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Reddy S, Agrawal S, Reddy H, Kumar S, Dhondge RH, Acharya S, Kothari M, Khan M, Javvaji CK. Assessing the Utility of the Aspartate Aminotransferase to Platelet Ratio Index (APRI) as a Noninvasive Indicator for Liver Cirrhosis. Cureus 2024; 16:e59680. [PMID: 38836137 PMCID: PMC11148697 DOI: 10.7759/cureus.59680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 06/06/2024] Open
Abstract
Background Of liver-related disorders, cirrhosis is currently the leading cause of death and has become a significant global public health concern. Aspartate aminotransferase to platelet ratio index (APRI), a newer prognostic modality, is a very effective noninvasive diagnostic for identifying advanced liver fibrosis. Methods A prospective observational study was conducted among individuals with liver disease, 100 cases and 100 controls for two years. All the sociodemographic details, clinical features of the patients, and clinical findings such as prothrombin time (PT), liver function tests, kidney function tests, and total blood count were recorded using a pretested semi-structured questionnaire. Results According to our survey results, 48% of the participants were between the ages of 40 and 60. Regarding aPTT (activated partial thromboplastin time) and liver function test characteristics (serum glutamic-oxaloacetic transaminase(SGOT), serum glutamic pyruvic transaminase (SGPT)), we showed a substantial difference between the patients and controls. Regarding the APRI distribution, we also found a statistically significant variation between the research groups. When we compared the validity of APRI scores in diagnosing cirrhosis, we discovered that the ideal cutoff value of APRI was determined to be 3.99, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 33%, 86%, 70%, and 56%, respectively. The area under the receiver operating characteristic (ROC) curve for APRI in detecting cirrhosis was also 0.693. Conclusion Thus, our study results conclude that APRI is a crucial noninvasive prognostic tool that can be utilized to prognostize liver cirrhosis.
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Affiliation(s)
- Siva Reddy
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Agrawal
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshitha Reddy
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rushikesh H Dhondge
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manjeet Kothari
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Maimoona Khan
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Mita A, Shimizu S, Ichiyama T, Yamamoto T, Yamaguchi A, Sonoda K, Mori K, Yamada T, Nakamura H, Imamura H. Outcomes of critically ill patients with liver failure who require mechanical ventilation: A retrospective, single-center study. Health Sci Rep 2024; 7:e1926. [PMID: 38469112 PMCID: PMC10925802 DOI: 10.1002/hsr2.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/28/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024] Open
Abstract
Background and Aims Critically ill patients with liver failure have high mortality. Besides the management of organ-specific complications, liver transplantation constitutes a definitive treatment. However, clinicians may hesitate to introduce mechanical ventilation for patients on liver transplantation waitlists because of poor prognosis. This study investigated the outcomes of intensive care and ventilation support therapy effects in patients with liver failure. Methods This single-center study retrospectively enrolled 32 consecutive patients with liver failure who were admitted to the intensive care unit from January 2014 to December 2020. The medical records were reviewed and analyzed retrospectively for Acute Physiologic and Chronic Health Evaluation (APACHE)-II. The model for end-stage liver disease scores, 90-day mortality, and survival was assessed using the Kaplan-Meier method. Results The average patient age was 45.5 ± 20.1 years, and 53% of patients were women. On intensive care unit admission, APACHE-II and model for end-stage liver disease scores were 20 and 28, respectively. Among 13 patients considered for liver transplantation, 4 received transplants. Thirteen patients (40.6%) were intubated and mechanically ventilated in the intensive care unit. The 90-day mortality rate of patients with and without mechanical ventilation in the intensive care unit (13, 61.5% vs. 19, 47.4%, p = 0.4905) was similar. APACHE-II score >21 was an independent predictor of mechanical ventilation requirement in patients with liver failure during intensive care unit stay. Conclusion Although critically ill patients with liver failure are at risk of multiorgan failure with poor outcomes, mechanical ventilation did not negatively affect the 90-day mortality or performance rates of liver transplantation. Clinicians should consider mechanical ventilation-based life support in critically ill patients with liver failure who are awaiting liver transplantation.
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Affiliation(s)
- Atsuyoshi Mita
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Sari Shimizu
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Takashi Ichiyama
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Takateru Yamamoto
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Akinori Yamaguchi
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Kosuke Sonoda
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Kotaro Mori
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Tomokatsu Yamada
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Hiroyuki Nakamura
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
| | - Hiroshi Imamura
- Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan
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Liu S, Zhao Q, Wang Z, Zhao B, Zhang X. Albumin‑bilirubin grade is an independent prognostic factor for small lung cell cancer. Mol Clin Oncol 2024; 20:12. [PMID: 38213660 PMCID: PMC10777464 DOI: 10.3892/mco.2023.2710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024] Open
Abstract
Albumin-bilirubin (ALBI) grade was first described in 2015 as an indicator of liver dysfunction in patients with hepatocellular carcinoma. ALBI grade has been reported to have prognostic value in several malignancies including non-small cell lung cancer (NSCLC). The present study aimed to explore the prognostic impact of ALBI grade in patients with small cell lung cancer (SCLC). It retrospectively analyzed 135 patients with SCLC treated at Hebei General Hospital between April 2015 and August 2021. Patients were divided into two groups according to the cutoff point of ALBI grade determined by the receiver operating characteristic (ROC) curve: Group 1 with pre-treatment ALBI grade ≤-2.55 for an improved hepatic reserve and group 2 with ALBI grade >-2.55. Kaplan-Meier and Cox regression analysis were performed to assess the potential prognostic factors associated with progression free survival (PFS) and overall survival (OS). Propensity score matching (PSM) was applied to eliminate the influence of confounding factors. PFS and OS (P<0.001) were significantly improved in group 1 compared with in group 2. Multivariate analysis revealed that sex (P=0.024), surgery (P=0.050), lactate dehydrogenase (LDH; P=0.038), chemotherapy (P=0.038) and ALBI grade (P=0.028) are independent risk factors for PFS and that surgery (P=0.013), LDH (P=0.039), chemotherapy (P=0.009) and ALBI grade (P=0.013) are independent risk factors for OS. After PSM, ALBI grade is an independent prognostic factor of PFS (P=0.039) and OS (P=0.007). It was concluded that ALBI grade was an independent prognostic factor in SCLC.
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Affiliation(s)
- Shicheng Liu
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
| | - Qingtao Zhao
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
| | - Zengming Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
- Graduate School, Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Bin Zhao
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Xiaopeng Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
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Oh J, Kim J, Lee S, Park G, Baritugo KAG, Han KJ, Lee S, Sung GH. 1H NMR Serum Metabolomic Change of Trimethylamine N-oxide (TMAO) Is Associated with Alcoholic Liver Disease Progression. Metabolites 2024; 14:39. [PMID: 38248842 PMCID: PMC10818766 DOI: 10.3390/metabo14010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Without early detection and treatment, chronic and excessive alcohol consumption can lead to the development of alcoholic liver disease (ALD). With this in mind, we exploit the recent concept of the liver-gut axis and analyze the serum profile of ALD patients for identification of microbiome-derived metabolites that can be used as diagnostic biomarkers for onset of ALD. 1H-NMR was used to analyze serum metabolites of 38 ALD patients that were grouped according to their Child-Turcotte-Pugh scores (CTP): class A (CTP-A; 19), class B(CTP-B; 10), and class C (CTP-C; 9). A partial least squares-discriminant analysis (PLS-DA) and a variable importance of projection (VIP) score were used to identify significant metabolites. A receiver operating characteristic (ROC) curve and correlation heatmap were used to evaluate the predictability of identified metabolites as ALD biomarkers. Among 42 identified metabolites, 6 were significantly correlated to exacerbation of ALD. As ALD progressed in CTP-C, the levels of trimethylamine N-oxide (TMAO), malate, tyrosine, and 2-hydroxyisovalerate increased, while isobutyrate and isocitrate decreased. Out of six metabolites, elevated levels of TMAO and its precursors (carnitine, betaine, choline) were associated with severity of ALD. This indicates that TMAO can be used as an effective biomarker for the diagnosis of ALD progression.
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Affiliation(s)
- Junsang Oh
- Biomedical Institute of Mycological Resource, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea; (J.O.); (J.K.); (K.-A.G.B.)
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Gang-won-do, Republic of Korea
| | - Jayoung Kim
- Biomedical Institute of Mycological Resource, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea; (J.O.); (J.K.); (K.-A.G.B.)
- Department of Laboratory Medicine, International St. Mary’s Hospital and College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea
| | - Sanghak Lee
- Department of Biomedical Science, Graduate School, Catholic Kwandong University, Gangneung-si 25601, Gang-won-do, Republic of Korea; (S.L.); (G.P.)
| | - Gyubin Park
- Department of Biomedical Science, Graduate School, Catholic Kwandong University, Gangneung-si 25601, Gang-won-do, Republic of Korea; (S.L.); (G.P.)
| | - Kei-Anne Garcia Baritugo
- Biomedical Institute of Mycological Resource, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea; (J.O.); (J.K.); (K.-A.G.B.)
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Gang-won-do, Republic of Korea
| | - Ki Jun Han
- Department of Internal Medicine, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea;
| | - Sangheun Lee
- Biomedical Institute of Mycological Resource, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea; (J.O.); (J.K.); (K.-A.G.B.)
- Department of Internal Medicine, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea;
| | - Gi-Ho Sung
- Biomedical Institute of Mycological Resource, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea; (J.O.); (J.K.); (K.-A.G.B.)
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Gang-won-do, Republic of Korea
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Nguyen-Khac E, Nahon P, Ganry O, Ben Khadhra H, Merle P, Amaddeo G, Ganne-Carrie N, Silvain C, Peron JM, Mathurin P, Anty R, Uguen T, Decaens T, Riachi G, Bouattour M, Baron A, Bronowicki JP, Pageaux GP, Rosmorduc O, Ducournau G, Gilberg M, Tanang A, Dupin J, Gilbert-Marceau A, Blanc JF. Unresectable hepatocellular carcinoma at dawn of immunotherapy era: real-world data from the French prospective CHIEF cohort. Eur J Gastroenterol Hepatol 2023; 35:1168-1177. [PMID: 37577805 DOI: 10.1097/meg.0000000000002546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Hepatocellular carcinoma epidemiological data are limited in France. The Epidemio Liver Immunotherapy Tecentriq outcome research (ELITor) retrospective study, based on real-world data from the Carcinome HépatocellulaIrE en France (CHIEF) French cohort of hepatocellular carcinoma patients, aimed to get insight into the treatment patterns, the sociodemographic, clinical, biological, and etiological characteristics, and the quality of life of patients with unresectable hepatocellular carcinoma. METHODS AND RESULTS Between 1 September 2019 and 4 December 2020, 367 patients from the CHIEF cohort received at least one locoregional (52.8%) chemoembolization or radioembolization or systemic treatment (88.3%) and were selected for ELITor. Most patients had a Barcelona Clinic Liver Cancer (BCLC) C (93.2%) hepatocellular carcinoma stage and were affected by cirrhosis (67.7%). Alcohol was confirmed as the main etiology both as a single etiology (29.1%) and in association with other risk factors (26.9%), mainly metabolic disorders (16.2%).Tyrosine-kinase inhibitors, mainly sorafenib, were the most administered systemic treatments in first line. Patients who received at least one combination of atezolizumab and bevacizumab during the study period ( N = 53) had a better performance status and less portal hypertension frequency than the overall population and more hepatitis B virus infection and fewer metabolic disorders as single etiology. Overall, the global health score before treatment (62.3 ± 21.9) was in line with that of reference cancer patients and worsened in 51.9% of the cases after first-line palliative-intent treatment. CONCLUSION This study provided real-life data on advanced hepatocellular carcinoma characteristics and treatment patterns and described the first patients to receive the atezolizumab-bevacizumab combination before it became the new standard of care for advanced hepatocellular carcinoma.
