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Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care

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World Journal of Gastroenterology 2020年第18期26卷 2221-2231页

作者： Anuj Bohra Thomas Worland Samuel Hui Ryma Terbah Ann Farrell marcus robertson Department of Gastroenterology Monash HealthClayton 3168VictoriaAustralia Department of Gastroenterology Austin HealthHeidelberg 3084VictoriaAustralia Department of Medicine School of Clinical SciencesMonash UniversityClayton 3168VictoriaAustralia

BACKGROUND Hepatic encephalopathy(HE)is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50%of cirrhotic *** examining the prognostic significance of HE are limited despite the high prevalence in *** To define the clinical outcomes of patients after an episode of HE treated with current *** All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over46-mo(2012–2016)were identified via pharmacy dispensing *** with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were *** records were reviewed to determine baseline characteristics and *** Kaplan-Meier method was used to calculate survival *** survival analysis was performed with variables reaching statistical significance included in a multivariate *** primary outcome was 12-mo mortality following commencement of ***188 patients were *** 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)*** 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 *** a mean follow up period of 12±13 mo 107(57%)patients died and 32(17%)received orthotopic liver *** 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 *** multivariate analysis a model for end stage liver disease>15 and international normalised ratio reached statistical significance in predicting *** Despite advances made in the management of HE patients continue to have poor ***,in all patients

关键词： Hepatic encephalopathy Cirrhosis Portal hypertension Prognosis Rifaximin Lactulose

Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax

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World Journal of Gastroenterology 2022年第35期28卷 5175-5187页

作者： Sarah Romero Andy KH Lim Gurpreet Singh Chamani Kodikara Rachel Shingaki-Wells Lynna Chen Samuel Hui marcus robertson Department of Gastroenterology Monash HealthClayton 3168VictoriaAustralia Department of General Medicine School of Clinical SciencesMonash UniversityClayton 3168VictoriaAustralia Gastroenterology and Liver Transplant Unit Austin HealthHeidelberg 3084VictoriaAustralia

BACKGROUNDHepatic hydrothorax (HH) is an uncommon and difficult-to-manage complicationof cirrhosis with limited treatment *** define the clinical outcomes of patients presenting with HH managed withcurrent standards-of-care and to identify factors associated with *** patients with HH presenting to 3 tertiary centres from 2010 to 2018 wereretrospectively identified. HH was defined as pleural effusion in the absence ofcardiopulmonary disease. The primary outcomes were overall and transplant-freesurvival at 12-mo after the index admission. Cox proportional hazards analysiswas used to determine factors associated with the primary ***, 84 patients were included (mean age, 58 years) with a mean model forend-stage liver disease score of 29. Management with diuretics alone achievedlong-term resolution of HH in only 12% patients. At least one thoracocentesis wasperformed in 73.8% patients, transjugular intrahepatic portosystemic shuntinsertion in 11.9% patients and 33% patients received liver transplantation within12-mo of index admission. Overall patient survival and transplant-free survival at12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidneyinjury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increasedrisk of *** patients with HH are a challenging population with a poor 12-mo survival despitecurrent treatments. Current smoking and episodes of AKI are potential modifiable factors affectingsurvival. HH is often refractory of diuretic therapy and transplant assessment should beconsidered in all cases.

关键词： Cirrhosis Portal hypertension Hepatic hydrothorax Ascites Liver transplantation

Survival outcomes and predictors of mortality,re-bleeding and complications for acute severe variceal bleeding requiring balloon tamponade

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World Journal of Hepatology 2022年第8期14卷 1584-1597页

作者： Charlotte Y Keung Aparna Morgan Suong T Le marcus robertson Paul Urquhart Michael P Swan Department of Gastroenterology Monash HealthMelbourne 3168VictoriaAustralia Department of Gastroenterology Eastern HealthMelbourne 3128VictoriaAustralia Department of Medicine Monash UniversityMelbourne 3168VictoriaAustralia Monash Digital Therapeutics and Innovation Laboratory Monash UniversityMelbourne 3168VictoriaAustralia

BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high *** cohort studies from 1970-1980s no longer represent the current population as balloon tamponade is no longer first-line therapy for variceal bleeding;treatments including vasoactive therapies,intravenous antibiotics,endoscopic variceal band ligation are routinely used,and there is improved access to definitive treatments including transjugular intrahepatic portosystemic ***,only a few studies from the current era exist to describe the practice of balloon tamponade,its outcomes,and predictors with a requirement for further updated *** To describe current management of AVB requiring balloon tamponade and identify the outcomes and predictors of mortality,re-bleeding and *** A retrospective multi-centre cohort study of 80 adult patients across two large tertiary health networks from 2008 to 2019 in Australia who underwent balloon tamponade using a Sengstaken-Blakemore tube(SBT)were included for *** were identified using coding for balloon *** primary outcome of this study was all-cause mortality at 6 wk after the index *** outcomes included re-bleeding during hospitalisation and complications of balloon *** of these outcomes were determined using univariate and multivariate binomial *** The all-cause mortality rates during admission and at 6-,26-and 52 wk were 48.8%,51.2%and 53.8%,*** haemostasis was achieved in 91.3%and re-bleeding during hospitalisation occurred in 34.2%.Independent predictors of 6 wk mortality on multivariate analysis included the Model for Endstage Liver disease(MELD)score(OR 1.21,95%CI 1.06-1.41,P=0.006),advanced hepatocellular carcinoma(OR 11.51,95%CI 1.61-82.20,P=0.015)and re-bleeding(OR 13.06,95%CI 3.06-55.71,P<0.001).There were no relevant predictors of re-bleeding but a larg

关键词： Balloon tamponade Acute variceal bleeding Sengstaken-Blakemore tube Mortality Complications Haemostasis

Comparison of two emergency medical services in Beijing and Hong Kong, China

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Chinese Medical Journal 2019年第11期132卷 1372-1374页

作者： Fei Shao Kit-Ling Fan Colin robertson marcus Ong Nan Liu Ling-Pong Leung Reynold Leung Chun-Sheng Li Departm ent of Emergency Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Accident and Emergency Department The Hong Kong University-Shenzhen Hospital Shenzhen Guangdong 518053 China Accident and Emergency Medicine and Surgery University of Edinburgh Scotland UK Department of Emergency Medicine Singapore General Hospital Singapore Health Services Research Centre Singapore Health Services Singapore Emergency Medicine Unit Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong China

To Out-of-hospital cardiac arrest (OHCA) is a major issue in emergency care worldwide. The incidence of OHCA is estimated to be 50 to 60 per 100,000 persons *** advances in treatment and technology, survival following OHCA remains low. There are multiple factors affecting the survival outcome. The type of emergency medical service (EMS) system is likely to be one of them. In Asia, the EMS structure and its service capability in terms of dispatch, airway management, and medications vary widely between communities. This study aimed to evaluate the survival outcomes of OHCA in Beijing and Hong Kong (HK), China and the effect of the type of EMS system on the survival outcomes for patients with OHCA.

关键词： Extrahospital cardiac arrest (ohca) cardiac arrest emergency medical service