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Abstract
This article reviews the incidence of acute hepatitis B virus (HBV) infection, its clinical course, strategies to prevent acute HBV infection in susceptible individuals, and the management of patients with acute HBV.
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Affiliation(s)
- Simone E Dekker
- Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Ellen W Green
- Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Joseph Ahn
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, MNP 4112, Portland, OR 97239, USA.
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2
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Berber I, Cagin YF, Erdogan MA, Ataman E, Gozukara H, Erkurt MA, Yildirim O, Kuku İ, Kaya E, Bilgic Y, Sarici A, Bicim S, Polat A. Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis. Transfus Apher Sci 2021; 60:103250. [PMID: 34666895 DOI: 10.1016/j.transci.2021.103250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Acute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure. MATERIALS AND METHODS A total of 335 patients who received TPE between 2010-2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22-84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE. RESULTS Acute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed. CONCLUSION TPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.
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Affiliation(s)
- Ilhami Berber
- Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Yasir Furkan Cagin
- Inonu University, Faculty of Medicine, Department of Gastroenterology, Malatya, Turkey.
| | - Mehmet Ali Erdogan
- Inonu University, Faculty of Medicine, Department of Gastroenterology, Malatya, Turkey
| | - Engin Ataman
- Inonu University, Faculty of Medicine, Department of Gastroenterology, Malatya, Turkey
| | - Harika Gozukara
- Inonu University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Malatya, Turkey
| | - Mehmet Ali Erkurt
- Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Oguzhan Yildirim
- Inonu University, Faculty of Medicine, Department of Gastroenterology, Malatya, Turkey
| | - İrfan Kuku
- Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Emin Kaya
- Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Yilmaz Bilgic
- Inonu University, Faculty of Medicine, Department of Gastroenterology, Malatya, Turkey
| | - Ahmet Sarici
- Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Soykan Bicim
- Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Alaadin Polat
- Inonu University, Faculty of Medicine, Department of Physiology, Malatya, Turkey
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Patidar KR, Davis BC, Slaven JE, Ghabril MS, Kubal CA, Lee WM, Stravitz RT. Admission Factor V Predicts Transplant-Free Survival in Acute Liver Failure. Dig Dis Sci 2021; 66:619-627. [PMID: 32185661 PMCID: PMC10668526 DOI: 10.1007/s10620-020-06197-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Traditional laboratory markers are insensitive in distinguishing between patients with acute liver failure (ALF) who will require urgent liver transplantation (LT) from those who will recover spontaneously, particularly within 24 h of presentation. Coagulation factor-V (FV) may improve the accuracy of outcome prediction in ALF due to its predominant synthesis in the liver and short half-life in plasma. METHODS Patients enrolled in the ALF Study Group Registry from a single site had FV determined within 24 h of presentation (Derivation-Cohort). Area under the receiver operating characteristic curves (AUROC) dichotomized by ALF etiology [acetaminophen (APAP) or non-APAP] were constructed to evaluate the diagnostic performance of FV for transplant-free-survival (TFS). Multivariate logistic regression modeling was performed using FV and other clinical variables to predict TFS. Accuracy of FV and multivariable model were performed in a Validation-Cohort from a different site. RESULTS 90-patients (56% with APAP) were included in the Derivation-Cohort. Median FV was significantly higher in TFS versus those who died/LT (31% vs. 15%, respectively; p = 0.001). When dichotomized by etiology, AUROC for FV was 0.77 for APAP (cutoff, sensitivity, specificity 10.5%, 79%, 69%, respectively) and 0.77 for non-APAP (22%, 85%, 67%, respectively). When the optimal cutoffs for FV in the Derivation-Cohort were applied to the Validation-Cohort (N = 51; 59% with APAP), AUROC for FV was 0.75 for APAP (sensitivity/specificity 81/44) and 0.95 for non-APAP (sensitivity/specificity 90/73). In multivariate analyses, AUROC for FV model was 0.86 in the Derivation-Cohort and 0.90 in the Validation-Cohort. CONCLUSION Admission FV may improve selection of patients who are likely to improve without LT.