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Affiliation(s)
| | - Pierre Nahon
- CHU Bobigny, APHP, Liver Unit, Bobigny; Université Sorbonne Paris Nord, F-93000 Bobigny; Inserm, UMR-1138, Université de Paris, Paris
| | - Olivier Ganry
- Hepato-Gastroenterology Department, CHU Amiens, Amiens
| | | | - Philippe Merle
- Hepatology Unit, Groupement Hospitalier Lyon Nord, Hospices Civils de Lyon
| | | | - Nathalie Ganne-Carrie
- CHU Bobigny, APHP, Liver Unit, Bobigny; Université Sorbonne Paris Nord, F-93000 Bobigny; Inserm, UMR-1138, Université de Paris, Paris
| | | | | | | | - Rodolphe Anty
- Hepato-Gastroenterology Department, Université Côte d'Azur, CHU, INSERM, U1065, C3M, Nice
| | - Thomas Uguen
- Hepato-Gastroenterology Department, CHU Rennes, Rennes
| | - Thomas Decaens
- Hepato-Gastroenterology Department, Université Grenoble Alpes, Service d'Hépato-Gastroentérologie, Centre Hospitalier universitaire Grenoble-Alpes, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Grenoble
| | | | | | - Aurore Baron
- Hepato-Gastroenterology Department, CH sud-francilien, Corbeil-Essonnes
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Torsemide Pharmacometrics in Healthy Adult Populations Including CYP2C9 Genetic Polymorphisms and Various Patient Groups through Physiologically Based Pharmacokinetic-Pharmacodynamic Modeling. Pharmaceutics 2022; 14:pharmaceutics14122720. [PMID: 36559213 PMCID: PMC9784843 DOI: 10.3390/pharmaceutics14122720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Torsemide is a widely used diuretic in clinical practice. In this study, pharmacokinetic (PK) and pharmacodynamic (PD) simulations of torsemide for various population groups and exposure scenarios were performed through human-scale physiologically-based PK-PD (PBPK-PD) modeling of torsemide. For PBPK-PD modeling of torsemide, invitro and clinical data of torsemide reported previously were used. After exposure to clinical doses of torsemide, observed plasma (or serum) concentration and urine torsemide excretion profiles were used as PK-data, and observed urinary sodium excretion rate was used as PD-data. The model was then extended to take into account physiological and biochemical factors according to different CYP2C9 phenotypes or patient populations. The established model captured various torsemide clinical results well. Differences in torsemide PKs and PDs between patient groups or CYP2C9 genetic polymorphisms were modelologically identified. It was confirmed that degrees of differences in torsemide PKs and PDs by disease groups were greater than those according to different CYP2C9 phenotypes. According to torsemide administration frequency or dose change, it was confirmed that although the difference in plasma PKs between groups (healthy adult and patient groups) could increase to 14.80 times, the difference in PDs was reduced to 1.01 times. Results of this study suggested that it is very important to consider disease groups in the setting of torsemide clinical therapy and that it is difficult to predict PD proportionally with only differences in PKs of torsemide between population groups. The PBPK-PD model established in this study is expected to be utilized for various clinical cases involving torsemide application in the future, enabling optimal drug therapy.
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Karballaei-Mirzahosseini H, Kaveh-Ahangaran R, Shahrami B, Rouini MR, Najafi A, Ahmadi A, Sadrai S, Mojtahedzadeh A, Najmeddin F, Mojtahedzadeh M. Pharmacokinetic study of high-dose oral rifampicin in critically Ill patients with multidrug-resistant Acinetobacter baumannii infection. Daru 2022; 30:311-322. [PMID: 36069988 PMCID: PMC9715901 DOI: 10.1007/s40199-022-00449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Although rifampicin (RIF) is used as a synergistic agent for multidrug-resistant Acinetobacter baumannii (MDR-AB) infection, the optimal pharmacokinetic (PK) indices of this medication have not been studied in the intensive care unit (ICU) settings. This study aimed to evaluate the PK of high dose oral RIF following fasting versus fed conditions in terms of achieving the therapeutic goals in critically ill patients with MDR-AB infections. METHODS 29 critically ill patients were included in this study. Under fasting and non-fasting conditions, RIF was given at 1200 mg once daily through a nasogastric tube. Blood samples were obtained at seven time points: exactly before administration of the drug, and at 1, 2, 4, 8, 12, and 24 h after RIF ingestion. To quantify RIF in serum samples, high-performance liquid chromatography (HPLC) was used. The MONOLIX Software and the Monte Carlo simulations were employed to estimate the PK parameters and describe the population PK model. RESULTS The mean area under the curve over the last 24-h (AUC0-24) value and accuracy (mean ± standard deviation) in the fasting and fed states were 220.24 ± 119.15 and 290.55 ± 276.20 μg × h/mL, respectively. There was no significant difference among AUCs following fasting and non-fasting conditions (P > 0.05). The probability of reaching the therapeutic goals at the minimum inhibitory concentration (MIC) of 4 mg/L, was only 1.6%. CONCLUSION In critically ill patients with MDR-AB infections, neither fasting nor non-fasting administrations of high-dose oral RIF achieve the therapeutic aims. More research is needed in larger populations and with measuring the amount of protein-unbound RIF levels.
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Affiliation(s)
- Hossein Karballaei-Mirzahosseini
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, 16-Azar St., Enghelab Ave., Tehran, 14176-14418, Iran
| | - Romina Kaveh-Ahangaran
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, 16-Azar St., Enghelab Ave., Tehran, 14176-14418, Iran
| | - Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, 16-Azar St., Enghelab Ave., Tehran, 14176-14418, Iran
| | - Mohammad Reza Rouini
- Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Department of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Ahmadi
- Department of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Sadrai
- Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Najmeddin
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, 16-Azar St., Enghelab Ave., Tehran, 14176-14418, Iran.
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, 16-Azar St., Enghelab Ave., Tehran, 14176-14418, Iran
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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Jeong SH, Jang JH, Lee YB. Physiologically Based Pharmacokinetic (PBPK) Modeling of Lornoxicam: Exploration of doses for CYP2C9 Genotypes and Patients with Cirrhosis. J Pharm Sci 2022; 111:3174-3184. [PMID: 36057318 DOI: 10.1016/j.xphs.2022.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
Lornoxicam physiologically based pharmacokinetic (PBPK) models were developed and validated on the basis of clinical pharmacokinetic results obtained by considering CYP2C9 genetic polymorphisms in healthy adult populations. PBPK models were extended to predict lornoxicam pharmacokinetics for patients with cirrhosis by quantitatively examining the pathophysiological information associated with cirrhosis. The predicted plasma exposure to lornoxicam was approximately 1.12-2.83 times higher in the CYP2C9*1/*3 and *1/*13 groups than in the CYP2C9*1/*1 group of healthy adult populations and patients with cirrhosis. The predicted plasma exposure to lornoxicam was approximately 1.28-3.61 times higher in patients with cirrhosis than in healthy adult populations. If the relationship between lornoxicam exposure in plasma and drug efficacy was proportional, then the proposed adjusted doses of lornoxicam for each group varied from 1.25 mg to 8 mg. As the severity of cirrhosis increased, or when the CYP2C9 genotype was *1 heterozygous, the dose adjustment range of lornoxicam increased. Therefore, the effect of pathophysiological factors (cirrhosis severity) on the pharmacokinetics of lornoxicam might be more important than that of CYP2C9 genetic factors. These results could be useful for broadening the scope of clinical application of lornoxicam by enabling dose selection based on CYP2C9 genotypes and liver cirrhosis degree.
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Affiliation(s)
- Seung-Hyun Jeong
- College of Pharmacy, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju, 61186, Republic of Korea; Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Ji-Hun Jang
- College of Pharmacy, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju, 61186, Republic of Korea; Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Yong-Bok Lee
- College of Pharmacy, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju, 61186, Republic of Korea.
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Schilling U, Hsin CH, Delahaye S, Krause A, Wuelfrath H, Halabi A, Dingemanse J. Influence of hepatic impairment on the pharmacokinetics and pharmacodynamics of the P2Y12 receptor antagonist selatogrel. Clin Transl Sci 2022; 15:1906-1915. [PMID: 35583936 PMCID: PMC9372424 DOI: 10.1111/cts.13298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/18/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022] Open
Abstract
Selatogrel is a potent and selective reversible P2Y12 receptor antagonist in development for early treatment of acute myocardial infarction via subcutaneous (s.c.) self‐injection. Selatogrel is almost exclusively eliminated via the hepatobiliary route. Hepatic impairment is associated with reduced drug clearance and primary hemostasis. This single‐center, open‐label study investigated the effect of mild and moderate hepatic impairment on pharmacokinetics (PK) and pharmacodynamics (PD) of a single s.c. dose of selatogrel (16 mg). The study included groups of eight subjects with mild and moderate hepatic impairment, and matched healthy control subjects. Compared to healthy subjects, exposure to selatogrel in subjects with mild and moderate hepatic impairment was 30% and 108% (maximum plasma concentration [Cmax]) and 47% and 212% (area under the concentration‐time curve from zero to infinity [AUC0–∞]) higher, respectively. Hepatic impairment was associated with lower clearance and volume of distribution, whereas plasma protein binding was not affected. Marked inhibition of platelet aggregation (IPA > 80%) was attained within 30 min in all subjects and hepatic impairment prolonged IPA duration. Area under the effect curve was 60% and 160% higher in subjects with mild and moderate hepatic impairment, respectively. PK/PD modeling identified a change in the relationship between exposure and IPA, with a steeper concentration‐effect relationship in healthy subjects compared to subjects with hepatic impairment. The combination of higher exposure and lower half‐maximum inhibitory concentration resulted in longer lasting effect. In conclusion, hepatic impairment alters the PK/PD relationship leading to prolonged effects. Therefore, dose adjustments may be warranted in subjects with moderate hepatic impairment.
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Affiliation(s)
- Uta Schilling
- Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
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Al-Dury S, Waern J, Waldenström J, Alavanja M, Saed HH, Törnell A, Arabpour M, Wiktorin HG, Einarsdottir S, Ringlander J, Ringström G, Hellstrand K, Martner A, Lagging M. Impaired SARS-CoV-2-specific T cell reactivity in patients with cirrhosis following mRNA COVID-19 vaccination. JHEP REPORTS : INNOVATION IN HEPATOLOGY 2022; 4:100496. [PMID: 35502229 PMCID: PMC9045869 DOI: 10.1016/j.jhepr.2022.100496] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 01/03/2023]
Abstract
Background & Aims Cirrhosis entails elevated risk of COVID-19-associated mortality. This study determined T cell-mediated and antibody reactivity against the spike 1 (S1) protein of SARS-CoV-2 among 48 patients with cirrhosis and 39 healthy controls after mRNA COVID-19 vaccination. Methods SARS-CoV-2-specific T-cell reactivity was measured by induced level of T cell-derived interferon-γ (IFN-γ) in blood cells stimulated ex vivo with multimeric peptides spanning the N-terminal portion of S1. S1-induced IFN-γ was quantified before and after the 1st and 2nd vaccination (BNT162b2, Pfizer-BioNTech or mRNA-1273, Moderna) alongside serum IgG against the receptor-binding domain (RBD) within S1 (anti-RBD-S1 IgG). Results T-cell reactivity against S1 was reduced in patients with cirrhosis after the 1st (p <0.001 vs. controls) and 2nd (p <0.001) vaccination. Sixty-eight percent of patients lacked detectable S1-specific T-cell reactivity after the 1st vaccination vs. 19% in controls (odds ratio 0.11, 95% CI 0.03-0.48, p = 0.003) and 36% remained devoid of reactivity after the 2nd vaccination vs. 6% in controls (odds ratio 0.12, 95% CI 0.03-0.59, p = 0.009). T-cell reactivity in cirrhosis remained significantly impaired after correction for potential confounders in multivariable analysis. Advanced cirrhosis (Child-Pugh class B) was associated with absent or lower T-cell responses (p <0.05 vs. Child-Pugh class A). The deficiency of T-cell reactivity was paralleled by lower levels of anti-RBD-S1 IgG after the 1st (p <0.001 vs. controls) and 2nd (p <0.05) vaccination. Conclusions Patients with cirrhosis show deficient T-cell reactivity against SARS-CoV-2 antigens along with diminished levels of anti-RBD-S1 IgG after dual COVID-19 vaccination, highlighting the need for vigilance and additional preventative measures. Clinical trial registration EudraCT 2021-000349-42 Lay summary T cells are a pivotal component in the defence against viruses. We show that patients with cirrhosis have impaired SARS-CoV-2-specific T-cell responses and lower antibody levels after mRNA vaccination against COVID-19 compared with healthy controls. Patients with more advanced liver disease exhibited particularly inferior vaccine responses. These results call for additional preventative measures in these patients. After COVID-19 vaccination, patients with cirrhosis had impaired T-cell and antibody responses. Child-Pugh class B cirrhosis was associated with poorer immune responses than class A. Multivariate analyses excluded potential confounding variables.
