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Clinical characteristics and corticosteroid therapy in patients with autoimmune-hepatitis-induced liver failure

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World Journal of Gastroenterology 2014年第23期20卷 7473-7479页

作者： Bing Zhu Shao-Li You Zhi-Hong Wan Hong-Ling Liu Yi-Hui Rong Hong Zang Shao-Jie Xin liver failure treatment and research center 302~(nd) Military Hospital

AIM: To investigate the clinical features, response to corticosteroids, and prognosis of autoimmune hepatitis (AIH)-induced liver failure in China.

关键词： Autoimmune hepatitis liver failure Autoantibody Prognosis Corticosteroid therapy

Granulocyte-colony stimulating factor therapy improves survival in patients with hepatitis B virus-associated acuteon-chronic liver failure

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World Journal of Gastroenterology 2013年第7期19卷 1104-1110页

作者： Xue-Zhang Duan Fang-Fang Liu Jing-Jing Tong Hao-Zhen Yang Jing Chen Xiao-Yan Liu Yuan-Li Mao Shao-Jie Xin Jin-Hua Hu liver failure treatment and research center Beijing 302 Hospital center for Clinical Laboratory Beijing 302 Hospital

AIM:To evaluate the safety and efficacy of granulocyte-colony stimulating factor(G-CSF) therapy in patients with hepatitis B virus(HBV)-associated acuteon-chronic liver failure(ACLF).METHODS:Fifty-five patients with HBV-associated ACLF were randomized into two groups:the treatment group and the control ***-seven patients in the treatment group received G-CSF(5 μg/kg per day,six doses) treatment plus standard therapy,and 28 patients in the control group received standard therapy *** peripheral CD34 + cell count was measured consecutively by flow *** white blood cell count,biochemical parameters,and other clinical data of these patients were recorded and *** patients were followed up for a period of 3 mo to evaluate the changes in liver function and survival ***:The peripheral neutrophil and CD34 + cell counts in the G-CSF group increased on day 3 from the onset of therapy,continued to rise on day 7,and remained elevated on day 15 compared to those of the control ***-Turcotte-Pugh score of patients in the treatment group was improved on day 30 from the onset of G-CSF therapy,compared to that in the controls(P = 0.041).Model for End-Stage of liver Disease score of patients in the treatment group was improved on day 7(P = 0.004) and remained high on day 30 from the onset of G-CSF therapy(P treatment group(48.1%) was significantly higher than that in the control group(21.4%)(P = 0.0181).CONCLUSION:G-CSF therapy promoted CD34 + cell mobilization in patients with HBV-associated ACLF,and improved the liver function and the survival rate of these patients.

关键词： Acute-on-chronic liver failure Granulocytecolony stimulating factor Hepatitis B virus

Clinical characteristics and 28-d outcomes of bacterial infections in patients with hepatitis B virus-related acute-on-chronic liver failure

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World Journal of Clinical Cases 2020年第6期8卷 1042-1055页

作者： Chen Li Hai-Bin Su Xiao-Yan Liu Jin-Hua Hu liver failure treatment and research center The Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China

BACKGROUND Acute-on-chronic liver failure (ACLF),which includes hepatic and multiple extrahepatic organ failure,is a severe emergency condition that has high *** can rapidly progress and requires an urgent assessment of condition and referral for liver *** infections (BIs) trigger ACLF and play pivotal roles in the deterioration of clinical *** To investigate the clinical characteristics and 28-d outcomes of first Bis either at admission or during hospitalization in patients with hepatitis B virus (HBV)-ACLF as defined by the Chinese Group on the Study of Severe Hepatitis B(COSSH).METHODS A total of 159 patients with HBV-ACLF and 40 patients with acute decompensation of HBV-related chronic liver disease combined with first BIs were selected for a retrospective analysis between October 2014 and March 2016 The characteristics of BIs,the 28-d transplant-free survival rates,and the independent predictors of the 28-d outcomes were *** A total of 194 episodes of BIs occurred in 159 patients with *** the episodes,13.4 To were community-acquired,46.4 To were healthcare-associated,and 40.2% belonged to nosocomial *** (40.7%),spontaneous bacterial peritonitis (SBP)(34.5%),and bloodstream infection (BSI)(13.4%) were the most *** the ACLF grade increased,the incidence of SBP showed a downward trend (P=0.021).Sixty-one strains of bacteria,including 83.6% Gramnegative bacteria and 29.5% multidrug-resistant organisms,were cultivated from 50 patients with *** coli (44.3%) and Klebsiella pneumoniae (23.0%)were the most common *** the ACLF grade increased,the 28-d transplant-free survival rates showed a downward trend (ACLF-1,55.7%;ACLF-2,29.3%;ACLF-3,5.4%;P <0.001).The independent predictors of the 28-doutcomes of patients with HBV-ACLF were COSSH-ACLF score (hazard ratio[HR]=1.371),acute kidney injury (HR=2.187),BSI (HR=2.339),prothrombin activity (HR=0.967),and invasive cathete