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Affiliation(s)
- Kavish R Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, USA.
| | - Brian C Davis
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marwan S Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, USA
| | - Chandrashekhar A Kubal
- Division of Transplant Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William M Lee
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Richard T Stravitz
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
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Winters AC, Kabany ME, Choi G, Saab S. Acute Liver Failure During Pregnancy: Happy to Recover from Hep E. Dig Dis Sci 2020; 65:2515-7. [PMID: 32524414 DOI: 10.1007/s10620-020-06367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Varghese J, Joshi V, Bollipalli MK, Malleeswaran S, Patcha R, Nair H, Vij V, Sachan D, Subramanian P, Jain M, Venkataraman J. Role of therapeutic plasma exchange in acute liver failure due to yellow phosphorus poisoning. Indian J Gastroenterol 2020; 39:544-549. [PMID: 33409946 PMCID: PMC7787244 DOI: 10.1007/s12664-020-01095-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) has been utilized in various liver disorders. There is limited data on the efficacy of TPE in patients with acute liver failure (ALF). METHODS Study group consisted of patients who underwent TPE for ALF due to yellow phosphorous poisoning (YPP) between 2015 and 2019. Demographic data and biochemical parameters were recorded before and after TPE. Overall survival and transplant-free survival (based on King's College Hospital Criteria [KCHC]) were analyzed. RESULTS Forty-three patients underwent TPE for ALF due to YPP. Most of them were young males. Overall survival was 34 (79.06%). In our study population, 20 patients fulfilled KCHC (Group A) and 23 did not fulfill KCHC (Group B). Both the groups showed significant improvement in alanine aminotransferase, aspartate aminotransferase, and international normalized ratio (INR) after TPE (p < 0.05). In Group B, there was significant improvement in ammonia after TPE (p < 0.05) and all 23 patients (100%) survived after TPE. In Group A, 4 underwent liver transplantation (LT), 7 survived without LT, and the remaining 9 died without LT. Mean survival after completing TPE was 41.2 ± 44.5 days in Group A and 90 days in Group B. This difference was statistically significant (p = 0.001). There was statistically significant difference in post-TPE values of INR (p = 0.012) and ammonia (p = 0.011) between non-survivors and survivors. Adverse events such as hypotension (11.62%) and minor allergic reaction (4.65%) were managed conservatively. CONCLUSION TPE is an effective procedure in ALF due to YPP, not fulfilling KCHC for LT. In KCHC fulfilled group, though it shows LT-free survival benefit, there is requirement of prospective, large volume, multi-center study to assess its efficacy.
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Affiliation(s)
- Joy Varghese
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Vivek Joshi
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | | | - Selvakumar Malleeswaran
- Department of Liver Anesthesia and ICU, Gleneagles Global Health City, Chennai 600 100, India
| | - Rajinikanth Patcha
- Department of HPB and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Harikumar Nair
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Vivek Vij
- Department of HPB and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Deepti Sachan
- Department of Transfusion Medicine, Dr. Rela Institute and Medical Centre, Chennai 600 044, India
| | - Pushkala Subramanian
- Department of Immunology, The Tamil Nadu Dr. MGR University, Chennai 600 032, India
| | - Mayank Jain
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute for Higher Education and Research, Chennai 600 116, India
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Tao YC, Wang ML, Wu DB, Luo C, Tang H, Chen EQ. Apolipoprotein A5 alleviates LPS/D-GalN-induced fulminant liver failure in mice by inhibiting TLR4-mediated NF-κB pathway. J Transl Med 2019; 17:151. [PMID: 31077206 PMCID: PMC6511152 DOI: 10.1186/s12967-019-1900-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fulminant liver failure (FHF) is a serious clinical problem and liver transplantation is the major intervention. But the overall survival rate of FHF is low owing to the donated organ shortage. Apolipoprotein A-V (ApoA5) is a regulator of triglyceride metabolism and has been reported to act as a predictor for remnant liver growth after preoperative portal vein embolization and liver surgery. This study aimed to investigate the therapeutic effect of ApoA5 on lipopolysaccharide/D-galactosamine (LPS/D-GalN)-induced fulminant liver failure in mice. METHODS FHF mouse model was established using LPS/D-GalN and ApoA5 plasmid was injected by tail vein prior to LPS/D-GalN treatment. The