Immune function biomarker QuantiFERON-monitor is associated with infection risk in cirrhotic patients

AIM To investigate whether a novel immune function biomarker Quanti FERON-Monitor(QFM) can identify cirrhotic patients at greatest risk of infection. METHODS Adult cirrhotic patients on the liver transplant waiting list were recruited for this observational cohort study from a tertiary liver transplant referral unit. The immune function biomarker, QFM was performed using the same method as the widely available Quantiferon-gold assay, and measures output in interferon gamma in IU/mL after dual stimulation of the innate and adaptive immune systems. Ninety-one cirrhotic patients were recruited, with 47(52%) transplanted on the day of their QFM. The remaining 44(48%) were monitored for infections until transplant, death, or census date of 1st February 2014.RESULTS Cirrhotic patients express a median QFM significantly lower than healthy controls(94.5 IU/mL vs 423 IU/mL), demonstrating that they are severely immunosuppressed.Several factors including model for end stage liver disease, presence of hepatocellular carcinoma, bilirubin, international normalized ratio and haemoglobin were associated with QFM on univariate analysis. Disease aetiology did not appear to impact QFM. On multivariate analysis, only Child-Pugh score and urea were significantly associated with a patient's immune function as objectively measured by QFM. In the 44 patients who were not transplanted immediately after their blood test and could be monitored for subsequent infection risk, 13(29.5%) experienced a pre-transplant infection a median 20 d(range 2-182) post-test. QFM 214 IU/mL was associated with HR = 4.1(P = 0.01) for infection. A very low QFM 30 IU/mL was significantly associated(P = 0.003) with death in three patients who died while awaiting transplantation(HR = 56.6).CONCLUSION QFM is lower in cirrhotics, allowing objective determinations of an individual's unique level of immune dysfunction. Low QFM was associated with increased susceptibility to infection.     

Knowledge about infection is the only predictor of treatment in patients with chronic hepatitis C

HCV is the leading cause of cirrhosis and liver cancer in the U.S. The Center for Disease Control (CDC) has recently recommended ‘Birth Cohort Screening’ of the U.S. Adult population to reduce the future burden of undiagnosed HCV infections in the U.S. Our aim was to assess independent predictors of receiving treatment in a cohort of HCV‐infected patients. The Hepatitis C follow‐up questionnaires of the National Health and Nutrition Examination Surveys (NHANES) conducted from 2001 to 2010 were used. The NHANES participants who tested positive for HCV RNA were followed by CDC 6 months after initial testing with questions related to their awareness of their infection and history or intention to receive treatment. A total of 500 NHANES participants tested positive for HCV RNA and were targeted for follow‐up. Of these, only 203 had completed the follow‐up questionnaire (response rate of 40.6%). Of these, only 101 (50%) knew about their HCV positivity before NHANES, and from them, only 34 (17%) had received treatment. In multivariate analysis, prior knowledge about their HCV infection in HCV‐positive individuals was independently associated with receiving routine care from a doctor or HMO, with higher income, female gender, being in poor or fair health and not consuming excessive amounts of alcohol. On the other hand, the knowledge about HCV infection was the only independent predictor of receiving anti‐HCV treatment (odds ratio 6.14). Knowledge about having HCV infection is the only independent predictor of receiving treatment. Therefore, birth cohort screening of the U.S. General population could lead to wider identification of HCV and potentially better management of the future burden of HCV and its complications.     

Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding

Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection.However,mortality from variceal bleeding is largely determined by the severity of liver disease.Besides a higher Child-Pugh score,patients with hepatocellular carcinoma are particularly susceptible to infections.Despite several hypotheses that include increased use of instruments,greater risk of aspiration pneumonia and higher bacterial translocation,it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis.Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures,but more recently,gram positives and quinolone-resistant organisms are increasingly seen,even though their clinical significance is unclear.Fluoroquinolones(including ciprofloxacin and norfloxacin)used for short term(7 d)have the most robust evidence and are recommended in most expert guidelines.Short term intravenous cephalosporin(especially ceftriaxone),given in a hospital setting with prevalent quinolone-resistant organisms,has been shown in studies to be beneficial,particularly in high risk patients with advanced cirrhosis.     