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Affiliation(s)
- Samer Al-Dury
- Department of Medicine, Gastroenterology and Hepatology Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Waern
- Department of Medicine, Gastroenterology and Hepatology Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jesper Waldenström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marko Alavanja
- Department of Medicine, Gastroenterology and Hepatology Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hevar Hamah Saed
- Department of Medicine, Gastroenterology and Hepatology Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Törnell
- TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mohammad Arabpour
- TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Grauers Wiktorin
- TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sigrun Einarsdottir
- Department of Hematology and Coagulation, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Ringlander
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
| | - Gisela Ringström
- Department of Medicine, Gastroenterology and Hepatology Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristoffer Hellstrand
- TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
| | - Anna Martner
- TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Lagging
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
- Corresponding author. Address: Department of Infectious, /VirologySahlgrenska University Hospital and University of Gothenburg, 413 45 Gothenburg, Sweden
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Prognostic Role of MELD-Lactate in Cirrhotic Patients' Short- and Long-Term Prognosis, Stratified by Causes of Cirrhosis. Can J Gastroenterol Hepatol 2022; 2022:8449579. [PMID: 35392026 PMCID: PMC8983169 DOI: 10.1155/2022/8449579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Recently, model for end-stage liver disease-lactate (MELD-LA) proved to be a superior predicting factor of inpatient mortality in patients with chronic liver disease. The study's objective was to evaluate the ability of MELD-LA to predict both short- and long-term mortality in critically ill cirrhotic patients stratified by causes of cirrhosis. MATERIALS AND METHODS This was a retrospective observational research of 469 cirrhotic patients entering intensive care unit. Clinical parameters and prognostic scores were measured and collected in the first 24 hours after entering intensive care unit. Follow-up duration was at least 5 years. Independent relationship between MELD-LA and mortality was evaluated by multivariate logistic regression analyses. Discrimination of scoring system was evaluated by the area under the receiver operating characteristic curve. Calibration of the score was evaluated by Hosmer-Lemeshow goodness of fit test for significance. RESULTS The MELD-LA score (odds ratio: 1.179, 95% confidence interval: 1.112-1.250, P < 0.001) was an independent risk factor for 15-day mortality. The area under the curve of MELD-LA was the highest (0.808, 95% confidence interval: 0.765-0.852) in predicting 15-day mortality and it had superior calibration. We found MELD-LA showed the best discrimination ability in cirrhotic patients caused by both alcohol and hepatitis (0.783, 95% confidence interval: 0.651-0.915) or alcohol alone (0.805, 95% confidence interval: 0.743-0.867). CONCLUSIONS MELD-LA performs better for predicting short-term prognosis in critically ill cirrhotic patients, especially caused by both alcohol and hepatitis or alcohol alone.
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Liao JN, Kuo L, Liu CM, Chen SA, Chao TF. Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with advanced chronic kidney and liver diseases. Eur Heart J Suppl 2022; 24:A11-A18. [PMID: 35185405 PMCID: PMC8850708 DOI: 10.1093/eurheartj/suab154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Advanced chronic kidney disease (CKD) or chronic liver disease (CLD) is frequent in patients with atrial fibrillation (AF) because of their common risk factors. Chronic kidney disease and CLD superimposed on AF are associated with increased risks of thrombosis and bleeding, which further complicates the use of oral anticoagulants (OACs). Because currently approved non-vitamin K antagonist oral anticoagulants (NOACs) undergo certain degrees of metabolism and clearance in the liver and kidney, increased exposure to medications and risk of bleeding are major concerns with the use of NOACs in patients with advanced CKD and CLD. Besides, these patients were mostly excluded from landmark trials of NOACs and related cohort studies are also limited. Therefore, the optimal strategy for the use of NOACs in this population remains unclear. This review would go through current evidence regarding the safety and efficacy of NOACs in AF patients with advanced CKD and CLD and provide a comprehensive discussion for clinical practices.
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Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Min Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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13
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Su PS, Wu SH, Chu CJ, Su CW, Lin CC, Lee SD, Wang YJ, Lee FY, Huang YH, Hou MC. Sofosbuvir-based antiviral therapy provided highly treatment efficacy, safety, and good tolerability for Taiwanese chronic hepatitis C patients with decompensated cirrhosis. J Chin Med Assoc 2022; 85:152-159. [PMID: 34759209 DOI: 10.1097/jcma.0000000000000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For patients with hepatitis C virus (HCV)-related decompensated cirrhosis, poor prognosis was documented due to the development of portal hypertension-related complications and hepatocellular carcinoma. Sofosbuvir-based direct-acting antiviral agents (DAAs) has revolutionized the treatment landscape of HCV, particularly in this subpopulation. To date, real-world efficacy, tolerability, and safety profiles for Taiwanese HCV-related decompensated cirrhosis treated by DAAs have not been reported. METHODS Between December 2015 and June 2020, 50 consecutive HCV-related Child-Turcotte-Pugh (CTP) classes B or C cirrhotics treated by sofosbuvir-based DAAs (with daclatasvir: 7, with ledipasvir: 32, with velpatasvir: 10, with ledipasvir then shifted to velpatasvir: 1) were enrolled. Forty-seven (94%) patients used DAAs in combination with low-dose ribavirin. SVR12 was defined by undetectable HCV RNA (<15 IU/mL) at treatment end and 12 weeks after the completion of therapy. RESULTS The mean age of the enrolled patients was 68.1 ± 11.2 years, 18% of the patients were CTP class C, and the baseline HCV RNA level was 5.42 ± 1.2 log10 IU/mL. The genotype distribution was as follows: 1a: 3; 1b: 34; 2: 9; 6: 3; and one patient with an unclassified HCV genotype. After DAAs treatment, the rates of undetectable HCV RNA at week 4 and at the end of the treatment were 88.9% and 98.0%, respectively. Subjective adverse events were reported by 42.0% of the patients, but they were generally mild and could be relieved by medications. One patient did not finish therapy due to sepsis with multiple organ dysfunction. The overall SVR12 rate was 96.0% (CTP class B: 97.6%, CTP class C: 88.9%). A significant improvement in hepatic functional reserve was noted after successful antiviral therapy. CONCLUSION For patients with HCV-related decompensated cirrhosis, which has been considered a contraindication for interferon-based therapy, sofosbuvir-based all-oral DAAs provided high treatment efficacy, acceptable safety, and good tolerability.
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Affiliation(s)
- Pin-Shuo Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Sih-Hsien Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chi-Jen Chu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chung-Chi Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Yuan-Jen Wang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Elkholy MM, Eid RA. Quantitative motor unit potential analysis and nerve conduction studies for detection of subclinical peripheral nerve dysfunction in patients with compensated liver cirrhosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00348-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peripheral neuropathy is an underestimated problem of compensated liver cirrhosis despite its negative effect on quality of life. The aim was to assess the role of meticulous electrophysiological screening (nerve conduction responses and quantitative motor unit potential analysis) of subclinical peripheral nerve dysfunction in patients with compensated cirrhosis and also to explore its relations with different characteristics of liver disease. Severity of cirrhosis was assessed by Child–Pugh and albumin-bilirubin (ALBI) scores.
Results
Prevalence of hepatic neuropathy (HN) was 82%. It involved sensory and motor fibers (66%), and its pathophysiology was axonal (53.7%) or mixed axonal and demyelinating (46.3). The most sensitive discriminating tests were ulnar sensory conduction velocity (area under curve (AUC) = 0.915) and peak latency (AUC = 0.887), peroneal motor conduction velocity (AUC = 0.885), ulnar distal motor latency (AUC = 0.842), and first dorsal interosseous number of phases (AUC = 0.736). HN showed significant correlation with the severity of liver disease assessed by both child (P = 0.029) and ALBI (P = 0.016) scores and also correlated with the low serum albumin level (P = 0.001).
Conclusions
Subclinical mild axonal polyneuropathy is very common in post-hepatitis C compensated cirrhosis picked up by meticulous electrophysiological testing, and it is related to severity of liver cirrhosis and low serum albumin level.
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15
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The Interplay between Gut Microbiota and the Immune System in Liver Transplant Recipients and Its Role in Infections. Infect Immun 2021; 89:e0037621. [PMID: 34460287 DOI: 10.1128/iai.00376-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Liver transplantation (LT) is a life-saving strategy for patients with end-stage liver disease, hepatocellular carcinoma, and acute liver failure. LT success can be hampered by several short-term and long-term complications. Among them, bacterial infections, especially those due to multidrug-resistant germs, are particularly frequent, with a prevalence between 19 and 33% in the first 100 days after transplantation. In the last decades, a number of studies have highlighted how the gut microbiota (GM) is involved in several essential functions to ensure intestinal homeostasis, becoming one of the most important virtual metabolic organs. The GM works through different axes with other organs, and the gut-liver axis is among the most relevant and investigated ones. Any alteration or disruption of the GM is defined as dysbiosis. Peculiar phenotypes of GM dysbiosis have been associated with several liver conditions and complications, such as chronic hepatitis, fatty liver disease, cirrhosis, and hepatocellular carcinoma. Moreover, there is growing evidence of the crucial role of the GM in shaping the immune response, both locally and systemically, against pathogens. This paves the way to the manipulation of the GM as a therapeutic instrument to modulate infectious risk and outcome. In this minireview, we provide an overview of the current understanding of the interplay between the gut microbiota and the immune system in liver transplant recipients and the role of the former in infections.
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Singh Tejavath A, Mathur A, Nathiya D, Singh P, Raj P, Suman S, Mundada PR, Atif S, Rai RR, Tomar BS. Impact of Branched Chain Amino Acid on Muscle Mass, Muscle Strength, Physical Performance, Combined Survival, and Maintenance of Liver Function Changes in Laboratory and Prognostic Markers on Sarcopenic Patients With Liver Cirrhosis (BCAAS Study): A Randomized Clinical Trial. Front Nutr 2021; 8:715795. [PMID: 34631765 PMCID: PMC8494250 DOI: 10.3389/fnut.2021.715795] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023] Open
Abstract
Background: This study aimed to investigate the long-term effects of branched-chain amino acids (BCAAs) supplementations on the parameters associated with improved prognosis in sarcopenic patients with liver cirrhosis (LC) and evaluate its impact on cirrhotic-related events. Methods: A 24-week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention study was carried out by comparing the efficacy of BCAAs against lactoalbumin (L-ALB) on 106 sarcopenic patients with LC. The BCAA (intervention) group was treated with 7.2 g BCAA per dose, whereas the L-ALB group was treated with 6.3 g of L-ALB. The primary outcome was to assess the effect of BCAA on the parameters of sarcopenia, such as muscle mass, muscle strength, and physical performance. The secondary outcomes were to study the combined survival and maintenance of liver function changes in laboratory and prognostic markers over the duration of 6 months. Results: The treatment with BCAA leads to the significant improvement in sarcopenic parameters, such as muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. In addition, prognostic markers improved significantly in the study. Conclusion: The current study demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced LC.