expressions of ApoA5, toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88), and nuclear factor kappa B p65 (NF-κBp65) were assessed by real-time PCR and western blotting. Serum alanine aminotransferase (ALT) and tumor necrosis factor-α (TNF-α) levels were measured using automatic biochemical analyzer. Histological assessment and immunohistochemical (IHC) staining were conducted. Survival rate after LPS/D-GalN administration was also determined with Kaplan-Meier curve. Meanwhile, the expression of ApoA5 in injured huh7 cells was tested. Cell apoptosis analysis was performed after huh7 cells were transfected with ApoA5 plasmid and stimulated with LPS. RESULTS The expressions of ApoA5 decreased both in injured huh7 cells and FHF mice. ApoA5 overexpression reduced cell death rate using flow cytometry. ApoA5 not only decreased the serum ALT and TNF-α levels but also attenuated hepatic damage in hematoxylin-eosin (HE)-stained liver section. The protein expressions of TLR4, MyD88 and NF-κBp65 were inhibited when ApoA5 overexpressed. But the inhibitory effect would weaken with the increasing concentration of LPS in spite of ApoA5 overexpression. Besides, ApoA5 improved liver injury in a dose-dependent manner and the survival rate in FHF mice increased with increasing concentration of ApoA5. CONCLUSION ApoA5 had a protective effect against LPS/D-GalN-induced fulminant liver failure in mice within a certain range by inhibiting TLR4-mediated NF-κB pathway.
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Affiliation(s)
- Ya-Chao Tao
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, China.,Division of Infectious Diseases, National Key Laboratory of Biotherapy (Sichuan University), West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Meng-Lan Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, China.,Division of Infectious Diseases, National Key Laboratory of Biotherapy (Sichuan University), West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Dong-Bo Wu
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, China.,Division of Infectious Diseases, National Key Laboratory of Biotherapy (Sichuan University), West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chen Luo
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, China.,Division of Infectious Diseases, National Key Laboratory of Biotherapy (Sichuan University), West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, China.,Division of Infectious Diseases, National Key Laboratory of Biotherapy (Sichuan University), West China Hospital of Sichuan University, Chengdu, 610041, China
| | - En-Qiang Chen
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, China. .,Division of Infectious Diseases, National Key Laboratory of Biotherapy (Sichuan University), West China Hospital of Sichuan University, Chengdu, 610041, China.
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Kularatne SAM, Ralapanawa U, Dalugama C, Jayasinghe J, Rupasinghe S, Kumarihamy P. Series of 10 dengue fever cases with unusual presentations and complications in Sri Lanka: a single centre experience in 2016. BMC Infect Dis 2018; 18:674. [PMID: 30563480 PMCID: PMC6299528 DOI: 10.1186/s12879-018-3596-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/07/2018] [Indexed: 12/31/2022] Open
Abstract
Background Dengue has global importance as a dreaded arboviral infection. It has 4 serotypes of epidemiological imporatnce. The classification denotes two clinical spectrums- dengue fever (DF) and dengue haemorragic fever (DHF). Most cases are stereotype and amenable to fluid resuscitation. However, unusual manifestations cause fatalities and often overlooked. This study describes 10 such dengue cases to fill the knowledge gaps. Case presentation All 10 patients presented to the Teaching Hospital, Peradeniya, Sri Lanka during mid-year epidemic of dengue in 2016. The mean age is 27 years (range 12-51 years) comprising 6 females and 4 males. The group had 7 DHF, 3 DF and 2 primary dengue infections who predominantly had severe bleeding into gut. Other potentially life threatening problems were acute severe hepatitis, severe septic shock, myocarditis, erratic rapid plasma leak, intracranial bleeding, diarrhoea and decompenstaed dengue shock due to 3rd space fluid leak. Blood transfusions and other empirical therapeutic methods were used apart from meticulous fluid management to suit issues of each patient. Bedside ultrasound scanning helped early detection of critical phase. All recovered fully. Conclusions Dengue is an extremely challenging infection to treat in the globe today. Above unusual presentation and complications could be fatal, if not detected early where therapeutic window period is very short. Clinicians need awareness of these problems which are not uncommon, but underreported and often overlooked. The clinical management of each patient was described for the purpose sharing the experiences.