关键词： Hepatitis B virus Acute-on-chronic liver failure Bacterial infections Outcomes Chronic liver disease Spontaneous bacterial peritonitis

Hepatitis E virus-related acute liver failure associated with pure red cell aplasia

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Hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 557-558页

作者： Chen Li Hui-Fen Wang Department of liver failure treatment and research center 302 Hospital of PLABeijingChina

The Editor welcomes submissions for possible publication in the Letters to the Editor section. Letters commenting on an article published in the Journal or other interesting pieces will be considered if they are received within 6 weeks of the time the article was published. Authors of the article being commented on will be given an opportunity to offer a timely response to the letter. Authors of letters will be notified that the letter has been received. Unpublished letters cannot be returned.

关键词： cell TBIL Hepatitis E virus-related acute liver failure associated with pure red cell aplasia PRCA IgM RBC HAV HEV GGT AST WBC

High-dependency units play a key role in the treatment of a Chinese military patient who developed liver failure while abroad

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Military Medical research 2020年第2期7卷 242-244页

作者： Chen Li Hai-Bin Su Xiao-Yan Liu Li-Na Zhang Jin-Hua Hu liver failure treatment and research center The Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China

High-dependency units(HDUs)provide high-level care to patients who suffer from single organ failure,with the exception of respiratory failure requiring mechanical ventilation;HDUs serve as an intermediary between general wards and Intensive Care *** to military and civilian needs,our hospital has established a unique HDU for patients with liver disease in China.A Chinese military officer in the United Nations Peacekeeping Forces in South Sudan was transferred to our HDU for liver failure treatment in *** patient’s disease status,nutrition,sleep habits,and psychological behaviour were monitored on different *** patient was provided with vascular monitoring,telemetry,pulse oximetry,drug treatment,nutritional support,sleep intervention,psychological intervention,and humanistic care by a multidisciplinary treatment *** treatment,the patient recovered and avoided liver *** on the experience with this HDU,this new model may create an efficient treatment process for military and civilian patients with severe liver disease at home or abroad.

关键词： High-dependency units liver failure treatment Military patient

New perspectives in the definition and classification of acute-on-chronic liver failure

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中华医学杂志(英文版) 2024年第21期137卷 2521页

作者： Xu Manman Chen Yu Fourth Department of liver Disease Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research Beijing You’an Hospital Capital Medical University Beijing China

According to APASL, ACLF is characterized by the onset of jaundice (bilirubin ≥5 mg/dL) and prolonged international normalised ratio (INR) (INR ≥1.5), within a 4-week period, in patients with previously uncompensated cirrhosis or chronic liver disease.Item CMA APASL EASL NACSELD ACG AASLD Definition Acute liver failure, developing on the basis of chronic liver disease, is indicated by serum TBil = 10 times the ULN or increasing by 17.1 μmol·L–1·day–1, with PTA ≤40% or an INR ≥1.5 Acute hepatic insult, manifesting as jaundice (Bilirubin ≥5 mg/dL) and coagulopathy (INR ≥1.5), complicated within 4 weeks by clinical ascites and/or encephalopathy An acute deterioration of preexisting chronic liver disease usually related to a precipitating event and associated with increased mortality at 3 months due to multi-organ failure Presence of at least two severe extrahepatic organ failures, including shock, grade III/IV HE, RRT, or mechanical ventilation A potentially reversible condition in patients with chronic liver disease that is associated with the potential for multiple organ failure and mortality within three months in the absence of treatment of the underlying liver disease, liver support, or liver transplantation Acute onset with rapid deterioration in clinical condition, the presence of liver failure defined by elevated bilirubin and elevated INR, and the presence of at least one extrahepatic (neurologic, circulatory, respiratory, or renal) organ failure Underlying liver diseases Non-cirrhotic, compensated cirrhosis, decompensated cirrhosis Non-cirrhotic, compensated cirrhosis Compensated cirrhosis, decompensated cirrhosis Compensated cirrhosis, decompensated cirrhosis Non-cirrhotic, compensated cirrhosis, decompensated cirrhosis Non-cirrhotic, compensated cirrhosis, decompensated cirrhosis Organ failures Intrahepatic Intrahepatic Intrahepatic and/or extrahepatic Extrahepatic Intrahepatic and/or extrahepatic Intrahepatic and extrahepatic AASLD:North American Conso

