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Wolfgang Maximilian Kremer Simon Johannes Gairing Leonard Kaps Esmeralda Ismail Vasiliki Kalampoka Max Hilscher Maurice Michel Ekkehard Siegel Jörn M. Schattenberg Peter R. Galle Martin F. Sprinzl Marcus-Alexander Wörns Michael Nagel Christian Labenz 《Annals of hepatology》2022,27(5):100719
Introduction and ObjectivesBacterial infections are associated with a dismal prognosis in patients with liver cirrhosis. Data on their prevalence and the associated pathogen spectra in Germany are scarce. This study aimed to evaluate the impact of bacterial infections on mortality in hospitalized patients with liver cirrhosis and to analyze the prevalence of multidrug-resistant (MDR) bacteria in a German tertiary care center.Patients and MethodsConsecutive, non-electively hospitalized patients with liver cirrhosis were enrolled in this study between 03/2019-06/2021. All patients underwent clinical, laboratory and microbiological testing to detect potential bacterial infections. Patients were followed for 30 days regarding the composite endpoint of death or liver transplantation (mortality).ResultsIn total, 239 patients were recruited (median MELD 18). Bacterial infection was detected in 81 patients (33.9%) at study inclusion. A total of 70 patients (29.3%) developed a hospital-acquired infection. When comparing community-acquired and hospital-acquired infections, the pathogen pattern shifted from a gram-negative to a more gram-positive spectrum and showed an increase of Staphylococcus spp.. MDR bacteria were detected in seven infected patients (5.8%). 34 patients reached the composite endpoint during 30-days follow-up. In multivariable logistic regression analysis, the presence of infection during hospitalization remained independently associated with higher mortality (OR 2.522, 95% CI 1.044 - 6.091, p = 0.040).ConclusionsThis study demonstrates that bacterial infections are common in hospitalized patients with liver cirrhosis in Germany and are a major determinant of short-term mortality. Our data highlight the importance of regional differences in MDR bacteria and may guide physicians' decision-making regarding calculated antibiotic treatment. 相似文献
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Florence Wong Salvatore Piano Virendra Singh Michele Bartoletti Rakhi Maiwall Carlo Alessandria Javier Fernandez Elza Cotrim Soares Dong Joon Kim Sung Eun Kim Monica Marino Julio Vorobioff Rita de Cassia Ribeiro Barea Manuela Merli Laure Elkrief Victor Vargas Aleksander Krag Shivaram Prasad Singh Giacomo Zaccherini 《Journal of hepatology》2021,74(2):330-339
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Jian-Wu Yu Li-Jie Sun Yong-Hua Zhao Shu-Chen Li 《Journal of gastroenterology and hepatology》2008,23(8PT1):1242-1249
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目的探讨复方甘草酸苷联合恩替卡韦治疗乙型肝炎病毒(HBV)相关慢加急性肝衰竭(ACLF)患者的疗效。 方法选取HBV相关ACLF患者73例,根据用药不同将其分为观察组(恩替卡韦口服+复方甘草酸苷注射)和对照组(恩替卡韦口服)。比较两组治疗前后HBsAg、HBeAg和HBV DNA载量、肝功能指标[白蛋白(ALB)、总胆红素(TBIL)、谷草转氨酶(AST)和谷丙转氨酶(ALT)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平、凝血酶原活动度(PTA)和国际标准化比值(INR)],以及患者生存状况。 结果与治疗前比较,两组治疗后HBsAg、HBeAg和HBV DNA载量降低(P＜0.05)。与治疗前比较,两组治疗后ALB、FIB、PTA升高,TBIL、AST、ALT、PT、APTT、TT、INR降低,且观察组较对照组改善更为显著(P＜0.05)。观察组患者生存时间长于对照组(P＜0.05)。 结论复方甘草酸苷联合恩替卡韦治疗HBV相关ACLF具有显著疗效,可延长患者生存期。 相似文献