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Affiliation(s)
- S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Udaya Ralapanawa
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Chamara Dalugama
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jayanika Jayasinghe
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sawandika Rupasinghe
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Peroutka C, Salas J, Britton J, Bishop J, Kratz L, Gilmore MM, Fahrner JA, Golden WC, Wang T. Severe Neonatal Manifestations of Infantile Liver Failure Syndrome Type 1 Caused by Cytosolic Leucine-tRNA Synthetase Deficiency. JIMD Rep 2019; 45:71-6. [PMID: 30349989 DOI: 10.1007/8904_2018_143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Deleterious mutations in cytosolic leucine-tRNA synthetase (LARS) cause infantile liver failure syndrome, type 1 (ILFS1), a recently recognized, rare autosomal recessive disorder (OMIM151350). Only six families with ILFS1 have been reported in the literature. Patients with ILFS1 are typically diagnosed between 5 and 24 months of age with failure to thrive, developmental delays, encephalopathy, microcytic anemia, and chronic liver dysfunction with recurrent exacerbations following childhood illnesses. Neonatal manifestations of this disorder have not been well documented. CASE REPORT We report a premature female newborn with intrauterine growth restriction, failure to thrive, congenital anemia, anasarca, and fulminant liver failure leading to lethal multiple organ failure. Liver failure in this infant was characterized by a disproportionate impairment of liver synthetic function, including severe coagulopathy and hypoalbuminemia without significant defects in liver detoxification or evidence of hepatocellular injury during early phase of the disease. Whole-exome sequencing of child-parent trio identified two inherited missense mutations in LARS in this patient. One, c.1292T>A; p.Val431Asp, has been reported in patients with ILFS1, while the other, c.725C>T; p.Pro242Leu, is novel. Both mutations involve amino acid residues in the highly conserved editing domain of LARS, are predicted to be functionally deleterious, and presumably contribute to the clinical manifestations in this patient. CONCLUSION This is the first case documenting neonatal manifestation of ILFS1, highlighting early, severe, and disproportionate defects in liver synthetic function. Timely diagnosis of ILFS1 is crucial to guide critical clinical management and improve outcomes of this rare and potentially life-threatening disorder.
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Abstract
Acute liver failure is a rare condition with high short-term morbidity and mortality. The most widely accepted definition is an abnormality in coagulation with any degree of encephalopathy in a patient without cirrhosis and an illness duration of less than 26 weeks. Multiple classifications systems are currently in use to help categorize the condition. This article reviews the most commonly used systems. The epidemiologic aspects of the disease are also reviewed, including incidence, prevalence, demographics, geographic distribution, and racial and cultural factors and are discussed for the various subtypes of acute liver failure.
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Affiliation(s)
- Daniel Pievsky
- Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, University Hospital, 185 South Orange Avenue, Newark, NJ 07101-1709, USA
| | - Neil Rustgi
- Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA 23507, USA
| | - Nikolaos T Pyrsopoulos
- Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, University Hospital, 185 South Orange Avenue, Newark, NJ 07101-1709, USA.
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Gao S, Joshi SS, Osiowy C, Chen Y, Coffin CS, Duan ZP. Chronic hepatitis B carriers with acute on chronic liver failure show increased HBV surface gene mutations, including immune escape variants. Virol J 2017; 14:203. [PMID: 29065883 PMCID: PMC5655973 DOI: 10.1186/s12985-017-0870-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/13/2017] [Indexed: 02/07/2023] Open
Abstract
