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New Algorithm Rules Out Acute-on-chronic liver Failure Development within 28 Days from Acute Decompensation of Cirrhosis

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Journal of Clinical and Translational Hepatology 2023年第3期11卷 550-559页

作者： Xiaoting Tang Hai Li Guohong Deng Xin Zheng Xianbo Wang Yan Huang Yanhang Gao Zhongji Meng Zhiping Qian Feng Liu Xiaobo Lu Yu Shi Beiling Li Wenyi Gu Xiaomei Xiang Yan Xiong Yixin Hou Jun Chen Na Gao Sen Luo Liujuan Ji Jing Li Rongjiong Zheng Haotang Ren Jinjun Chen Hepatology unit Department of Infectious DiseasesNanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina Department of Gastroenterology Ren Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShang-haiChina Shanghai Institute of Digestive Disease Key Laboratory of Gastroenterology and HepatologyChinese Ministry of Health(Shanghai Jiao Tong University)ShanghaiChina Department of Infectious Diseases Southwest HospitalThird Military Medical University(Army Medical University)ChongqingChina Department of Infectious Diseases Institute of Infection and ImmunologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina Center of Integrative Medicine Beijing Ditan HospitalCapital Medical UniversityBeijingChina Department of Infectious Diseases Hunan Key Laboratory of Viral HepatitisXiangya HospitalCentral South UniversityChangshaHunanChina Department of Hepatology The First Hospital of Jilin UniversityChangchunJilinChina Department of Infectious Diseases Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver CancerTaihe HospitalHubei University of MedicineShiyanHubeiChina Department of liver intensive Care unit Shanghai Public Health Clinical CenterFudan UniversityShanghaiChina Department of Infectious Diseases and Hepatology The Second Hospital of Shandong Univer-sityJinanShandongChina Infectious Disease Center The First Affiliated Hospital of Xinjiang Medical UniversityXinjiangChina The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The First Affiliated Hospital of School of MedicineZhejiang UniversityHangzhouZhejiangChina Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease HangzhouZhejiangChina National Clinical Research Center of Infectious Disease HangzhouZhejiangChina Hepatology unit Zengcheng BranchNanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina.

Background and Aims:Approximately 10%of patients with acute decompensated(AD)cirrhosis develop acute-on-chronic liver failure(ACLF)within 28 *** cases have high mortality and are difficult to ***,we aimed to establish and validate an algorithm to identify these patients on ***:Hospitalized patients with AD who developed ACLF within 28 days were considered *** dysfunction was defined accord-ing to the chronic liver failure-sequential organ failure as-sessment(CLIF-SOFA)criteria,and proven bacterial infec-tion was taken to indicate immune system dysfunction.A retrospective multicenter cohort and prospective one were used to derive and to validate the potential algorithm,re-spectively.A miss rate of<5%was acceptable for the calcu-lating algorithm to rule out ***:In the deri-vation cohort(n=673),46 patients developed ACLF within 28 *** total bilirubin,creatinine,international normalized ratio,and present proven bacterial infection at admission were associated with the development of *** patients with≥2 organ dysfunctions had a higher risk for pre-ACLF patients[odds ratio=16.58195%confidence interval:(4.271-64.363),p<0.001].In the derivation co-hort,67.5%of patients(454/673)had≤1 organ dysfunction and two patients(0.4%)were pre-ACLF,with a miss rate of 4.3%(missed/total,2/46).In the validation cohort,65.9%of patients(914/1388)had≤1 organ dysfunction,and four(0.3%)of them were pre-ACLF,with a miss rate of 3.4%(missed/total,4/117).Conclusions:AD patients with≤1 organ dysfunction had a significantly lower risk of developing ACLF within 28 days of admission and could be safely ruled out with a pre-ACLF miss rate of<5%.

关键词： liver cirrhosis Prognosis liver failure End-stage liver disease Organ dysfunction scores.

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Actively implementing enteral nutrition to reduce parenteral nutrition-associated liver disease

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Hepatobiliary Surgery and Nutrition 2018年第5期7卷 409-411页

作者： Shuifang Jin Ronglin Jiang Weibin Ma intensive Care unit First Affiliated HospitalZhejiang Chinese Medical UniversityHangzhou 310006China Department of Pharmacy First Affiliated HospitalZhejiang Chinese Medical UniversityHangzhou 310006China

For critically ill patients whose vital signs have been basically stable, especially those who have already suffered from malnutrition, the need to provide nutritional support has become the consensus of the medical c... 详细信息

关键词： parenteral patients Active

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Analysis of infections in the first 3-month after living donor liver transplantation

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World Journal of Gastroenterology 2012年第16期18卷 1975-1980页

作者： Chuan Li Tian-Fu Wen Kai Mi Chuan Wang Lu-Nan Yan Bo Li Division of liver Transplantation West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

AIM:To identify factors related to serious postoperative bacterial and fungal infections in the first 3 mo after living donor liver transplantation(LDLT).METHODS:In the present study,the data of 207 patients from 2004 to 2011 were *** pre-,intra-and post-operative factors were statistically *** transplantations were approved by the ethics committee of West China Hospital,Sichuan *** with definitely preoperative infections and infections within 48 h after transplantation were excluded from current *** potential risk factors were analyzed using univariate *** significant at a P intensive care unit stay longer than 9 d,postoperative bile leak and severe hyperglycemia were independent risk factors for postoperative bacterial *** red blood cells transfusion and postoperative bacterial infection may be related to postoperative fungal ***:Predictive risk factors for bacterial and fungal infections were indentified in current ***-,intra-and post-operative factors can cause postoperative bacterial and fungal infections after LDLT.

