Affiliation(s)
- Cameron B Wilhoit
- Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathan D Holman
- Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Don C Rockey
- Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Thromboelastography-guided Blood Product Transfusion in Cirrhosis Patients With Variceal Bleeding: A Randomized Controlled Trial. J Clin Gastroenterol 2020; 54:255-262. [PMID: 31008867 DOI: 10.1097/mcg.0000000000001214] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS The aim of this study was to assess the use of thromboelastography (TEG)-directed blood product transfusion in cirrhotic patients with acute variceal bleeding compared with conventional transfusion for correction of coagulopathy. BACKGROUND Coagulopathy is common in patients with cirrhosis. Recommendations for correction of conventional parameters of coagulation-platelets and the international normalized ratio before endoscopy in patients with acute variceal bleeding-need more validation. STUDY In this randomized controlled trial, cirrhotic patients with severe coagulopathy and acute variceal bleeding were randomized to either TEG-guided blood product transfusion or conventional transfusion from March 2017 to December 2017. The primary outcome was the difference in the amount of fresh frozen plasma and platelet units transfused between the groups. Secondary outcomes were rebleeding at 5 days and 42 days, and 6-week mortality. RESULTS Of the 60 recruited patients, 30 each were randomized to the TEG and conventional transfusion groups. There were no differences in baseline characteristic and endoscopic findings between the 2 groups. Four subjects in the TEG group received blood product transfusions versus all in the conventional transfusion group (13.3% vs. 100%; P<0.001). The control of bleeding on initial endoscopy was similar in the 2 groups. Rebleeding in the TEG and conventional transfusion groups at 5 days was similar [1 (3.3%) vs. 4 (13.3%), P=0.167], whereas it was significantly less in the TEG group at 42 days [3 (10%) vs. 11 (36.7%), P=0.012]. Mortality at 6 weeks was seen in 4 (13.3%) in the TEG group and in 8 (26.7%) patients in the conventional transfusion group (P=0.176). CONCLUSIONS TEG-guided strategy was associated with reduced blood product transfusion to correct coagulopathy without compromising hemostasis in cirrhotic patients (Clinical trial ID: CTRI/2017/02/007864).
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Lee JM, Kim ES, Chun HJ, Hwang YJ, Lee JH, Kang SH, Yoo IK, Kim SH, Choi HS, Keum B, Seo YS, Jeen YT, Lee HS, Um SH, Kim CD. Discharge hemoglobin and outcome in patients with acute nonvariceal upper gastrointestinal bleeding. Endosc Int Open 2016; 4:E865-9. [PMID: 27540574 PMCID: PMC4988841 DOI: 10.1055/s-0042-110176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Many patients with acute gastrointestinal bleeding present with anemia and frequently require red blood cell (RBC) transfusion. A restrictive transfusion strategy and a low hemoglobin (Hb) threshold for transfusion had been shown to produce acceptable outcomes in patients with acute upper gastrointestinal bleeding. However, most patients are discharged with mild anemia owing to the restricted volume of packed RBCs (pRBCs). We investigated whether discharge Hb influences the outcome in patients with acute nonvariceal upper gastrointestinal bleeding. PATIENTS AND METHODS We retrospectively analyzed patients with upper gastrointestinal bleeding who had received pRBCs during hospitalization between January 2012 and January 2014. Patients with variceal bleeding, malignant lesion, stroke, or cardiovascular disease were excluded. We divided the patients into 2 groups, low (8 g/dL ≤ Hb < 10 g/dL) and high (Hb ≥ 10 [g/dL]) discharge Hb, and compared the clinical course and Hb changes between these groups. RESULTS A total of 102 patients met the inclusion criteria. Fifty patients were discharged with Hb levels < 10 g/dL, whereas 52 were discharged with Hb levels > 10 g/dL. Patients in the low Hb group had a lower consumption of pRBCs and shorter hospital stay than did those in the high Hb group. The Hb levels were not fully recovered at outpatient follow-up until 7 days after discharge; however, most patients showed Hb recovery at 45 days after discharge. The rate of rebleeding after discharge was not significantly different between the 2 groups. CONCLUSIONS In patients with acute upper gastrointestinal bleeding, a discharge Hb between 8 and 10 g/dL was linked to favorable outcomes on outpatient follow-up. Most patients recovered from anemia without any critical complication within 45 days after discharge.