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Affiliation(s)
- Arun Singh Tejavath
- Department of Gastroenterology, National Institute of Medical Sciences, Nims University Rajasthan, Jaipur, India
| | - Amit Mathur
- Department of Gastroenterology, National Institute of Medical Sciences, Nims University Rajasthan, Jaipur, India
| | - Deepak Nathiya
- Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Pratima Singh
- Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Preeti Raj
- Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Supriya Suman
- Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | | | - Sheikh Atif
- Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Ramesh Roop Rai
- Department of Gastroenterology, National Institute of Medical Sciences, Nims University Rajasthan, Jaipur, India
| | - Balvir Singh Tomar
- Department of Gastroenterology, National Institute of Medical Sciences, Nims University Rajasthan, Jaipur, India.,Institute of Pharmacy, Nims University Rajasthan, Jaipur, India.,Institute of Pediatric Gastroenterology and Hepatology, Nims University Rajasthan, Jaipur, India
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Ngu NLY, Anderson P, Hunter J, Figredo A, Papaluca T, Pianko S, Dev A, Bell S, Le S. Short‐term intraperitoneal catheters: An ambulatory care intervention for refractory ascites secondary to cirrhosis during
COVID
‐19. JGH Open 2021; 5:1154-1159. [PMID: 34622001 PMCID: PMC8485402 DOI: 10.1002/jgh3.12641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Natalie LY Ngu
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Patricia Anderson
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Jo Hunter
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
- Pharmacy Department Monash Health Melbourne Victoria Australia
| | - Anita Figredo
- Hospital in the Home Monash Health Melbourne Victoria Australia
| | - Timothy Papaluca
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
| | - Stephen Pianko
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Anouk Dev
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Sally Bell
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Suong Le
- Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
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18
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Öcal O, Peynircioglu B, Loewe C, van Delden O, Vandecaveye V, Gebauer B, Zech CJ, Sengel C, Bargellini I, Iezzi R, Benito A, Schütte K, Gasbarrini A, Seidensticker R, Wildgruber M, Pech M, Malfertheiner P, Ricke J, Seidensticker M. Correlation of liver enhancement in gadoxetic acid-enhanced MRI with liver functions: a multicenter-multivendor analysis of hepatocellular carcinoma patients from SORAMIC trial. Eur Radiol 2021; 32:1320-1329. [PMID: 34467453 PMCID: PMC8795026 DOI: 10.1007/s00330-021-08218-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study. METHODS A total of 359 patients who underwent gadoxetic acid-enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses. RESULTS There was a significant positive correlation between LSR and albumin (rho = 0.193; p < 0.001), platelet counts (rho = 0.148; p = 0.004), and sodium (rho = 0.161; p = 0.002); and a negative correlation between LSR and total bilirubin (rho = -0.215; p < 0.001) and AST (rho = -0.191; p < 0.001). Multivariate analysis confirmed independent significance for each of albumin (p = 0.022), total bilirubin (p = 0.045), AST (p = 0.031), platelet counts (p = 0.012), and sodium (p = 0.006). The presence of ascites (1.47 vs. 1.69, p < 0.001) and varices (1.55 vs. 1.69, p = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408, p < 0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33, p = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = -0.137; p = 0.013). However, one scanner brand was significantly associated with lower LSR (p < 0.001). CONCLUSIONS The liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands. KEY POINTS • The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI and liver function is consistent in a multicenter-multivendor cohort. • Signal intensity-based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function. • However, absolute values might change between vendors.
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Affiliation(s)
- Osman Öcal
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bernhard Gebauer
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Christoph J Zech
- Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sengel
- Radiology Department, Grenoble University Hospital, La Tronche, France
| | - Irene Bargellini
- Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Rome, Italy
| | - Alberto Benito
- Abdominal Radiology Unit, Deparment of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, Osnabrück, Germany
| | - Antonio Gasbarrini
- Fondazione Policlinico Gemelli IRCCS, Università' Cattolica del Sacro Cuore, Rome, Italy
| | - Ricarda Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maciej Pech
- Departments of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | | | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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Umemura T, Nishikawa K, Mutoh Y, Sasano H, Kozaki K, Yamada T, Ichihara T. Usage experience of remdesivir for SARS-CoV-2 infection in a patient with chronic cirrhosis of Child-Pugh class C. J Antimicrob Chemother 2021; 76:1947-1948. [PMID: 33712855 PMCID: PMC7989446 DOI: 10.1093/jac/dkab076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Takumi Umemura
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan.,Department of Infection and Prevention, Tosei General Hospital, Seto, Aichi, Japan
| | - Kazuki Nishikawa
- Department of Gastroenterology, Tosei General Hospital, Seto, Aichi, Japan
| | - Yoshikazu Mutoh
- Department of Infection and Prevention, Tosei General Hospital, Seto, Aichi, Japan.,Department of Infectious Disease, Tosei General Hospital, Seto, Aichi, Japan
| | - Hajime Sasano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Koji Kozaki
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan
| | - Tetsuya Yamada
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshihiko Ichihara
- Department of Infection and Prevention, Tosei General Hospital, Seto, Aichi, Japan
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20
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Wang S, Ding S, Luo H, Chai X. International Normalized Ratio to Albumin Ratio (PTAR): An Objective Risk Stratification Tool in Patients with Sepsis. Int J Gen Med 2021; 14:1829-1841. [PMID: 34012289 PMCID: PMC8126875 DOI: 10.2147/ijgm.s305085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
Background Sepsis is a life-threatening multiple-organ dysfunction caused by dysregulation of host response to severe infection. Liver failure is a validated independent predictor of mortality. Accurate and rapid assessment of liver function is critical in patients with sepsis. However, an appropriate scoring system for liver function requires further development. Objective Our study aimed to validate the usefulness of the prothrombin time-international normalized ratio (PT-INR) to albumin ratio (PTAR) in predicting the mortality of patients with sepsis. Methods Data on a total of 4536 patients, obtained from the Multiparameter Intelligent Monitoring in Intensive Care III database, were included in our retrospective study. Logistic regression, Poisson regression with robust variance estimate analysis, and Cox proportional hazards models were used to explore the relationship between PTAR and mortality. Area under the curve (AUC) and decision curve analysis (DCA) were used to estimate the performance of PTAR in predicting the prognosis in septic patient. Results Multivariable Poisson regression showed that the relative risk (RR) of PTAR to ICU mortality, hospital mortality, and 28-day and 90-day mortality in septic patients was 1.26 (95% CI: 1.15-1.37), 1.24 (95% CI: 1.15-1.34), 1.23 (95% CI: 1.15-1.31), and 1.21 (95% CI: 1.13-1.28), respectively. Multivariable Cox regression showed that the hazard ratio (HR) of PTAR to 28-day mortality and 90-day mortality was 1.56 (95% CI: 1.44-1.70), and 1.55 (95% CI: 1.43-1.68), respectively. PTAR showed a moderate discrimination capacity in predicting hospital mortality (AUC: 0.655, 95% CI: 0.636-0.675) and 90-day mortality (AUC: 0.650, 95% CI: 0.633-0.667). Conclusion The PTAR scoring system is a convenient tool for predicting the prognosis of patients with sepsis.
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Affiliation(s)
- Shaoxiong Wang
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Trauma Center, The Second Xiangya Hospital, Central South University, Changsha,Hunan, People's Republic of China
| | - Shuizi Ding
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiangping Chai
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Trauma Center, The Second Xiangya Hospital, Central South University, Changsha,Hunan, People's Republic of China
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21
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Mocan T, Kang DW, Molloy BJ, Jeon H, Spârchez ZA, Beyoğlu D, Idle JR. Plasma fetal bile acids 7α-hydroxy-3-oxochol-4-en-24-oic acid and 3-oxachola-4,6-dien-24-oic acid indicate severity of liver cirrhosis. Sci Rep 2021; 11:8298. [PMID: 33859329 PMCID: PMC8050265 DOI: 10.1038/s41598-021-87921-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
Two 3-oxo-Δ4 fetal bile acids, 3-oxachola-4,6-dien-24-oic acid (1) and 7α-hydroxy-3-oxochol-4-en-24-oic acid (2), occur normally in the human fetus but remain elevated in neonates and children with severe cholestatic liver disease due to an autosomal recessive inborn error of metabolism affecting Δ4-3-oxo-steroid 5β-reductase (AKR1D1). Relatively little is known about 1 and 2 in adult patients with liver disease. The chemical synthesis of 1 and 2 is therefore described and their quantitation in plasma by ultrarapid chromatography-triple quadrupole mass spectrometry. Plasma concentrations of 1 and 2 were investigated in 25 adult patients with varying degrees of liver cirrhosis with and without hepatocellular carcinoma (HCC). Highly statistically significant correlations (P < 0.0001) were found between severity of liver cirrhosis, determined by the Child–Pugh and MELD scores, with plasma 1 and 2 concentrations, both alone and combined. The presence of HCC did not influence these correlations. Plasma cholic, chenodeoxycholic, deoxycholic, lithocholic or ursodeoxycholic acids, free and as their glycine or taurine conjugates, did not correlate with Child–Pugh or MELD score when corrected for multiple comparisons. These findings demonstrate that plasma levels of fetal bile acids 3-oxachola-4,6-dien-24-oic acid and 7α-hydroxy-3-oxochol-4-en-24-oic acid and likely deteriorating AKR1D1 activity indicate the severity of liver cirrhosis measured by the Child–Pugh and MELD scores.
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Affiliation(s)
- Tudor Mocan
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dong Wook Kang
- Department of Pharmaceutical Science and Technology, College of Health and Medical Science, Catholic University of Daegu, Gyeongsan-si, Gyeongsangbuk-do, 38430, Republic of Korea
| | | | - Hyeonho Jeon
- Department of Pharmaceutical Science and Technology, College of Health and Medical Science, Catholic University of Daegu, Gyeongsan-si, Gyeongsangbuk-do, 38430, Republic of Korea
| | - Zeno A Spârchez
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diren Beyoğlu
- Division of Systems Pharmacology and Pharmacogenomics, Samuel J. and Joan B. Williamson Institute, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, 11201, USA
| | - Jeffrey R Idle
- Division of Systems Pharmacology and Pharmacogenomics, Samuel J. and Joan B. Williamson Institute, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, 11201, USA. .,Department of BioMedical Research, University of Bern, 3008, Bern, Switzerland.