关键词：真菌感染肝移植活体细菌感染单因素分析风险因素白色念珠菌统计分析

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Stratified Platelet-to-lymphocyte Ratio:A Novel Target for Prognostic Prediction of Hepatocellular Carcinoma after Curative liver Resection

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Journal of Clinical and Translational Hepatology 2017年第1期5卷 35-42页

作者： Gui-Qian Huang Ji-Na Zheng Tian-Tian Zou Yi-Ran Chen Ke-Qing Shi Sven Van Poucke Zhang Cheng Lu-Yi Ruan Ming-Hua Zheng Department of Hepatology Liver Research CenterThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina Renji School of Wenzhou Medical University WenzhouChina School of The First Clinical Medical Sciences Wenzhou Medical UniversityWenzhouChina School of The Second Clinical Medical Sciences Wenzhou Medical UniversityWenzhouChina Institute of Hepatology Wenzhou Medical UniversityWenzhouChina Department of Anesthesiology Intensive CareEmergency Medicine and Pain TherapyZiekenhuis Oost-LimburgGenkBelgium

Background and Aims:Platelet-to-lymphocyte ratio(PLR)has been shown to predict prognosis of *** aimed to evaluate the prognostic value of stratification of PLR in patients after curative liver resection(CLR)for hepatocellular carcinoma(HCC).Methods:A total of 1804 patients who underwent CLR for suspected HCC between January 2007 and January 2014 were screened for the *** of the patients were categorized into equal tertiles according to the number of patients and the distribution of *** significance was determined for overall survival(OS)and was assessed using Kaplan-Meier *** and multi-variate Cox proportional hazard regression analyses were evaluated for association of all independent parameters with disease ***:The optimal cut-off points of preoperative PLR were:(T1)11.98-75.00,(T2)75.00-113.33 and(T3)*** were obvious differences in each PLR tertile with mortality within 36 months of CLR(Plog-rank<0.001).Multivariable analysis suggested that the level of PLR(HR=1.004,95%CI:1.001-1.008,P=0.006),portal vein thrombosis(HR=3.406,95%CI:1.185-9.794,P=0.023),number of nodules(HR=1.810,95%CI:1.345-2.437,P<0.001),Child-Turcotte-Pugh score(HR=1.741,95%CI:1.129-2.684,P=0.012)and microvascular invasion(HR=2.730,95%CI:1.777-4.196,P<0.001)were significant predictors of ***-Meier analysis of overall survival(OS)demonstrated that each PLR tertile showed a progressively worse OS and apparent separation(Plog-rank=0.016).The highest 5-year OS rate following CLR(58%)was revealed in tertile *** contrast,the lowest 5-year OS rate(30%)was revealed in tertile ***:Stratified preoperative PLR could strengthen the predictive power for OS in HCC patients with CLR.

关键词： Platelet-to-lymphocyte ratio Hepatocellular carcinoma Curative liver resection Overall survival

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Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality

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World Journal of Transplantation 2023年第5期13卷 264-275页

作者： Azam Farahani Fereshteh Ghiasvand Setareh Davoudi Zahra Ahmadinejad Department of Infectious Diseases Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehran ***Iran liver Transplantation Research Center Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehran ***Iran

BACKGROUND Infections,including invasive fungal infections(IFIs),are among the leading causes of mortality in liver transplant recipients during the first year *** To investigate the epidemiology,clinical manifestations,risk factors,treatment outcomes,and mortality rate of post-liver transplantation invasive aspergillosis(IA).METHODS In this case-control study,22 patients with IA were identified by reviewing the archived and electronic medical records of 850 patients who received liver transplants at the Imam Khomeini Hospital complex in Tehran,Iran,between 2014 and *** control group comprised 38 patients without IA infection matched for age and *** information obtained included the baseline characteristics of liver transplant patients,operative reports,post-transplantation characteristics of both groups and information about the fungal infection of the patient *** The prevalence rate of IA among liver transplant recipients at Imam Khomeini Hospital was 2.7%.The risk factors of IA among studied patients included high serum creatinine levels before and post-transplant,renal replacement therapy,antithymocyte globulin induction therapy,post-transplant bile leakage,posttransplant hepatic artery thrombosis,repeated surgery within 30 d after the transplant,bacterial pneumonia before the aspergillosis diagnosis,receiving systemic antibiotics before the aspergillus infection,cytomegalovirus infection,and duration of post-transplant hospitalization in the intensive care *** most prevalent form of infection was invasive pulmonary aspergillosis,and the most common chest computed tomography scan findings were nodules,pleural effusion,and the halo *** the case group,prophylactic antifungal therapy was administered more frequently than in the control *** antifungal therapy response rate at 12 wk was 63.7%.The 3-and 12-mo mortality rates of the patients with IA were 36.4%and 45.4%,respectively(compared with the mortality rate o

