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Diagnosis of cirrhosis and portal hypertension:imaging,non-invasive markers of fibrosis and liver biopsy

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Gastroenterology Report 2017年第2期5卷 79-89,I0001页

作者： bogdan procopet Annalisa Berzigotti University of Medicine and Pharmacy‘Iuliu Hatieganu’ 3rd Medical Clinic and Hepatology DepartmentRegional Institute of Gastroenterology and Hepatology‘O Fodor’Cluj-NapocaRomania Swiss Liver Center HepatologyUniversity Clinic for Visceral Surgery and MedicineInselspitalUniversity of BernBernSwitzerland

The concept of‘cirrhosis’is evolving and it is now clear that compensated and decompensated cirrhosis are completely different in terms of ***,the term‘advanced chronic liver disease(ACLD)’better reflects the continuum of histological changes occurring in the liver,which continue to progress even after cirrhosis has developed,and might regress after removing the etiological factor causing the liver *** compensated ACLD,portal hypertension marks the progression to a stage with higher risk of clinical complication and requires an appropriate evaluation and *** tests to diagnose cirrhosis(liver biopsy)and portal hypertension(hepatic venous pressure gradient measurement and endoscopy)remain of crucial importance in several difficult clinical scenarios,but their need can be reduced by using different non-invasive tests in standard *** non-invasive tests,the accepted use,major limitations and major benefits of serum markers of fibrosis,elastography and imaging methods are summarized in the present review.

关键词： compensated advanced chronic liver disease hepatic venous pressure gradient elastography ultrasound

Viscoelastic tests in liver disease: where do we stand now?

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World Journal of Gastroenterology 2021年第23期27卷 3290-3302页

作者： Alina Buliarca Adelina Horhat Tudor Mocan Rares Craciun bogdan procopet Zeno Sparchez The Third Medical Department “Iuliu Hatieganu”University of Medicine and PharmacyInstitute for Gastroenterology and Hepatology“Prof.Dr.O.Fodor”Cluj-Napoca 400162Romania

Hemostasis is a complex physiological process based on the balance between procoagulant and anticoagulant systems to avoid pathological bleeding or *** changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder,and cirrhotic patients were considered naturally *** the light of the new evidence,the theory of rebalanced hemostasis replaced the old *** to this model,the hemostatic alteration leads to a unique balance between pro-coagulant,anticoagulant,and fibrinolytic *** the balance is fragile and may prone to bleeding or thrombosis depending on various risk *** standard coagulation tests[INR(international normalized ratio),platelet count and fibrinogen]only explore parts of the hemostasis,not offering an entire image of the *** thromboelastometry(ROTEM)and thromboelastography(TEG)are both point of care viscoelastic tests(VET)that provide real-time and dynamic information about the entire hemostasis process,including clot initiation(thrombin generation),clot kinetics,clot strength,and clot stability(lysis).Despite prolonged PT/INR(international normalized ratio of prothrombin time)and low platelet counts,VET is within the normal range in many patients with both acute and chronic liver ***,bleeding remains the dominant clinical issue in patients with liver diseases,especially when invasive interventions are *** has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests,leading to decrial use of blood products *** clotting is common but often subtle and may be challenging to predict even with the help of *** VET has shown its benefit,more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.

关键词： Liver diseases Viscoelastic tests Portal vein thrombosis Acute-on-chronic liver failure Bleeding risk Invasive procedures

Diagnostic challenges in non-cirrhotic portal hypertension-porto sinusoidal vascular disease

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World Journal of Gastroenterology 2020年第22期26卷 3000-3011页

作者： Oana Nicoara-Farcau Ioana Rusu Horia Stefanescu Marcel Tanțau Radu Ion Badea bogdan procopet University of Medicine and Pharmacy“Iuliu Hatieganu” Cluj-Napoca 400000Romania Gastroenterology Department Regional Institute of Gastroenterology and Hepatology“O.Fodor”Cluj-Napoca 400000Romania Pathology Department Regional Institute of Gastroenterology and Hepatology“O.Fodor”Cluj-Napoca 400000Romania Imagistic Department Regional Institute of Gastroenterology and Hepatology“O.Fodor”Cluj-Napoca 400000Romania

Non-cirrhotic portal hypertension consists of a group of diseases characterized by signs and complications of portal hypertension,which differ from cirrhosis through histological alterations,hemodynamic characterization and,clinical *** of the similarities in clinical presentation and imaging signs,frequently these patients,and particularly those with porto-sinusoidal vascular disease(PSVD),are misdiagnosed as having liver cirrhosis and thus raising difficulties in their *** most challenging differentiation to be considered is between PSVD and cirrhosis and,although not pathognomonic,liver biopsy is still the standard of *** they still require extended validation before being broadly used,new non-invasive methods for the diagnosis of porto-sinusoidal vascular disease,like transient elastography,contrast-enhanced ultrasound or metabolomic profiling,have shown promising *** issue is the differentiation between PSVD and chronic extrahepatic portal vein obstruction,especially now when it is known that 40%of patients suffering from PSVD develop portal vein *** this particular case,once the portal vein thrombosis occurred,the diagnosis of PSVD is impossible according to the current ***,so far,the differentiation between PSVD and sinusoidal obstruction syndrome has not been clear so far in particular *** this review we highlighted the diagnostic challenges regarding the PSVD,as well as the current techniques used in the evaluation of these patients.