Background The pathogenesis of acute-on-chronic liver failure (ACLF) in chronic hepatitis B (CHB) is not well understood. The aim of this study was to investigate whether there is an association between HBV polymerase (P)/overlapping surface (S) gene and basal core promoter (BCP)/precore (PC) variants and development of ACLF in CHB. Methods Two CHB patient cohorts were compared: (i) ACLF (N = 12) (11/12 M, median age 52 yrs., 5/9 genotype C, 6/12 HBeAg+), (ii) 27 treatment native CHB carriers (15/27 M, median age 44 yrs., 9 genotype B, 10 genotype C, 1 genotype A, 5 genotype D, 2 genotype E). Clonal sequencing of PCR-amplified HBV P/S and BCP/PC gene fragments was done and HBV diversity, frequency of immune escape (IE) and drug resistance (DR) mutations and mutations in BCP/PC gene (G1896A and A1762T/G1764A), were compared between each group. Results Our data showed the incidence of IE and clusters of mutations in the HBV S region was significantly greater in ACLF patients vs. treatment naïve CHB patients (p < 0.05). Additionally, a significantly higher frequency of G1896A and A1762T/G1764A mutations were found in HBeAg negative than in ACLF patients (p < 0.0001). Conclusion In our study, ACLF was not associated with a specific genomic mutation. However, higher frequency of IE mutations along with various mutations clustering in the HBV S region could contribute to or be an outcome of ACLF in CHB infection. (words 226). Electronic supplementary material The online version of this article (10.1186/s12985-017-0870-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shan Gao
- Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, 8 Xitoutiao, Youwai Street, Beijing, 100069, China.,Calgary Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary 6D21, Teaching, Research and Wellness Building, 3280 Hospital Drive N.W, Calgary, AB, T2N 4Z6, Canada.,Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shivali S Joshi
- Calgary Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary 6D21, Teaching, Research and Wellness Building, 3280 Hospital Drive N.W, Calgary, AB, T2N 4Z6, Canada.,Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carla Osiowy
- Bloodborne Pathogens and Hepatitis Laboratory of the National Microbiology Laboratory, Winnipeg, MB, Canada
| | - Y Chen
- Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, 8 Xitoutiao, Youwai Street, Beijing, 100069, China
| | - Carla S Coffin
- Calgary Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary 6D21, Teaching, Research and Wellness Building, 3280 Hospital Drive N.W, Calgary, AB, T2N 4Z6, Canada. .,Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Z-P Duan
- Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, 8 Xitoutiao, Youwai Street, Beijing, 100069, China.
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Ndekwe P, Ghabril MS, Zang Y, Mann SA, Cummings OW, Lin J. Substantial hepatic necrosis is prognostic in fulminant liver failure. World J Gastroenterol 2017; 23:4303-4310. [PMID: 28694671 PMCID: PMC5483505 DOI: 10.3748/wjg.v23.i23.4303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/21/2017] [Accepted: 05/19/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival.
METHODS Thirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient survived.
RESULTS The core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26%-75% of the parenchymal volume) and 26 massive (76%-100%) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40%, 71.4% and 100% in groups with necrosis of 76%-100%, 51%-75% and 26%-50%, respectively). Additionally, transplant-free survival rates were 66.7%, 57.1%, and 25.0% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80%, 100%, and 40% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively).
CONCLUSION Adequate liver biopsy with more than 75% necrosis is associated with significant transplant-free mortality that is critical in predicting survival.
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Escobar-Valdivia E, Monreal-Robles R, Delgado-García G, Hernández-Velazquez B. Fulminant hepatic failure due to metastatic choroidal melanoma. Caspian J Intern Med 2017; 8:59-62. [PMID: 28503286 PMCID: PMC5412252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute liver failure (ALF) as a consequence of metastatic disease is extremely uncommon. The liver is the most commonly affected organ by metastatic disease, but only a few cases of ALF in the setting of metastatic choroidal melanoma have been reported. CASE PRESENTATION We describe the case of a 47-year-old man with right upper quadrant pain, progressive jaundice, and unintentional weight loss. He also reported that he had experienced reduced left visual acuity which progressed to blindness over 2 months. On physical examination, we found a pigmented scleral lesion in the left eye. He had a coagulopathy and, during his hospital stay, he also developed encephalopathy. The diagnosis of ALF was therefore established and was later attributed to metastatic uveal melanoma. In addition, we briefly review the relevant literature. CONCLUSION Liver metastasis should be kept in mind when assessing abnormal liver function tests in patients with uveal malignant melanoma.