MELD score and hepatocellular carcinoma identify patients at different risk of short-term mortality among cirrhotics bleeding from esophageal varices

BACKGROUND/AIMS: The role of model for end stage liver disease (MELD) and the presence of hepatocellular carcinoma (HCC) as risk factors of short-term mortality in patients bleeding from oesophageal varices were evaluated. METHODS: From February 2002 to August 2003, 172 cirrhotic patients admitted for the first episode of bleeding from oesophageal varices received vasoactive and endoscopic therapy. Patients' survival was evaluated at 6 weeks and 3 months. The role of MELD and HCC as independent risk factors of mortality was evaluated. RESULTS: In the 172 patients, the overall mortality was 21.5% at 6 weeks and 30.2% at 3 months. MELD score resulted a good predictor of mortality either at 6 weeks or 3 months. Fifty-four patients (31.3%) had HCC. The presence of advanced HCC was an independent risk factor of mortality at 3 months. Patients with MELD score>15 and advanced HCC had a significantly worse survival than patients with MELD相似文献   

Neurocognitive impairment is associated with erectile dysfunction in cirrhotic patients

IntroductionErectile dysfunction (ED) is common in patients with chronic diseases. It is evaluated using the International Index of Erectile Function (IIEF5) questionnaire. The relationship between ED and cirrhosis is complex. The aims of our study were (1) to assess the prevalence of ED in cirrhosis and (2) to evaluate factors associated with ED, with a special focus on minimal hepatic encephalopathy (MHE).MethodsWe performed a prospective, observational study. Patients with cirrhosis were invited to complete the IIEF5 questionnaire. The exclusion criteria were clinical hepatic encephalopathy (HE) and dementia. MHE was evaluated by the psychometric hepatic encephalopathy test score (PHES) and the critical flicker frequency (CFF).ResultsBetween April 2016 and April 2017, 87 patients were included (age: 55 [51–57] years, Child–Pugh score: 8 [7–9], MELD score: 13 [11–16]. Minimal HE was diagnosed in 33% of the patients according to the PHES and in 44% of the patients according to the CFF. ED was diagnosed in 74/87 patients (85%) when compared to 12.5% in healthy controls (p < 0.001). In a multivariate analysis, the independent factors associated with ED were age, Child–Pugh and MELD scores. Significant correlations were identified between the IIEF5 and each component of the PHES.ConclusionED should be systematically screened in cirrhotics, especially in patients with MHE.     

Diabetes mellitus is associated with gastroesophageal variceal bleeding in cirrhotic patients

Diabetes mellitus (DM) has been reported to increase the risk of complications of liver cirrhosis of any etiology and subsequent survival. However, the impact of DM on the development of gastroesophageal variceal bleeding (GEVB) remains unclear. We aimed to elucidate whether DM is an independent risk factor for GEVB among cirrhotic patients. A total of 146 consecutive patients with liver cirrhosis (Child-Pugh Class A, n = 75; Class B, n = 40; and Class C, n = 31) were prospectively enrolled. Data on clinical and biochemical characteristics and history of ascites, GEVB, hepatic encephalopathy, and spontaneous bacterial peritonitis were retrospectively reviewed. Of these 146 patients, 37 (25%) had DM. Patients with DM had significantly higher ratio of Child-Pugh Class B/C (p = 0.043), renal insufficiency (p = 0.002), and history of GEVB (p = 0.006) compared with non-DM patients. GEVB was associated with Child-Pugh Class B/C (p = 0.001), ascites (p = 0.002), hepatic encephalopathy (p = 0.023), and low platelet counts (p < 0.001). Based on stepwise multiple logistic regression analysis, Child-Pugh class B/C [odds ratio (OR) = 4.90, p = 0.003] and DM (OR = 2.99, p = 0.022) were identified as independent predictors of GEVB. In the subgroup analysis, DM significantly correlated with GEVB in patients with Child-Pugh Class A (p = 0.042), but not in patients with Child-Pugh Class B/C (p = 0.128). DM is independently associated with GEVB in cirrhotic patients, especially in those with Child-Pugh Class A.     

Epidemiological investigation of non-fermentative bacterial infection in cirrhotic patients

ABSTRACT

Background: This study aimed to describe the clinical characteristics of NFGNB in patients with cirrhosis as well as the risk factors for short-term mortality.

Methods: A retrospective analysis was performed in patients with cirrhosis and NFGNB infections from 2011 to 2016 .