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22
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Lactate and Bilirubin Index: A New Indicator to Predict Critically Ill Cirrhotic Patients’ Prognosis. Can J Gastroenterol Hepatol 2021. [DOI: 10.1155/2021/6624177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives. We aimed to perform external validation of the prognostic value of the lactate and bilirubin (LB) index, a new indicator, and compare the ability of the LB index and other scoring systems to predict both short- and long-term mortality in critically ill cirrhotic patients. Materials and Methods. A number of 479 cirrhotic patients admitted into ICU were included in our research. We measured prognostic scores in the first 24 hours including LB index, Child–Pugh, SOFA, CLIF-SOFA, and MELD scores. The LB index was calculated as follows: ln [1000 × lactate (mmol/L) × bilirubin (µmol/L)]/2. The primary outcomes were 28-day and 3-year all-cause mortality. Multivariate logistic regression analyses were used to investigate the independent association between the LB index and the mortality in critically ill cirrhotic patients. The area under the receiver operating characteristic curve was used to assess the prediction accuracy of short- and long-term mortality of the clinical score. Calibration of the score was evaluated by Hosmer–Lemeshow goodness-of-fit test for significance. Results. Multivariate logistic regression analysis identified that the LB index (odds ratio: 5.487, 95% confidence interval: 3.542–8.501,
) was the strongest predictor for 28-day mortality. The LB index gave the highest area under the curve (0.791, 95% confidence interval: 0.747–0.836) in predicting 28-day mortality. For predicting 3-year mortality, the model for end-stage liver disease (MELD) score showed better discrimination ability with an area under the curve of 0.726 (95% confidence interval: 0.680–0.771). The risk of mortality significantly increased when the clinical scores were ≥ the optimal cutoff values. Conclusions. The LB index, a simple prognostic indicator, performs well in predicting critically ill cirrhotic patients’ short-term prognosis, while, for long-term prognosis, the MELD score is more appropriate.
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23
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Alraish R, Wicha SG, Frey OR, Roehr AC, Pratschke J, Stockmann M, Wuensch T, Kaffarnik M. Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx). Ann Intensive Care 2020; 10:106. [PMID: 32754775 PMCID: PMC7403243 DOI: 10.1186/s13613-020-00707-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 06/26/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In critically ill patients, tigecycline (TGC) remains an important therapeutic option due to its efficacy against multiresistant Gram-positive and Gram-negative bacteria. TGC is metabolized and eliminated predominantly by the liver. Critical illness-induced liver failure may have a profound impact on the pharmacokinetic of TGC. In the present study, we aimed to establish a link between the degree of liver dysfunction and TGC plasma concentration using the novel maximum liver function capacity (LiMAx) test, as a dynamic liver function test. MATERIALS/METHODS The prospective study included 33 patients from a surgical ICU with the clinical indication for antibiotic therapy with TGC. The patients received 100 mg loading dose of TGC followed by intermittent standard doses of 50 mg q12. Blood samples for TGC plasma concentration were collected at 0.3, 2, 5, 8 and 11.5 h in a steady-state condition after at least 36 h post-standard dosage. The results were analyzed by means of a high-performance liquid chromatography (HPLC) method. Within the same day, the LiMAx test was carried out and routine blood parameters were measured. RESULTS Peak plasma concentrations of TGC were significantly higher in patients with severe liver failure (LiMAx < 100 µg/kg/h) when compared to patients with normal liver function (LiMAx > 300 µg/kg/h). The pharmacokinetic curves revealed higher values in severe liver failure at any measured point. Moreover, LiMAx and total bilirubin were the only liver-related parameters that correlated with TGC Cmax. CONCLUSIONS The present study demonstrates a high variability of TGC plasma concentrations in critically ill patients. The results show a significant correlation between the degree of liver dysfunction, measured by the LiMAx test, and TGC Cmax. LiMAx test may be a helpful tool beyond others for adjusting the required dosage of hepatic metabolized antibiotics in critically ill patients. Trial registry DRKS-German clinical trials register; Trial registration number: DRKS00008888; Date of registration: 07-17-2015; Date of enrolment of the first participant to the trial: 12-10-2015.
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Affiliation(s)
- Rawan Alraish
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Sebastian G Wicha
- Dept. of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Bundesstr. 45, 20146, Hamburg, Germany
| | - Otto R Frey
- Clinical Pharmacy, Klinikum Heidenheim, Schlosshaustraße 100, 89522, Heidenheim, Germany
| | - Anka C Roehr
- Clinical Pharmacy, Klinikum Heidenheim, Schlosshaustraße 100, 89522, Heidenheim, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin Stockmann
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tilo Wuensch
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum Augustenburger Platz 1, 13353, Berlin, Germany
| | - Magnus Kaffarnik
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum Augustenburger Platz 1, 13353, Berlin, Germany
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24
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Gao F, Huang XL, Cai MX, Lin MT, Wang BF, Wu W, Huang ZM. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study. Aging (Albany NY) 2020; 11:4446-4462. [PMID: 31259742 PMCID: PMC6660055 DOI: 10.18632/aging.102062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/25/2019] [Indexed: 12/23/2022]
Abstract
Lactate clearance (Δ24Lac) was reported to be inversely associated with mortality in critically ill patients. The aim of our study was to assess the value of Δ24Lac for the prognosis of critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF). We analysed 954 cirrhotic patients with hyperlactatemia admitted to intensive care units (ICUs) in the United States and eastern China. The patients were followed up for at least 1 year. In the unadjusted model, we observed a 15% decrease in hospital mortality with each 10% increase in Δ24Lac. In the fully adjusted model, the relationship between the risk of death and Δ24Lac remained statistically significant (hospital mortality: odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.78- 0.90, p < 0.001; 90-day mortality: hazard ratio [HR] 0.94, 95%CI 0.92- 0.97, p < 0.001; for Δ24Lac per 10% increase). Similar results were found in patients with ACLF. We developed a Δ24Lac-adjusted score (LiFe-Δ24Lac), which performed significantly better in the area under the receiver operating characteristic curves (AUROCs) than the original LiFe score for predicting mortality. Lactate clearance is an independent predictor of death, and the LiFe-Δ24Lac score is a practical tool for stratifying the risk of death.
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Affiliation(s)
- Feng Gao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xie-Lin Huang
- Department of Gastroenterology Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meng-Xing Cai
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Miao-Tong Lin
- Department of Emergency Medicine, Intensive Care, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bin-Feng Wang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhi-Ming Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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25
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Cheeti S, Deng Y, Chang I, Georgescu I, Templeton I, Choong N, Cheung KWK, Girish S, Musib L. Effect of Hepatic Impairment on Cobimetinib Pharmacokinetics: The Complex Interplay Between Physiological Changes and Drug Characteristics. Clin Pharmacol Drug Dev 2020; 10:144-152. [PMID: 32696585 PMCID: PMC7891419 DOI: 10.1002/cpdd.847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/07/2020] [Indexed: 11/05/2022]
Abstract
Cobimetinib is a kinase inhibitor indicated for use in combination with vemurafenib for treatment of unresectable/metastatic melanoma with specific BRAF mutations. Cobimetinib is extensively metabolized in liver; thus, patients with hepatic impairment (HI) might have increased cobimetinib exposure. In this study, we investigated the impact of HI on the pharmacokinetics (PK) and safety of cobimetinib. Subjects with normal hepatic function and mild to severe HI were enrolled. All subjects received a single oral dose of 10 mg cobimetinib, and serial blood samples were collected at specified times. Cobimetinib PK in subjects with mild and moderate HI was similar to that in those with normal liver function. However, subjects with severe HI, on average, showed ∼30% lower total AUC0-∞ and ∼2-fold higher unbound AUC0-∞ compared with those with normal hepatic function. These exposure differences can be explained by lower albumin levels observed in subjects with severe HI, the strong correlation between albumin level and the unbound fraction and the general PK variability of cobimetinib. In addition, previous studies with cobimetinib showed a lack of an exposure-response relationship for efficacy and safety. Therefore, collectively, our results suggest that the starting dose for patients with hepatic impairment can be the same as that for those with normal hepatic function.
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Affiliation(s)
- Sravanthi Cheeti
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Yuzhong Deng
- Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California, USA
| | - Ilsung Chang
- Biostatistics, Genentech, Inc., South San Francisco, California, USA.,Present affiiation: Celltrion, Inc., Incheon, South Korea
| | | | - Ian Templeton
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA.,Present affiiation: Simcyp Ltd (Division of Certara), Seattle, Washington, USA
| | - Nicholas Choong
- PDO, Genentech, Inc., South San Francisco, California, USA.,Present affiliation: Seattle Genetics, South San Francisco, California, USA
| | | | - Sandhya Girish
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Luna Musib
- Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
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26
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Laursen TL, Sandahl TD, Kazankov K, George J, Grønbæk H. Liver-related effects of chronic hepatitis C antiviral treatment. World J Gastroenterol 2020; 26:2931-2947. [PMID: 32587440 PMCID: PMC7304101 DOI: 10.3748/wjg.v26.i22.2931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/26/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
More than five years ago, the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral (DAA) drugs. They proved highly efficient in curing patients with chronic hepatitis C (CHC), including patients with cirrhosis. The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis, but the exact cause of the expected benefit was unclear. Further, little was known about how the underlying liver disease would be affected during and after viral clearance. In this review, we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects, such as macrophage activation, and the time-dependent effects of therapy, with specific emphasis on inflammation, structural liver changes, and liver function, as these factors are all related to morbidity and mortality in CHC patients. It seems clear that antiviral therapy, especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis. There seems to be a time-dependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions. These improvements lead to favorable effects on liver function, followed by an improvement in cognitive dysfunction and portal hypertension. Overall, the data provide knowledge on the several beneficial effects of DAA therapy on liver-related parameters in CHC patients suggesting short- and long-term improvements in the underlying disease with the promise of an improved long-term prognosis.
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Affiliation(s)
- Tea L Laursen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Thomas D Sandahl
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Konstantin Kazankov
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney NSW 2145, Australia
- University of Sydney, Sydney NSW 2145, Australia
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
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27
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Bohra A, Worland T, Hui S, Terbah R, Farrell A, Robertson M. Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care. World J Gastroenterol 2020; 26:2221-2231. [PMID: 32476788 PMCID: PMC7235207 DOI: 10.3748/wjg.v26.i18.2221] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/27/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50% of cirrhotic patients. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.
AIM To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care.
METHODS All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over 46-mo (2012–2016) were identified via pharmacy dispensing records. Patients with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were excluded. Medical records were reviewed to determine baseline characteristics and survival. The Kaplan-Meier method was used to calculate survival probability. Univariate survival analysis was performed with variables reaching statistical significance included in a multivariate analysis. The primary outcome was 12-mo mortality following commencement of Rifaximin.
RESULTS 188 patients were included. Median age was 57 years (IQR 50-65), 71% were male and median model for end stage liver disease and Child Pugh scores were 25 (IQR 18-31) and 11 (IQR 9-12) respectively. The most common causes of cirrhosis were alcohol (62%), hepatitis C (31%) and non-alcoholic fatty liver disease (20%). A precipitating cause for HE was found in 92% patients with infection (43%), GI bleeding (16%), medication non-compliance (15%) and electrolyte imbalance (14%) the most common. During a mean follow up period of 12 ± 13 mo 107 (57%) patients died and 32 (17%) received orthotopic liver transplantation. The most common causes of death were decompensated chronic liver disease (57%) and sepsis (19%). The probability of survival was 44% and 35% at 12- and 24-mo respectively. At multivariate analysis a model for end stage liver disease > 15 and international normalised ratio reached statistical significance in predicting mortality.
CONCLUSION Despite advances made in the management of HE patients continue to have poor survival. Thus, in all patients presenting with HE the appropriateness of orthotopic liver transplantation should be considered.