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Affiliation(s)
| | - Roberto Monreal-Robles
- Division of Gastroenterology, University Hospital, Autonomous University of Nuevo León.,Correspondence: Roberto Monreal-Robles, Division of Gastroenterology, University Hospital, Autonomous University of Nuevo Leon, Monterrey, Mexico, E-mail:
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van Geel RM, Hendrikx JJ, Vahl JE, van Leerdam ME, van den Broek D, Huitema AD, Beijnen JH, Schellens JH, Burgers SA. Crizotinib-induced fatal fulminant liver failure. Lung Cancer. 2016;93:17-19. [PMID: 26898609 DOI: 10.1016/j.lungcan.2015.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/25/2015] [Indexed: 12/20/2022]
Abstract
Herein we describe a case of a 62-year-old female in good clinical condition with non-small-cell lung cancer who was treated with crizotinib. After 24 days of crizotinib therapy she presented with acute liver failure. Serum aspartate aminotransferase and alanine aminotransferase levels had increased from normal prior to crizotinib start to 2053 IU/L and 6194 IU/L, respectively. Total bilirubin and prothrombin time (PT-INR) increased up to 443 IU/L and 5.33, respectively, and symptoms of hepatic encephalopathy and hepatorenal syndrome emerged. Despite crizotinib discontinuation and intensive supportive therapy, the patient died 40 days after treatment with crizotinib was initiated due to acute liver failure with massive liver cell necrosis.
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Kotoh K, Enjoji M, Nakamuta M, Yoshimoto T, Kohjima M, Morizono S, Yamashita S, Horikawa Y, Yoshimitsu K, Tajima T, Asayama Y, Ishigami K, Hirakawa M. Arterial steroid injection therapy can inhibit the progression of severe acute hepatic failure toward fulminant liver failure. World J Gastroenterol 2006; 12:6678-82. [PMID: 17075983 PMCID: PMC4125675 DOI: 10.3748/wjg.v12.i41.6678] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To utilize transcatheter arterial steroid injection therapy (TASIT) via the hepatic artery to reduce hepatic macrophage activity in patients with severe acute hepatic failure.
METHODS: Thirty-four patients with severe acute hepatic failure were admitted to our hospital between June 2002 to June 2006 providing for the possibility of liver transplantation (LT). Seventeen patients were treated using traditional liver supportive procedures, and the other 17 patients additionally underwent TASIT with 1000 mg methylprednisolone per day for 3 continuous days.
RESULTS: Of the 17 patients who received TASIT, 13 were cured without any complications, 2 died, and 2 underwent LT. Of the 17 patients who did not receive TASIT, 4 were self-limiting, 7 died, and 6 underwent LT. Univariate logistic analysis revealed that ascites, serum albumin, prothrombin time, platelet count, and TASIT were significant variables for predicating the prognosis. Multivariate logistic regression analysis using stepwise variable selection showed that prothrombin time, platelet count, and TASIT were independent predictive factors.
CONCLUSION: TASIT might effectively prevent the progression of severe acute hepatic failure to a fatal stage of fulminant liver failure.
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Affiliation(s)
- Kazuhiro Kotoh
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Yu ZQ, Yang BS, Wang Y, Chen LY, Bi MR, Wang FX, Ma YJ. Protective effect of Stronger Neo-Minophagen C on patients with fulminant liver failure. Shijie Huaren Xiaohua Zazhi 2006; 14:1318-1322. [DOI: 10.11569/wcjd.v14.i13.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To discuss the protective effect of Stronger Neo-Minophagen C (SNMC) on patients with fulminant liver failure (FLF).
METHODS: From March 2003 to March 2005, 86 FLF patients were selected for this study, and they were assigned into group A and B. The patients in group A were intravenously injected with SNMC 120 mL per day, combined with symptomatic treatment to protect the liver. Symptomatic treatment was only performed on patients in group B, serving as controls. The level changes of serum alanine aminotransferase (ALT), cholesterol (CHOL), total bilirubin (TBIL), prothrombin activity (PTA), tumor necrosis factor TNF-α, nitrix oxide (NO), and interleukin-6 (IL-6), as well as the outcome of the disease, were observed and comparatively analyzed.
RESULTS: The levels of ALT and TBIL had no significant difference between the two groups (P > 0.05), while those of CHOL and PTA were significantly different between them (P < 0.01). After treatment, the levels of NO and IL-6 were markedly lower in group A than those in group B (24.5 ± 18.1 μmol/L vs 48.1 ± 24.1 μmol/L, P < 0.01; 76.9 ± 71.2 ng/L vs 357.1 ± 79.1 ng/L, P < 0.01). The fatality rates were 37.8% (17/45) and 70.7% (29/41), respectively, in group A and B, and there was significant difference between them (P < 0.01).
CONCLUSION: SNMC has obvious protective effect on FLF patients through inhibiting the inflammation mediated by inflammatory mediators.
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