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目的探讨乙肝相关慢加急性肝衰竭（HBV-ACLF）外周血Th17细胞的表达及其与临床转归的关系。方法采用流式细胞术分析外周血中Th17细胞比例,flowcytomix技术检测血清中IL-17的水平,荧光PCR检测HBV-DNA载量,ELISA检测HBeAg的状态,分析Th17细胞及IL-17的表达与HBV病毒及预后的关系。结果与健康对照组及慢乙肝组相比,HBV-ACLF患者Th17细胞及IL-17水平明显升高（P〈0.01）,且Th17细胞与IL-17水平成正相关;进一步分析发现不同病毒复制水平及HBeAg状态的HBV-ACLF患者Th17细胞及IL-17的差异无统计学意义;与预后好转患者相比,预后不佳HBV-ACLF患者Th17细胞及IL-17水平明显增高（P〈0.05）,且IL-17的水平与终末期肝病评分成正相关。结论 Th17细胞可能参与了HBV-ACLF的发病机制,且IL-17的表达越高可能提示患者的预后不佳。 相似文献
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目的探讨乙肝相关慢加急性肝衰竭(HBV-ACLF)外周血Th17细胞的表达及其与临床转归的关系。方法采用流式细胞术分析外周血中Th17细胞比例,flowcytomix技术检测血清中IL-17的水平,荧光PCR检测HBV-DNA载量,ELISA检测HBeAg的状态,分析Th17细胞及IL-17的表达与HBV病毒及预后的关系。结果与健康对照组及慢乙肝组相比,HBV-ACLF患者Th17细胞及IL-17水平明显升高(P<0.01),且Th17细胞与IL-17水平成正相关;进一步分析发现不同病毒复制水平及HBeAg状态的HBV-ACLF患者Th17细胞及IL-17的差异无统计学意义;与预后好转患者相比,预后不佳HBV-ACLF患者Th17细胞及IL-17水平明显增高(P<0.05),且IL-17的水平与终末期肝病评分成正相关。结论 Th17细胞可能参与了HBV-ACLF的发病机制,且IL-17的表达越高可能提示患者的预后不佳。 相似文献
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Mohammed A. AbdelRazek Mohammed Mohamed H. Khalaf Tie Liang David S. Wang Matthew P. Lungren Jarret Rosenberg Nishita Kothary 《Journal of vascular and interventional radiology : JVIR》2018,29(11):1527-1534.e1
Purpose
To evaluate validity of albumin-bilirubin (ALBI) grade as a predictor of acute-on-chronic liver failure (ACLF) after transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with baseline moderate to severe liver dysfunction.Materials and Methods
In this retrospective study, serum albumin and bilirubin levels measured before chemoembolization were used to calculate ALBI score in 123 patients treated with 187 high-risk chemoembolizations. Procedures were considered high risk if Child-Turcotte-Pugh score before chemoembolization was ≥ 8. ACLF was objectively measured using chronic liver failure–sequential organ failure assessment score at 30 and 90 d. The 30-day mortality and morbidity from new or worsening ascites and/or hepatic encephalopathy (HE) were assessed. Univariate and multivariate analyses were used to identify clinical and procedural predictors of ACLF in this high-risk population.Results
ACLF occurred after 15 (8%) high-risk chemoembolizations within 30 days and an additional 9 (5%) procedures between 30 and 90 days. Overall 30-day mortality was 2.7%. New or worsened ascites and/or HE occurred after 52 (28%) procedures within 30 days. Significant prognosticators of ACLF at 90 days revealed by univariate analysis were bilirubin (P = .004), albumin (P = .007), and ALBI score (P = .002), with ALBI score remaining statistically significant on multivariate regression analysis (OR = 3.99; 95% CI, 1.70–9.40; P = .002).Conclusions
Chemoembolization for HCC can be performed safely in patients with moderate to severe liver dysfunction. ALBI score before chemoembolization provides objective prognostication for ACLF after chemoembolization in this cohort and may be used for risk stratification. 相似文献58.
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