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Affiliation(s)
- Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea ,Corresponding author Hoon Jai Chun, MD, PhD Division of Gastroenterology and HepatologyDepartment of Internal MedicineInstitute of Gastrointestinal Medical Instrument ResearchKorea University College of Medicine Inchon-ro 73, Seongbuk-guSeoul 136-705Korea+82 2 920 6555+ 82 2 953 1943
| | - Young-Jae Hwang
- College of Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Jae Hyung Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Hun Kang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - In Kyung Yoo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
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Wang YU, Yuan C, Liu X. Characteristics of gastrointestinal hemorrhage associated with pancreatic cancer: A retrospective review of 246 cases. Mol Clin Oncol 2015; 3:902-908. [PMID: 26171204 DOI: 10.3892/mco.2015.563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/04/2015] [Indexed: 12/21/2022] Open
Abstract
While gastrointestinal (GI) hemorrhage is common in the general population, few studies have evaluated large numbers of GI hemorrhage patients with pancreatic cancer. The clinical features and potential risk factors of GI hemorrhage with pancreatic cancer was investigated in the present study and the effect of GI hemorrhage on survival rate was examined. Patients enrolled in the present study had pathologically proven pancreatic cancer, and received treatment between August 2006 and 2012. Their medical records were retrospectively reviewed. The data for the present study were obtained from a review of 246 patients with pancreatic cancer (average age, 63.4±10.92 years; 190 male cases, 56 female cases). In addition, 73 cases had stage I-II, 173 had stage III-IV, and only 67 cases (27.2%) were candidates for curative pancreatectomy. Among them, 32 cases (13.0%) were clinically diagnosed with GI hemorrhage. A total of 24 cases were male patients and the other 8 cases were female, the cases of hemorrhage history and alcoholism were 2 and 29 cases, respectively. The major initial clinical symptoms of GI hemorrhage included 18 patients with melena or blood stool (56.25%), 9 with haematemesis (28.13%), 3 with abdominal distention (9.37%) and 2 with stomach ache (6.25%). The independent risk factor for GI hemorrhage was tumor initial stage of IV. A continuous increase in carbohydrate antigen 19-9 (CA19-9) may be a warning of GI hemorrhage, particularly when it is >1,000 U/ml. The most frequent method of hemostasis was combination therapy (n=12, 37.5%). Only 3 cases (9.3%) of these 32 GI hemorrhage patients were blood stanched and only 10 patients (31.2%) received gastroscopy. The time from GI hemorrhage to fatality is extremely short (median 30 days, range from 1 h to 65 days), and the median overall survival time of the patients with GI hemorrhage was 9.0 months (range, 2.0-16.0 months) and was significantly shorter than that of patients without GI hemorrhage [14.5 months (range, 0.5-48.0 months)]. In conclusion, although GI hemorrhage was not common in patients with pancreatic cancer, it is critical. GI hemorrhage was controlled with endoscopic hemostasis. Clinicians should fully assess the risk factors of GI hemorrhage (such as alcohol, smoking, past hemorrhage history, initial stage, tumor location and CA19-9 level at diagnosis of pancreatic cancer) when the pancreatic cancer patients were on admission, particularly for patients of the late stage, preventive measures should be investigated to reduce suffering.
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Affiliation(s)
- Y U Wang
- Department of Oncology, Graduate School of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Caijun Yuan
- Department of Oncology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Xiaomei Liu
- Department of Oncology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
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Abstract
PURPOSE OF REVIEW Renal dysfunction causes significant morbidity in cirrhotic patients. Diagnosis is challenging because it is based on serum creatinine, which is used to calculate estimated glomerular filtration rate, which itself is not an ideal measure of renal function in patients with cirrhosis. Finding the exact cause of renal injury in patients with cirrhosis remains problematic due to the limitations of the current diagnostic tests. The purpose of this review is to highlight studies used to diagnose renal dysfunction in patients with renal dysfunction and review current treatments. RECENT FINDINGS New diagnostic criteria and classification of renal dysfunction, especially for acute kidney injury (AKI), have been proposed in hopes of optimizing treatment and improving outcomes. New biomarkers that help to differentiate structural from functional AKI in cirrhotic patients have been developed, but require further investigation. Vasoconstrictors are the most commonly recommended treatment of hepatorenal syndrome (HRS). Given the high mortality in patients with type 1 HRS, all patients with HRS should be evaluated for liver transplantation. When renal dysfunction is considered irreversible, combined liver-kidney transplantation is advised. SUMMARY Development of new biomarkers to differentiate the different types of AKI in cirrhosis holds promise. Early intervention in cirrhotic patients with renal dysfunction offers the best hope of improving outcomes.
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Affiliation(s)
- Nathalie H. Urrunaga
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ayse L. Mindikoglu
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Don C. Rockey
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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