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Clinical Course and Outcome Patterns of Acute-on-chronic liver failure:A Multicenter Retrospective Cohort Study

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Journal of Clinical and Translational Hepatology 2021年第5期9卷 626-634页

作者： Man-Man Xu Ming Kong Peng-Fei Yu Ying-Ying Cao Fang Liu Bing Zhu Yi-Zhi Zhang Wang Lu Huai-Bin Zou Bin-Wei Duan Shao-Li You Shao-Jie Xin Tao Han Zhong-Ping Duan Yu Chen Fourth Department of liver Disease(Difficult&Complicated liver Diseases and Artificial liver center) Beijing You’an Hospital Affiliated to Capital Medical UniversityBeijingChina Beijing Municipal Key Laboratory of liver failure and Artificial liver treatment research BeijingChina Department of Hepatology The Third Central Clinical College of Tianjin Medical UniversityTianjinChina liver failure treatment and research center The Fifth Medical Center of Chinese PLA General HospitalBeijingChina Department of General Surgery Beijing You’an Hospital Affiliated to Capital Medical UniversityBeijingChina

Background and Aims:Acute-on-chronic liver failure(ACLF)is acute decompensation of liver function in the setting of chronic liver disease,and characterized by high short-term *** this study,we sought to investigate the clinical course of patients at specific time points,and to propose dynamic prognostic ***:We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter *** clinical course of patients was defined as disease recovery,improvement,worsening or steady patterns based on the variation tendency in prothrombin activity(PTA)and total bilirubin(TB)at different time ***:Resolution of PTA was observed in 231 patients(51%)at 12 weeks after the diagnosis of *** the remaining patients,66(14.6%)showed improvement and 156(34.4%)showed a steady or worsening *** patients with resolved PTA,the clinical course of TB exhibited resolved pattern in 95.2%,improved in 3.9%,and steady or worse in 0.8%.Correspondingly,in patients with improved PTA,these values for TB were 28.8%,27.3%,and 43.9%,*** patients with steady or worsening PTA,these values for TB were 5.7%,32.3%,and 65.6%,*** prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF ***:We propose the following dynamic prognostic criteria:rapid progression,slow progression,rapid recovery,slow recovery,and slow persistence,which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.

关键词： Acute-on-chronic liver failure Clinical course Outcome patterns Retrospective cohort study

Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure

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World Journal of Gastroenterology 2011年第29期17卷 3448-3452页

作者： Kun Huang Jin-Hua Hu Hui-Fen Wang Wei-Ping He Jing Chen XueZhang Duan Ai-Min Zhang Xiao-Yan Liu liver failure treatment and research center 302 Military HospitalPeking University Health Science CenterBeijing 100191China liver failure treatment and research center 302 Military HospitalBeijing 100039China

AIM:To investigate the survival rates and prognostic factors in patients with hepatitis B virus-related acuteon-chronic liver failure(HBV-ACLF).METHODS:Clinical data in hospitalized patients with HBV-ACLF admitted from 2006 to 2009 were retrospectively *** general conditions and survival were analyzed by survival analysis and Cox regression ***:A total of 190 patients were included in this *** overall 1-year survival rate was 57.6%.Patients not treated with antiviral drugs had a significantly higher mortality[relative risk(RR)=0.609,P=0.014].The highest risk of death in patients with ACLF was associated with hepatorenal syndrome(HRS)(RR=2.084,P=0.026),while other significant factors were electrolyte disturbances(RR=2.062,P=0.010),and hepatic encephalopathy(HE)(RR=1.879,P<0.001).CONCLUSION:Antiviral therapy has a strong effect on the prognosis of the patients with HBV-ACLF by improving their 1-year survival ***,electrolyte disturbances,and HE also affect patient survival.

关键词： Hepatitis B virus Acute-on-chronic liver failure Antiviral therapy Nucleosides Survival analysis

Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy

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World Journal of Clinical Cases 2025年第6期13卷 1-8页

作者： Ahmed Tawheed Ibrahim Halil Bahcecioglu Mehmet Yalniz Mubin Ozercan Ali Cagri Oral Mohamed El-Kassas Department of Endemic Medicine Faculty of MedicineHelwan UniversityCairo 11795Egypt Department of Gastroenterology Firat UniversityElazig 23119Türkiye liver Disease research center College of MedicineKing Saud UniversityRiyadh 7805Saudi Arabia

Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal *** the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic *** recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased *** incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe ***,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case *** editorial provides an overview of the current guidelines for the management of iatrogenic colorectal *** insights are from the perspectives of endoscopists and *** also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency *** also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.

关键词： Colon Rectum Iatrogenic colonic perforation Colonoscopy Guidelines Endovacuum Endolumical vacuum therapy Endoscopic management