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Affiliation(s)
- Anuj Bohra
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Thomas Worland
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Samuel Hui
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Ryma Terbah
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Ann Farrell
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Marcus Robertson
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
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28
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Gao F, Lin MT, Yang XY, Cai MX, Nan H, Xie W, Huang ZM. Metabolic acidosis in critically ill patients with cirrhosis: Epidemiology and short-term mortality risk factors. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:883-891. [PMID: 31633484 DOI: 10.5152/tjg.2019.18813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS Metabolic acidosis is a common complication in patients with cirrhosis at the intensive care units (ICUs) and associated with increased mortality. The aim of our research was to explore the epidemiology and risk factors of metabolic acidosis in critically ill patients with cirrhosis. MATERIALS AND METHODS A total of 975 patients with cirrhosis were selected into our study, and all participants were followed up for at least 28 days. Cox regression model and machine-learning algorithm were used to identify the importance of different risk factors, respectively. Finally, an improved prognostic model as Model for End-stage Liver Disease and metabolic acidosis (MELD-MA) was developed. RESULTS Among the 975 patients with liver cirrhosis, 506 had metabolic acidosis, including 257 patients who had decompensated metabolic acidosis at ICU admission. The 28-day mortality was 41% (206/506) in patients with metabolic acidosis. Bilirubin (hazard ratio (HR): 1.023, 95% confidence interval (CI): 1.011-1.036), international normalized ratio (HR: 1.527, 95% CI: 1.332-1.750), pH (HR: 0.173, 95% CI: 0.047-0.640), BE-Lac (HR: 0.907, 95% CI: 0.868-0.948), and BE-Na (HR: 0.923, 95% CI: 0.859-0.991) were considered as independent prognostic parameters for 28-day mortality. MELD-NA had significantly higher discrimination (area under the receiver operating characteristic curve 0.79) than MELD and Child-Pugh score. CONCLUSION Critically ill patients with cirrhosis have a high mortality rate and poor prognosis because of the high prevalence of metabolic acidosis. Lactic acidosis is the worst prognosis of all types of metabolic acidosis. MELD-MA performs well on the short-term mortality assessment in critically ill patients with cirrhosis and metabolic acidosis.
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Affiliation(s)
- Feng Gao
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Miao-Tong Lin
- Department of Emergency Medicine, Intensive Care, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xing-Yi Yang
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meng-Xing Cai
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Nan
- Department of Respiratory Medicine, the Third People's Hospital of Yueqing, Wenzhou, China
| | - Wei Xie
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhi-Ming Huang
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Ishii M, Itano O, Shinoda M, Kitago M, Abe Y, Hibi T, Yagi H, Takeuchi A, Tsujikawa H, Abe T, Kitagawa Y. Pre-hepatectomy type IV collagen 7S predicts post-hepatectomy liver failure and recovery. World J Gastroenterol 2020; 26:725-739. [PMID: 32116420 PMCID: PMC7039827 DOI: 10.3748/wjg.v26.i7.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/11/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors. However, a method for preoperative evaluation of hepatic reserve has not yet been established. Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve. When determining eligibility for hepatectomy, the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.
AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.
METHODS This study was a retrospective cohort study. We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016. Early post-hepatectomy liver failure (PHLF) was defined using the International Study Group of Liver Surgery’s definition of PHLF. Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of < 2 mg/dL and > 2.8 g/dL, respectively, and the time taken for Child-Pugh score to return to Child-Pugh class A.
RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function. Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S ≤ 6 ng/mL than in those with type IV collagen 7S > 6 ng/mL. In additional analyses, similar results were observed in patients without chronic viral hepatitis associated with fibrosis.
CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and long-term postoperative liver function recovery. It can also be used in patients without chronic hepatitis virus.
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Affiliation(s)
- Masatsugu Ishii
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba 286-8686, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ayano Takeuchi
- Department of Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hanako Tsujikawa
- Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tokiya Abe
- Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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Ou YC, Preston RA, Marbury TC, Tang Z, Novotny W, Tawashi M, Li TK, Sahasranaman S. A phase 1, open-label, single-dose study of the pharmacokinetics of zanubrutinib in subjects with varying degrees of hepatic impairment. Leuk Lymphoma 2020; 61:1355-1363. [DOI: 10.1080/10428194.2020.1719097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Richard A. Preston
- Department of Medicine, Division of Pharmacology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | | | | | | | | | - Ta-Kai Li
- BeiGene USA, Inc, San Mateo, CA, USA
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31
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Ren QX, Li XG, Mu JS, Bi JF, Du CH, Wang YH, Zhu H, Lv P, Zhao QG. Population Pharmacokinetics of Voriconazole and Optimization of Dosage Regimens Based on Monte Carlo Simulation in Patients With Liver Cirrhosis. J Pharm Sci 2019; 108:3923-3931. [PMID: 31562869 DOI: 10.1016/j.xphs.2019.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 12/21/2022]
Abstract
Because voriconazole metabolism is highly influenced by liver function, the dose regimen of voriconazole should be carefully assessed in patients with liver cirrhosis. We aimed to identify significant factors associated with plasma concentrations. Blood samples were collected from patients with liver cirrhosis who received voriconazole, and voriconazole concentrations were determined. One-compartment model with first-order absorption and elimination appropriately characterized the in vivo process of voriconazole. The typical population value of voriconazole clearance (CL) was 1.45 L/h and the volume of distribution (V) was 132.12 L. The covariate analysis identified that CYP2C19 gene phenotype and Child-Pugh classification were strongly associated with CL and body weight had a significant influence on V. The results of the Monte Carlo simulation suggested that CYP2C19 gene phenotype was a critical factor for determining voriconazole dosage in patients with liver cirrhosis. The extensive metabolizer patients with Aspergillus fumigatus infections could be treated effectively with a recommended dose of 75 mg twice daily in mild to moderate liver cirrhosis and 100 mg once daily in moderate severe liver cirrhosis. However, the recommended dosage for Candida albicans infections patients was not achieved in present study.
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Affiliation(s)
- Qiu-Xia Ren
- Department of Pharmacy, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Xin-Gang Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jin-Song Mu
- Intensive Care Unit, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Jing-Feng Bi
- Research Center for Clinical and Translational Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Chun-Hui Du
- Department of Pharmacy, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Yan-Hong Wang
- Department of Pharmacy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Hong Zhu
- Department of Pharmacy, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Peng Lv
- Department of Pharmacy, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Qing-Guo Zhao
- Department of Pharmacy, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.
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32
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Wilcock A, Charlesworth S, Prentice W, Selby P, McKenna M, Cripps S, Considine A, Orr A, Wright M, Mihalyo M, Oxberry S. Prescribing in Chronic Severe Hepatic Impairment. J Pain Symptom Manage 2019; 58:515-537. [PMID: 31077785 DOI: 10.1016/j.jpainsymman.2019.04.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/29/2022]
Abstract
Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available via www.palliativedrugs.com. The series editors welcome feedback on the articles.
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Affiliation(s)
- Andrew Wilcock
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom.
| | - Sarah Charlesworth
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Wendy Prentice
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Paul Selby
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Maria McKenna
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Sarah Cripps
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Aisling Considine
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Alison Orr
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Mark Wright
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Mary Mihalyo
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
| | - Stephen Oxberry
- University of Nottingham (A.W.), Nottingham, United Kingdom; Pharmaceutical Press (S.Ch.), London, United Kingdom; Kings College Hospital (W.P.), London, United Kingdom; Cambridge University Hospital NHS Trust (P.S.), Cambridge, United Kingdom; Freeman Hospital (M.M), Newcastle Upon Tyne, United Kingdom; Oxford University Hospitals NHS Foundation Trust (S.Cr.), Oxford, United Kingdom; Kings College Hospital (A.C.), London, United Kingdom; Kings College Hospital (A.O.), London, United Kingdom; University Hospitals, Southampton (M.W.), Southampton, United Kingdom; Mylan School of Pharmacy, Duquesne University (M.M.), Pittsburgh, Pennsylvania, USA; Kirkwood Hospice (S.O.) Huddersfield, United Kingdom
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Prognostic value of international normalized ratio to albumin ratio among critically ill patients with cirrhosis. Eur J Gastroenterol Hepatol 2019; 31:824-831. [PMID: 30601338 DOI: 10.1097/meg.0000000000001339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Critically ill patients with cirrhosis are at an increased risk of mortality. Our study aimed to externally validate the ability of the prothrombin time-international normalized ratio to albumin ratio (PTAR), an objective and simple scoring system, to predict 90-day mortality in critically ill patients with cirrhosis. PATIENTS AND METHODS A total of 865 patients were entered into the study, and all the participants were followed up for at least 90 days. Clinical parameters on the first day of intensive care unit admission were included to compare survivors with nonsurvivors. RESULTS After multivariable adjustment, the association between the risk of 90-day mortality and PTAR remained statistically significant with a hazard ratio of 2.71 (95% confidence interval: 1.99-3.68). The PTAR score showed good discrimination ability for predicting 90-day mortality with an area under receiver operating characteristic curve of 0.72 (95% confidence interval: 0.68-0.75). To improve its feasibility, we regrouped the PTAR scores into three levels of risk (low risk: <0.55, intermediate risk: 0.55-1.00, and high risk: ≥1.00); the 90-day mortality rates were 20.1% (74/368), 41.7% (168/403), and 73.4% (69/94), respectively. CONCLUSION The PTAR score system is a convenient and practical tool for predicting the prognosis of critically ill patients with cirrhosis.
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Lee CZ, Peng SSF, Lee CS, Chen HL, Ni YH, Chang MH, Wu JF. Transient elastography correlated with diffusion-weighted magnetic resonance imaging and cholestatic complications. J Formos Med Assoc 2019; 118:1522-1527. [PMID: 30621960 DOI: 10.1016/j.jfma.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 12/21/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/PURPOSE The study aim to investigate the correlation between diffusion-weighted magnetic resonance imaging (DW-MRI) and transient elastography (TE) liver fibrosis findings in children with cholestatic liver diseases, and the utility of TE findings to predict cholestatic complications in children. METHODS This cross-sectional study enrolled 36 cholestatic children (21 boys and 15 girls). All study subjects underwent TE and DW-MRI studies to assess liver stiffness. All study subjects were followed prospectively, and their cholestatic complications were analyzed. The optimum cut-off TE value for the prediction of cholestatic complications was determined by receiver operating characteristic (ROC) analysis. RESULTS A significant negative correlation between liver stiffness measurements (LSMs) and right-liver-to-psoas apparent diffusion coefficient ratios (LTPARs) was found in the study cohort (correlation coefficient = -0.52, p = 0.001). An LSM cut-off > 8.6 kPa was optimal for predicting complications of cholestasis in 6 months of this cohort (p < 0.001). Survival analysis revealed that an LSM of >8.6 kPa was significantly predictive of cholestatic complications in 6 months (hazard ratio = 4.89; 95% CI = 1.41-16.97; p = 0.01). CONCLUSION TE and DW-MRI findings showed a similar ability to predict liver fibrosis in cholestatic children. The LSMs measured by TE are predictive of the occurrence of cholestatic complications in 6 months in children with cholestatic liver diseases.
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Affiliation(s)
- Chai-Zhaou Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, Changhua Christian Hospital, Yun Lin Branch, Xiluo Township, Yunlin County, Taiwan
| | | | - Chee-Seng Lee
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Huey-Ling Chen
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hwei Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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35
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Takehara T, Sakamoto N, Nishiguchi S, Ikeda F, Tatsumi T, Ueno Y, Yatsuhashi H, Takikawa Y, Kanda T, Sakamoto M, Tamori A, Mita E, Chayama K, Zhang G, De-Oertel S, Dvory-Sobol H, Matsuda T, Stamm LM, Brainard DM, Tanaka Y, Kurosaki M. Efficacy and safety of sofosbuvir-velpatasvir with or without ribavirin in HCV-infected Japanese patients with decompensated cirrhosis: an open-label phase 3 trial. J Gastroenterol 2019; 54:87-95. [PMID: 30203225 PMCID: PMC6314981 DOI: 10.1007/s00535-018-1503-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Japan, hepatitis C virus (HCV)-infected patients with decompensated cirrhosis currently have no treatment options. In this Phase 3 study, we evaluated sofosbuvir-velpatasvir with or without ribavirin for 12 weeks in patients with any HCV genotype and decompensated cirrhosis [Child-Pugh-Turcotte (CPT) class B or C] in Japan. METHODS Patients were randomized 1:1 to receive sofosbuvir-velpatasvir with or without ribavirin for 12 weeks. Randomization was stratified by CPT class and genotype. Sustained virologic response 12 weeks following completion of treatment (SVR12) was the primary efficacy endpoint. RESULTS Of the 102 patients enrolled, 57% were treatment naive, 78% and 20% had genotype 1 and 2 HCV infection, respectively, and 77% and 20% had CPT class B and C cirrhosis, respectively, at baseline. Overall, 61% of patients were female and the mean age was 66 years (range 41-83). SVR12 rates were 92% (47/51) in each group. Among patients who achieved SVR12, 26% had improved CPT class from baseline to posttreatment week 12. Most adverse events (AEs) were consistent with clinical sequelae of advanced liver disease or known toxicities of ribavirin. Four patients (8%) who received sofosbuvir-velpatasvir and seven (14%) who received sofosbuvir-velpatasvir plus ribavirin experienced a serious AE. The 3 deaths (bacterial sepsis, gastric varices hemorrhage, hepatocellular carcinoma) were attributed to liver disease progression. CONCLUSION Sofosbuvir-velpatasvir for 12 weeks provides a highly effective and well-tolerated therapy for Japanese patients with HCV and decompensated cirrhosis. Ribavirin did not improve efficacy but increased toxicity.