Results: 144 episodes in 134 patients with liver cirrhosis and NFGNB infections were found in total. Of these, 81.2% were hospital-acquired or healthcare- associated infections, while only 18.8% of NFGNB infections originated from the community. A. baumannii were the most frequently isolated bacteria (39 episodes), followed by S. maltophilia (38 episodes) and P. aeruginosa (31 episodes). MDR- and non-MDR-NFGNB comprised 62.5% and 37.5% of infections respectively. The Kaplan-Meier survival curve showed no significant difference between MDR and non-MDR NFGNB patients (74.1% vs 75.5%, P = 0.811). Neither MDR or the subgroup of common NFGNB (P. aeruginosa, A. baumannii, S. maltophilia) was associated with the 28-day mortality (all P >0.05). Low albumin levels and high Tbil levels were both independent risk factors for 28-day mortality (HR = 0.930, 95%CI (0.869, 0.995), P = 0.035; HR = 1.003, 95%CI (1.002, 1.005), P < 0.001, respectively).

Conclusions: Diabetes increased 28-day mortality significantly, however, MDR status, site of infection and bacteria type did not.     

MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding

AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL procedures performed for EVH between January 2007 and December 2008,128 patients with early rebleeding,defined as rebleeding within 6 wk after EVL,were enrolled for analysis.RESULT:The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817).The 5-d,6-wk,3-mo,and 6-mo mortality rat...     

Child-Pugh,MELD, and ALBI scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure

Objectives: Our study aimed to evaluate the discriminative abilities of Child-Pugh, model for end-stage liver disease (MELD), and albumin-bilirubin (ALBI) scores in predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure (ACLF).

Methods: Cirrhotic patients with ACLF admitted between 2010 January and 2014 June were retrospectively reviewed. Areas under the receiver operating characteristic curves (AUROCs) with 95% confidence intervals (CIs) were calculated.

Results: One hundred patients were eligible for the Asia-Pacific Association for the Study of the Liver (APASL) criteria. AUROCs of Child-Pugh, MELD, and ALBI scores in predicting the in-hospital mortality was 0.63 (95%CI: 0.52–0.72, P = 0.05), 0.75 (95%CI: 0.65–0.83, P < 0.0001), and 0.53 (95%CI: 0.42–0.63, P = 0.69), respectively. Eighty-eight patients were eligible for the EASL/AASLD criteria. AUROCs of Child-Pugh, MELD, and ALBI scores in predicting the in-hospital mortality were 0.59 (95%CI: 0.48–0.69, P = 0.14), 0.57 (95%CI: 0.46–0.68, P = 0.26), and 0.57 (95%CI: 0.46–0.67, P = 0.29), respectively. There was no significant difference among them.

Conclusion: Child-Pugh, MELD, and ALBI scores might be ineffective in predicting the in-hospital mortality of cirrhosis with ACLF.     

乙型肝炎肝硬化患者外周血树突状细胞亚群的鉴定及其临床意义

目的：探讨检测乙型肝炎肝硬化患者外周血树突状细胞（DC）亚群的临床意义。方法采用流式细胞分析技术检测42例乙型肝炎肝硬化患者、45例慢性乙型肝炎患者和30例健康人外周血 DC 细胞亚群和淋巴细胞亚群的构成,比较三者间的差异。结果乙型肝炎肝硬化患者外周血 DC1和 DC2百分数分别为（0.2±0.1）%和（0.2±0.04）%,慢性乙型肝炎患者为（0.3±0.1）%和（0.2±0.1）%,均显著低于健康人群[（0.4±0.1）%和（0.3±0.1）%, P＜0.01];13例 HBeAg 阳性乙型肝炎肝硬化患者外周血 DC2亚群细胞绝对计数为（5.62±1.28）个/μL,显著低于29例 HBeAg 阴性的乙型肝炎肝硬化患者[（8.75±2.32）个/μL,P＆lt;0.05],但是两者 DC1细胞水平无明显差别;乙型肝炎肝硬化患者外周血 CD4＋T 淋巴细胞和 CD8＋T 淋巴细胞计数分别为（588.4±124.2）个/μL 和（338.5±97.4）个/μL,均显著低于慢性乙型肝炎患者[（686.7±106.5）个/μL 和（432.1±102.6）个/μL,P＜0.05],而且乙型肝炎肝硬化患者和慢性乙型肝炎患者外周血 CD8＋T 细胞数均显著低于健康对照人群[（560.2±105.6）个/μL,P＜0.05]。结论乙型肝炎肝硬化患者外周血 DC1和 DC2数量减少,伴 CD8＋T 细胞数降低,可能是导致肝硬化形成的原因之一。     