关键词： Porto-sinusoidal vascular disease Extrahepatic portal vein obstruction Noncirrhotic portal hypertension Non-invasive diagnosis Idiopathic portal hypertension Cirrhosis

Pulmonary complications of portal hypertension:The overlooked decompensation

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World Journal of Clinical Cases 2022年第17期10卷 5531-5540页

作者： Rares Craciun Tudor Mocan bogdan procopet Andrada Nemes Cristian Tefas Mihaela Sparchez Lavinia-Patricia Mocan Zeno Sparchez 3^(rd)Medical Clinic Department of Internal Medicine"Iuliu Hatieganu"University of Medicine and PharmacyCluj-Napoca 400162Romania Gastroenterology Clinic "Prof.Dr.O.Fodor"Regional Institute of Gastroenterology and HepatologyCluj-Napoca 400162Romania Intensiv Care Unit I Cluj County Emergency HosptialCluj-Napoca 400006Romania 2^(nd)Paediatric Clinic "Iuliu Hatieganu"University of Medicine and PharmacyCluj-Napoca 400126Please enter the state or provinceRomania Department of Histology "Iuliu Hatieganu"University of Medicine and PharmacyCluj-Napoca 400349Romania

The systemic nature of cirrhosis and portal hypertension has long been recognized,and the amount of data characterizing the interplay between each system is becoming ever so *** involvement was among the first described associated entities in cirrhosis,with reports dating back to the late nineteenth ***,it appears that throughout the years,interest in the pulmonary complications of portal hypertension has generally faded,especially in contrast to other decompensating events,as expertise in this field has primarily been concentrated in highly experienced tertiary care facilities and liver transplantation *** affecting up to 10%-15%of patients with advanced liver disease and having a proven prognostic impact,hepato-pulmonary syndrome,porto-pulmonary hypertension,and hepatic hydrothorax are frequently misdiagnosed,mistreated,or *** lack of precision might adversely impact patient care,referral to expert centers,and,ultimately,liver disease-related mortality and successful transplantation *** present minireview aims to increase awareness of the pulmonary complications of chronic liver disease by providing a brief overview of each of the three *** paper focuses on the essential theoretical aspects,addressing the most critical knowledge gaps on the one hand and,on the other hand,critically discussing one key issue for each complication.

关键词： Hepato-pulmonary syndrome Porto-pulmonary hypertension Hepatic hydrothorax Cirrhosis Portal hypertension Advanced liver disease

Metabolomics: From liver chiromancy to personalized precision medicine in advanced chronic liver disease

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World Journal of Hepatology 2018年第3期10卷 371-378页

作者： bogdan procopet Petra Fischer Oana Farcau Horia Stefanescu 3~(rd) Medical Clinic University of Medicine and Pharmacy Hepatology Unit Regional Institute of Gastroenterology and Hepatology

Currently there is a lack of accurate biomarkers for diagnosis and prognosis in advanced liver diseases. Either the occurrence of first decompensation, or diagnosis of acute on chronic liver failure, severe alcoholic hepatitis, or hepatocellular carcinoma(HCC), none of the available biomarkers are satisfactory. Metabolomics is the newest of omics, being much closer than the others to the actual phenotype and pathologic changes that characterizes a certain condition. It deals with a much wider spectrum of low molecular weight bio-compounds providing a powerful platform for discovering novel biomarkers and biochemical pathways to improve diagnostic, prognostication and therapy. Until now metabolomics was applied in a wide spectrum of liver conditions, but the findings were contradictory. This review proposes a synthesis of the existing evidences of metabolomics use in advanced chronic liver diseases, decompensated liver cirrhosis, severe alcoholic hepatitis and HCC.

关键词： Metabolomics Biomarker Prediction Advanced chronic liver disease Decompensation Alcoholic hepatitis Hepatocellular carcinoma

Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival

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World Journal of Hepatology 2020年第10期12卷 829-840页

作者： Dana Crisan bogdan procopet Alexandra Epure Horia Stefanescu Alina Suciu Andreea Fodor Emil Mois Rares Craciun Nicolae Crisan Internal Medicine Department “Iuliu Hatieganu”University of Medicine and PharmacyCluj-Napoca 400126Romania 3rd Medical Clinic “Iuliu Hatieganu”University of Medicine and PharmacyCluj-Napoca 400126Romania Hepatology Unit “Prof.Dr.Octavian Fodor”Regional Institute of Gastroenterology and HepatologyCluj-Napoca 400162Romania Surgery Department “Prof.Dr.Octavian Fodor”Regional Institute of Gastroenterology and HepatologyCluj-Napoca 400126Romania Hepatology Unit “Prof.Dr.Octavian Fodor”Regional Institute of Gastroenterology and HepatologyCluj-Napoca 400126Romania

BACKGROUND Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their *** evaluating the burden of malnutrition in cirrhosis is gathering momentum,as suggested by multiple recently published reports,there is still a persistent scarcity of solid data in the field,especially with regards to the role of nutritional *** To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on *** One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment(SGA)criteria and the mid-arm circumference(MAC).Malnutrition was defined as SGA class B and C and MAC<10th *** patients were interviewed regarding their food intake using an adapted ***,total energy intake was calculated and further subdivided in main *** data were then compared to the available recommendations at the time of analysis to assess *** 54/79 patients(68.4%)in the decompensated group had malnutrition,while only 3/22 patients(13.6%)were malnourished in the compensated *** a median follow-up time of 27 mo(0-53),the overall mortality was 70%.Survival was significantly lower among patients with *** mortality rates were 50%at 1 year and 63%at 2 years for the patients with malnutrition,compared to 21%at 1 year and 30%at 2 years for patients without malnutrition(P=0.01).On multivariate analysis,the factors independently associated with mortality were age,creatinine level and adherence to the protein intake *** mortality was lower in patients with the appropriate protein intake:8%at 1 year and 28%at 2 years in the adherent group,compared to 47%at 1 year and 56%at 2 years in the non-adherent *** The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherenc

关键词： Malnutrition Decompensated cirrhosis Survival Subjective global assessment Protein intake