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Affiliation(s)
- Tetsuo Takehara
- Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871 Japan
| | | | | | | | | | | | | | | | | | | | | | - Eiji Mita
- National Hospital Organization Osaka National Hospital, Osaka, Japan
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Abstract
For patients with unresectable or medically inoperable hepatocellular carcinoma, there are many local and regional therapies available, including stereotactic body radiotherapy, radiofrequency ablation, and transcatheter embolic approaches. This article will describe these treatment options and review the current comparative literature, suggesting that stereotactic body radiotherapy provides similar or better tumor control and a favorable side effect profile.
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Affiliation(s)
- Yao Yu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
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Myeloid cell-like transcript 2 is related to liver inflammation and the pathogenesis of hepatitis B via the involvement of CD8 +T cell activation. Clin Exp Med 2018; 19:93-104. [PMID: 30361846 DOI: 10.1007/s10238-018-0534-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022]
Abstract
This study analysed the biological significance of TLT-2 on CD8+T cells in hepatitis B patients and provided a theoretical basis for the potential role of TLT-2 as an immune regulator. Flow cytometry sorting, isobaric tags for relative and absolute quantitation and short hairpin RNAs were used to analyse the function of TLT-2 on CD8+T cells in hepatitis B patients. The TLT-2 expression levels in the acute hepatitis B and chronic hepatitis B groups were significantly higher than that in the healthy control group and were positively correlated with ALT and AST. The CD8+TLT-2+T cells exhibited stronger immune function and greater cell proliferation ability and secreted higher levels of cytokines than the CD8+TLT-2-T cells. An analysis of the proteome differences between the TLT-2+CD8+T and TLT-2-CD8+T cells revealed that TLT-2 affected CD8+T cell activation by regulating Granzyme B expression and by further action on the NF-κB signalling pathway. This study first elucidated the mechanism by which TLT-2 influences the activation of CD8+T cells, improved the understanding of the TLT-2 signalling pathway and clarified the role of the TLT-2+CD8+T cell subset in hepatitis B virus infection. The study proposed a novel subset of CD8+T cells that could be useful for understanding the immune function of patients with hepatitis B and further elucidating the pathogenesis of hepatitis B by analysing changes in this subpopulation with the goal of providing a new target for the treatment of hepatitis B.
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Kuscuoglu D, Janciauskiene S, Hamesch K, Haybaeck J, Trautwein C, Strnad P. Liver - master and servant of serum proteome. J Hepatol 2018; 69:512-524. [PMID: 29709680 DOI: 10.1016/j.jhep.2018.04.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022]
Abstract
Hepatocytes synthesise the majority of serum proteins. This production occurs in the endoplasmic reticulum (ER) and is adjusted by complex local and systemic regulatory mechanisms. Accordingly, serum levels of hepatocyte-made proteins constitute important biomarkers that reflect both systemic processes and the status of the liver. For example, C-reactive protein is an established marker of inflammatory reaction, whereas transferrin emerges as a liver stress marker and an attractive mortality predictor. The high protein flow through the ER poses a continuous challenge that is handled by a complex proteostatic network consisting of ER folding machinery, ER stress response, ER-associated degradation and autophagy. Various disorders disrupt this delicate balance and result in protein accumulation in the ER. These include chronic hepatitis B infection with overproduction of hepatitis B surface antigen or inherited alpha1-antitrypsin deficiency that give rise to ground glass hepatocytes and alpha1-antitrypsin aggregates, respectively. We review these ER storage disorders and their downstream consequences. The interaction between proteotoxic stress and other ER challenges such as lipotoxicity is also discussed. Collectively, this article aims to sharpen our view of liver hepatocytes as the central hubs of protein metabolism.
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Affiliation(s)
- Deniz Kuscuoglu
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; The Interdisciplinary Center for Clinical Research (IZKF), University Hospital Aachen, Aachen, Germany
| | - Sabina Janciauskiene
- Department of Respiratory Medicine, Hannover Medical School, BREATH, German Center for Lung Research (DZL), Hannover, Germany
| | - Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Johannes Haybaeck
- Institute of Pathology, Medical University Graz, Graz, Austria; Department of Pathology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Christian Trautwein
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; The Interdisciplinary Center for Clinical Research (IZKF), University Hospital Aachen, Aachen, Germany.
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Adler M, Bourgeois N, van de Stadt J, Gelin M. A Pugh score of 8 adequately selects patients with parenchymal cirrhosis for liver transplantation. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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40
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Wang T, Yan M, Tang D, Xue L, Zhang T, Dong Y, Zhu L, Wang X, Dong Y. A retrospective, multicenter study of voriconazole trough concentrations and safety in patients with Child-Pugh class C cirrhosis. J Clin Pharm Ther 2018; 43:849-854. [PMID: 29893015 DOI: 10.1111/jcpt.12724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/17/2018] [Indexed: 12/19/2022]
Affiliation(s)
- T. Wang
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - M. Yan
- Department of Pharmacy; the Second Xiangya Hospital; Central South University; Changsha China
| | - D. Tang
- School of Basic Medicine and Clinical Pharmacy; China Pharmaceutical University; Nanjing China
| | - L. Xue
- Department of Clinical Pharmacology; The First Affiliated Hospital of Soochow University; Suzhou China
| | - T. Zhang
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - Y. Dong
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - L. Zhu
- Department of infectious disease; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - X. Wang
- Department of Pharmacy; Pulmonary Hospital of Lanzhou; Lanzhou China
| | - Y. Dong
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
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Marcinak J, Vakilynejad M, Kogame A, Tagawa Y. Evaluation of the Pharmacokinetics and Safety of a Single Oral Dose of Fasiglifam in Subjects with Mild or Moderate Hepatic Impairment. Drugs R D 2018; 18:109-118. [PMID: 29488154 PMCID: PMC5995786 DOI: 10.1007/s40268-018-0229-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIMS Fasiglifam, a potent, selective novel agonist of G protein-coupled receptor 40, stimulates insulin secretion at elevated blood glucose levels in a glucose-dependent manner. This study evaluated the potential effect of hepatic impairment on the pharmacokinetics and safety of a single dose of fasiglifam and its metabolite M-I. Fasiglifam's clinical development was halted due to liver safety concerns. METHODS In this phase I, open-label study, subjects with mild or moderate hepatic impairment, along with matched controls (gender, weight, age, and smoking status), received a single, 25-mg oral dose of fasiglifam. Blood samples were collected through 336 h post-dose for pharmacokinetic evaluation. RESULTS Overall, 73% of subjects were male with a mean age of 54 years. Compared with normal hepatic function subjects (n = 14), mean systemic fasiglifam exposure (Cmax and AUC∞) was reduced in mild (n = 8) and moderate (n = 8) hepatic impairment subjects by approximately 20-40%. However, the observed percent unbound drug plasma concentration appeared comparable across all groups. Mean oral clearance was higher and terminal half-life lower in subjects with mild or moderate hepatic impairment compared with normal hepatic function subjects. Fasiglifam M-I systemic exposure increased by approximately twofold in subjects with mild or moderate hepatic impairment compared with those with normal hepatic function. Fasiglifam was well tolerated, and there were no reports of hypoglycemia. CONCLUSION Hepatic status did not significantly impact systemic exposure of fasiglifam in this study, in fact, a decrease was observed, suggesting no dose reduction would be required for patients with hepatic impairment.
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Affiliation(s)
- John Marcinak
- Pharmacovigilence, Takeda Development Center Americas Inc., 1 Takeda Parkway, Deerfield, IL, 60015, USA.
| | - Majid Vakilynejad
- Quantitative Clinical Pharmacology, Takeda Development Center Americas Inc., Deerfield, IL, USA
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Moran S, Mina A, Duque X, Ortiz-Olvera N, Rodriguez-Leal G, Alfredo Sierra-Ramírez J, Medina-Santillán R, Mera RM, Uribe M. The utility of the
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C-methacetin breath test in predicting the long-term survival of patients with decompensated cirrhosis. J Breath Res 2017. [DOI: 10.1088/1752-7163/aa7b99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Tamai T, Oshige A, Tabu K, Tabu E, Ijyuin S, Sakae H, Onishi H, Muromachi K, Saisyoji A, Oda K, Kumagai K, Mawatari S, Moriuchi A, Sakurai K, Hori T, Ido A. Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma. Oncol Lett 2017; 14:3199-3206. [PMID: 28927066 DOI: 10.3892/ol.2017.6476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/30/2017] [Indexed: 01/13/2023] Open
Abstract
Percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) is an effective, standard therapy against small hepatocellular carcinoma (HCC). However, there is debate regarding the effectiveness of RFA combined with TACE (RFA/TACE) compared with RFA alone. These two approaches were compared for the treatment of early HCC. The present study examined 83 HCC tumors in 83 patients treated with RFA between April 2007 and August 2014 at three medical institutions. All HCCs were single hypervascular tumors, with a median diameter of 16 mm (range, 6-30 mm). The overall survival (OS) rate of all patients (n=83) was 97.5% at 1 year, 82.8% at 3 years and 48.6% at 5 years, and the local recurrence rate of all patients was 14.3% at 1 year, 32.3% at 3 years and 36.5% at 5 years. The tumor-free survival (TFS) rate of all patients was 95.1% at 1 year, 56.3% at 3 years and 23.4% at 5 years. Compared with RFA alone, RFA/TACE significantly improved OS (P<0.001), intrahepatic distant recurrence (IDR; P=0.038) and TFS (P=0.010). A univariate analysis of prognostic indicators revealed that age <70 years (P=0.008), aspartate transaminase <40 IU/l (P=0.003), alanine aminotransferase <40 IU/l (P=0.006) and platelet count >10×104/µl (P=0.05) were associated with a high survival rate. Multivariate analysis identified RFA/TACE [hazard ratio (HR), 0.108; P=0.001] as an independent prognostic indicator. RFA/TACE was identified as the only independent indicator of IDR (HR: 0.467; P=0.042) and TFS (HR: 0.452; P=0.012). RFA/TACE improved OS rate, IDR and TFS compared with RFA alone. The data suggested that RFA/TACE should be considered for the treatment of single hypervascular HCC.