Validation of a Mayo post‐operative mortality risk prediction model in Korean cirrhotic patients

Background: Patients with cirrhosis have an increased risk of mortality after surgery. In 2007, a new model was suggested to calculate mortality risk at specific time points after surgery at the Mayo clinic. Aims: We investigated the mortality risks in Korean cirrhotic patients who underwent various surgeries and applied the Mayo clinic model to our study populations. Methods: We conducted a retrospective review of the charts of 160 patients with cirrhosis who underwent surgical procedures under general anaesthesia between January 1996 and December 2006 at two hospitals. Results: The overall 30‐, 90‐day and 1‐year mortality rates were 7.5, 9.4 and 10.6% respectively. In multivariate analysis, the Child–Turcotte–Pugh (CTP) score, model for end‐stage liver disease (MELD) and the American Society of Anesthesiologists (ASA) physical status classification and age were significantly associated with mortality. The area under the receiver operating characteristic (AUROC) from the calculated value using Mayo model as a predictor of 30‐, 90‐day and 1‐year mortality was 0.832, 0.803 and 0.822 respectively, of which, 1‐year mortality was significantly different from AUROC of mortality prediction based on our patient's data (P=0.025). In addition, the mean of predicted 1‐year mortality rate (22.6±12.0%) using Mayo model was significantly higher than that from observed (8.9±1.4%, P<0.01). Conclusions: The CTP score or MELD score or ASA physical class and age were found to be significant predictors of post‐operative mortality in cirrhotic patients. The risk prediction model developed at the Mayo clinic showed good performance in Korean cirrhotic patients. However, we found that the model tended to overestimate mortality, especially 1 year after surgery.     

Hepatitis C virus infection in Italian patients with fibromyalgia

We evaluated the prevalence of hepatitis C virus (HCV) infection in Italian patients suffering from fibromyalgia (FM), in comparison with patients affected by non-HCV related rheumatic degenerative disorders. Consecutive patients with FM and a statistically comparable group of patients suffering from peripheral osteoarthritis (OA) or sciatica due to L4-L5 or L5-S1 herniated disc were tested for HCV infection with a third-generation microparticle enzyme immunoassay (MEIA). In the positive cases, a third-generation recombinant immunoblot assay (RIBA) confirmatory test and serum HCV-RNA test were performed. Fisher’s exact test was performed to compare the prevalence of HCV infection (MEIA- and RIBA-positive results) obtained in the two enrolled groups. Enrolled were 152 subjects suffering from FM and 152 patients with peripheral OA or sciatica. Anti-HCV antibodies were found in 7/152 (4.6%) patients suffering from FM and in 5/152 (3.3%) of control subjects. No statistically significant differences in HCV prevalence were detected between cases and controls. Our present report does not confirm previous data indicating an increased prevalence of HCV in FM patients and does not seem to support a significant pathogenetic role of HCV under this condition.     

Mean platelet volume as a novel predictor of systemic inflammatory response in cirrhotic patients with culture-negative neutrocytic ascites

AIM: To identify a mean platelet volume (MPV) cutoff value which should be able to predict the presence of bacterial infection.METHODS: An observational, analytic, retrospective study. We evaluated medical records of cirrhotic patients who were hospitalized from January 2012 to January 2014 at the Gastroenterology Department of “Hospital General de México Dr. Eduardo Liceaga”, we included 51 cirrhotic patients with ascites fluid infection (AFI), and 50 non-infected cirrhotic patients as control group. Receiver operator characteristic curves were used to identify the best cutoff value of several parameters from hematic cytometry, including MPV, to predict the presence of ascites fluid infection.RESULTS: Of the 51 cases with AFI, 48 patients (94.1%) had culture-negative neutrocytic ascites (CNNA), 2 (3.9%) had bacterial ascites, and one (2%) had spontaneous bacterial peritonitis. Infected patients had greater count of leucocytes and polymorphonuclear cells, greater levels of MPV and cardiac frequency (P < 0.0001), and lower mean arterial pressure compared with non-infected patients (P = 0.009). Leucocytes, polymorphonuclear count, MPV and cardiac frequency resulted to be good or very good predictive variables of presence of AFI in cirrhotic patients (area under the receiving operating characteristic > 0.80). A cutoff MPV value of 8.3 fl was the best to discriminate between cirrhotic patients with AFI and those without infection.CONCLUSION: Our results support that MPV can be an useful predictor of systemic inflammatory response syndrome in cirrhotic patients with AFI, particularly CNNA.