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Affiliation(s)
- Tsutomu Tamai
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Akihiko Oshige
- Department of Gastroenterology and Hepatology, Kagoshima City Hospital, Kagoshima 890-8760, Japan
| | - Kazuaki Tabu
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Eriko Tabu
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Syo Ijyuin
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Haruka Sakae
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Hiroka Onishi
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Kaori Muromachi
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Akiko Saisyoji
- Department of Hepatology, Kagoshima Teishin Hospital, Kagoshima 890-8798, Japan
| | - Kohei Oda
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Kotaro Kumagai
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Seiichi Mawatari
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Akihiro Moriuchi
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Kazuhiro Sakurai
- Department of Hepatology, Kagoshima Teishin Hospital, Kagoshima 890-8798, Japan
| | - Tsuyoshi Hori
- Department of Gastroenterology and Hepatology, Kagoshima City Hospital, Kagoshima 890-8760, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
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Nishikawa H, Nishijima N, Enomoto H, Sakamoto A, Nasu A, Komekado H, Nishimura T, Kita R, Kimura T, Iijima H, Nishiguchi S, Osaki Y. Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy. Oncol Lett 2017; 14:1637-1647. [PMID: 28789390 DOI: 10.3892/ol.2017.6287] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/17/2017] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to examine the impact of sarcopenia, defined as low muscle mass on computed tomography (CT), prior to sorafenib therapy on the clinical outcomes of patients with hepatocellular carcinoma (HCC) receiving sorafenib therapy. In total, 232 patients with unresectable HCC (median age, 72 years) were analyzed, and the extent of sarcopenia was assessed using CT. Cross-sectional areas (cm2) of the skeletal muscles at the third lumbar vertebra level were determined by manual outlining on the CT images. The cross-sectional areas were normalized for height [skeletal muscle index (SMI), cm2/m2]. Based on the findings of previous studies, male patients with SMI ≤36.2 cm2/m2 and female patients with SMI ≤29.6 cm2/m2 were defined as having sarcopenia. The baseline characteristics, overall survival (OS) rates, progression-free survival (PFS) rates and best treatment response of the sarcopenia group were retrospectively compared with those of the non-sarcopenia group, and the factors associated with OS and PFS were examined. Sarcopenia was observed in 151 patients (65.1%). There were 165 patients with Child-Pugh A and 67 with Child-Pugh B cirrhosis. In the sarcopenia group, the median treatment duration was 66 days, whereas in the non-sarcopenia group it was 103 days (P=0.001). The median OS time was 174 days in the sarcopenia group and 454 days in the non-sarcopenia group (P<0.0001). The median PFS was 77 days in the sarcopenia group and 106 days in the non-sarcopenia group (P=0.0131). Multivariate analysis identified sarcopenia to be an independent predictor of OS (hazard ratio, 0.365; P<0.0001). The objective response rate and disease control rate in the sarcopenia group were significantly lower, compared with those in the non-sarcopenia group (P=0.0146 and P=0.0151, respectively). In conclusion, sarcopenia may be an indicator of poor clinical course in patients with HCC receiving sorafenib.
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Affiliation(s)
- Hiroki Nishikawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Norihiro Nishijima
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Hirayuki Enomoto
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Azusa Sakamoto
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Akihiro Nasu
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Hideyuki Komekado
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Takashi Nishimura
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Ryuichi Kita
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Toru Kimura
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Shuhei Nishiguchi
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Yukio Osaki
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
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Dreher C, Høyer KI, Fode MM, Habermehl D, Combs SE, Høyer M. Metabolic liver function after stereotactic body radiation therapy for hepatocellular carcinoma. Acta Oncol 2016; 55:886-91. [PMID: 26878669 DOI: 10.3109/0284186x.2015.1137352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose The time course of changes of the liver function after stereotactic body radiotherapy (SBRT) was analyzed in patients treated for non-resectable hepatocellular carcinoma (HCC). Patients and methods Twenty-six patients with non-resectable HCC treated with SBRT were included in this study. Clinical, biochemical and treatment-related parameters were retrospectively collected. S-albumin, s-bilirubin, s-alkaline phosphatase (AP) and s-alanine transaminase (ALAT) at 0, 3, 6, and 12 months after radiotherapy were analyzed. Results Seventeen and nine patients were Child-Pugh class A and B, respectively. The liver was exposed to relatively high radiation doses with mean doses of 1.9-26 Gy. None of the patients developed classic radiotherapy-induced liver disease (RILD), but two patients developed non-classic RILD. Two patients developed grade 3 ascites and no grade 4-5 toxicities were observed. Six patients declined in Child-Pugh class. The s-albumin decreased significantly from a pretreatment median of 37.4-34.36 g/l at three months after SBRT and stabilized thereafter. S-bilirubin, s-AP and s-ALAT did not change significantly over the study period. Conclusion Despite the fact that patients received high radiation dose to the liver, there was only moderate morbidity related to the treatment. The s-albumin decreases over three months after SBRT reflecting minor to moderate hepatic toxicity. S-albumin should be observed in the follow-up of HCC patients treated with SBRT.
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Affiliation(s)
- Constantin Dreher
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katrine I. Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Mette Marie Fode
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Daniel Habermehl
- Department of Radiotherapy and Radiooncology, Klinikum Rechts Der Isar, Munich, Germany
| | - Stephanie E. Combs
- Department of Radiotherapy and Radiooncology, Klinikum Rechts Der Isar, Munich, Germany
| | - Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
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Edmark C, McPhail MJW, Bell M, Whitehouse T, Wendon J, Christopher KB. LiFe: a liver injury score to predict outcome in critically ill patients. Intensive Care Med 2016; 42:361-369. [DOI: 10.1007/s00134-015-4203-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/17/2015] [Indexed: 12/20/2022]
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Takamura T, Motosugi U, Ichikawa S, Sano K, Morisaka H, Ichikawa T, Enomoto N, Onishi H. Usefulness of MR elastography for detecting clinical progression of cirrhosis from child-pugh class A to B in patients with type C viral hepatitis. J Magn Reson Imaging 2016; 44:715-22. [DOI: 10.1002/jmri.25182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/22/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Utaroh Motosugi
- Department of Radiology; University of Yamanashi; Yamanashi Japan
| | | | - Katsuhiro Sano
- Department of Radiology; University of Yamanashi; Yamanashi Japan
| | | | - Tomoaki Ichikawa
- Department of Radiology; University of Yamanashi; Yamanashi Japan
| | - Nobuyuki Enomoto
- First Department of Internal Medicine; University of Yamanashi; Yamanashi Japan
| | - Hiroshi Onishi
- Department of Radiology; University of Yamanashi; Yamanashi Japan
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Abstract
AIM OF THE STUDY To report the outcomes of children who underwent Sengstaken-Blakemore tube (SBT) insertion for life-threatening haemetemesis. METHODS Single institution retrospective review (1997-2012) of children managed with SBT insertion. Patient demographics, diagnosis and outcomes were noted. Data are expressed as median (range). MAIN RESULTS 19 children [10 male, age 1 (0.4-16) yr] were identified; 18 had gastro-oesophageal varices and 1 aorto-oesophageal fistula. Varices were secondary to: biliary atresia (n=8), portal vein thrombosis (n=5), alpha-1-anti-trypsin deficiency (n=1), cystic fibrosis (n=1), intrahepatic cholestasis (n=1), sclerosing cholangitis (n=1) and nodular hyperplasia with arterio-portal shunt (n=1). Three children deteriorated rapidly and did not survive to have post-SBT endoscopy. The child with an aortooesophageal fistula underwent aortic stent insertion and subsequently oesophageal replacement. Complications included gastric mucosal ulceration (n=3, 16%), pressure necrosis at lips and cheeks (n=6, 31%) and SBT dislodgment (n=1, 6%). Six (31%) children died. The remaining 13 have been followed up for 62 (2-165) months; five required liver transplantation, two underwent a mesocaval shunt procedure and 6 have completed endoscopic variceal obliteration and are under surveillance. CONCLUSIONS SBT can be an effective, albeit temporary, life-saving manoeuvre in children with catastrophic haematemesis.
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Hansen L, Leo MC, Chang MF, Zaman A, Naugler W, Schwartz J. Symptom distress in patients with end-stage liver disease toward the end of life. Gastroenterol Nurs 2015; 38:201-10. [PMID: 26035777 PMCID: PMC4457294 DOI: 10.1097/sga.0000000000000108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Research on symptom distress experienced by patients with end-stage liver disease at the end of life is limited. The aims of the study were to describe presence, frequency, severity, and distress of symptoms in patients with end-stage liver disease toward the end of life and to describe the variability in psychological and physical symptom distress between and within patients over time. This study used a prospective, longitudinal descriptive design. Data were collected from 20 patients once a month for up to 6 months. Participants completed the Memorial Symptom Assessment Scale, which reports a total score, a Global Distress Index score, and a psychological and a physical distress score. Patients reported lack of energy, pain, difficulty sleeping, and feeling drowsy as the most frequent, severe, and distressing symptoms. Global Distress Index mean scores (measured on a 1-4 scale) ranged from 2.6 to 2.9 across time. There was notable variability in psychological and physical distress scores between and within patients across time. Gaining knowledge about the prevalent symptoms experienced by patients with end-stage liver disease and the trajectory of these symptoms is crucial for designing interventions that optimize well-being in patients with end-stage liver disease as they are approaching death.
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Affiliation(s)
- Lissi Hansen
- Oregon Health & Science University, School of Nursing, SN-ORD, 3455 S.W. US Veterans Hospital Rd., Portland, Oregon 97239-2941, Phone: 503-418-3357, Fax: 503-494-7783
| | - Michael C. Leo
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave Portland, OR 97227, Phone: 503-528-3909, Fax
| | - Michael F. Chang
- Portland Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, Phone: 503-220-8262 ext. 54482, Fax: 503-220-3426
| | - Atif Zaman
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., MC L461, Portland, Oregon 97239-3098, Phone: 503-494-8071, Fax: 503-494-8776
| | - Willscott Naugler
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., MC L461, Portland, Oregon 97239-3098, Phone: 503-713-3069, Fax: 503-494-8776
| | - Jonathan Schwartz
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx NY 10467, Phone: 503 351-6691, Fax
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Hepatic ADC map as an adjunct to conventional abdominal MRI to evaluate hepatic fibrotic and clinical cirrhotic severity in biliary atresia patients. Eur Radiol 2015; 25:2992-3002. [PMID: 25921590 DOI: 10.1007/s00330-015-3716-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Hepatic apparent diffusion coefficient (ADC) values and ADC-related indices were correlated with the Mayo risk score for primary biliary cirrhosis (MRSPBC) and METAVIR scores of liver specimens to determine the clinical and pathological significance of diffusion-weighted magnetic resonance imaging (DWMRI). METHODS Thirty-two patients with biliary atresia (BA; mean age 461 days, range 11-4616 days) received magnetic resonance examinations from March 2009 to August 2013. A free-breathing DWMRI sequence was performed with the single-shot echo-planar imaging technique with b = 0 and 500 s/mm(2) in all 32 BA patients and 24 controls. We used the ordinal logistic regression test and Spearman rank correlation test to analyse the relationships between the MRSPBC and METAVIR fibrosis scores and right liver-to-psoas ADC ratios (LTPARs). RESULTS BA patients had significantly lower LTPARs in both hepatic lobes than controls (p < 0.01). Right LTPARs, showing moderate intraobserver agreement (intraclass correlation coefficient = 0.736) and interobserver reliability (intraclass correlation coefficient = 0.659), were negatively correlated with MRSPBC and METAVIR fibrosis scores (R(2) = 0.398, p = 0.024 and R(2) = 0.628, p < 0.001, respectively). CONCLUSION Right LTPARs may be used for long-term follow-up of cirrhosis severity in BA patients. KEY POINTS • Hepatic ADC values by DWI correlates well with clinical/pathologic fibrosis scores • Periodic, non-invasive, quantitative imaging follow-up of patients with biliary cirrhosis is feasible • Information on cirrhosis severity could help decide on management options in children with BA • ADC values may be useful in this regard.
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