关键词： Aspergillosis Cytomegalovirus infection Immunosuppression therapy liver transplantation Risk factors Fungal infections Fungal pneumonia

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Early prediction of acute kidney injury in neonates with cardiac surgery

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World Journal of Pediatric Surgery 2020年第2期3卷 6-12页

作者： Shanshan Shi Jiajie Fan Qiang Shu Cardiac intensive Care unit The Children’s Hospital of Zhejiang University School of MedicineHangzhouChina Department of Thoracic and Cardiovascular Surgery The Children’s Hospital of Zhejiang University School of MedicineHangzhouChina

Background Acute kidney injury(AKI)occurs in 42%-64%of the neonatal patients experiencing cardiac surgery,contributing to postoperative morbidity and *** diagnostic criteria,which are mainly based on serum creatinine and hourly urine output,are not sufficiently sensitive and precise to diagnose neonatal AKI *** purpose of this review is to screen the recent literature,to summarize the novel and cost-effective biomarkers and approaches for neonatal AKI after cardiac surgery(CS-AKI),and to provide a possible research direction for future *** sources We searched PubMed for articles published before November 2019 with pertinent ***-seven articles were found and *** excluding 48 records,19 articles were enrolled for final *** Nineteen articles were enrolled,and 18 possible urinary biomarkers were identified and evaluated for their ability to diagnose *** neutrophil gelatinase-associated lipocalin(uNGAL),serum cystatin C(sCys),urinary human kidney injury molecule-1(uKIM-1),urinary liver fatty acid-binding protein(uL-FABP)and interleukin-18(uIL-18)were the most frequently described as the early predictors of neonatal *** Neonates are vulnerable to ***,sCys,uL-FABP,uKIM-1 and uIL-18 are potential biomarkers for early prediction of neonatal *** regional oxygen saturation by near-infrared spectroscopy is a non-invasive approach for early identification of neonatal *** work should focus on exploring a sensitive and specific combined diagnostic model that includes novel biomarkers and other complementary methods.

关键词： urinary prediction injury

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Predictive factors of short term outcome after liver transplantation: A review

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World Journal of Gastroenterology 2016年第26期22卷 5936-5949页

作者： Giuliano Bolondi Federico Mocchegiani Roberto Montalti Daniele Nicolini Marco Vivarelli Lesley De Pietri Anaesthesiology Intensive Care and Pain Therapy Medical Residency University of Modena and Reggio Emilia Division of Hepatobiliary and Transplant Surgery Department of Experimental Medicine Polytechnic University of Marche Division of Anaesthesiology and intensive Care unit Department of Cardiology Thoracic and Vascular Surgery Critical Care Medicine Arcispedale Santa Maria Nuova-IRCCS

liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early posttransplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests(platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores(model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1th and the 5th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be

关键词： liver transplant liver failure Early allograft dysfunction Primary non-function Initial poor functio

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Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria

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World Journal of Hepatology 2014年第10期6卷 696-703页

作者： Banwari Agarwal Andrew Davenport intensive Care unit The Royal Free HospitalNW32QG LondonUnited Kingdom UCL Centre for Nephrology The Royal Free HospitalNW32QG LondonUnited Kingdom

Renal function in patients with advanced cirrhosis is an important prognostic factor for survival both prior to and following liver transplantation. The importance of renal function is reflected by the introduction of the model for end stage liver disease(MELD) score, which includes serum creatinine. The MELD score has been shown to predict the short term risk of death for transplant wait listed patients and is currently used by many countries to allocate liver transplants on the basis of severity of underlying illness. Changes in serum creatinine are also used to stage acute kidney injury. However prior to liver transplantation the serum creatinine typically over estimates underlying renal function, particularly when a colorimetric Jaffe based assay is used, and paradoxically then under estimates renal function post liver transplantation, particularly when immunophyllins are started early as part of transplant immunosuppression. As acute kidney injury is defined by changes in serum creatinine, this potentially leads to over estimation of the incidence and severity of acute kidney injury in the immediate post-operative period.

关键词： Serum creatinine Acute kidney injury liver transplantation

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Hemoperfusion with polymyxin B-immobilized fiber column improves liver function after ischemia-reperfusion injury

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World Journal of Gastroenterology 2009年第36期15卷 4571-4575页

作者： Hiroaki Sato Kiyohiro Oshima Katsumi Kobayashi Hodaka Yamazaki Yujin Suto Izumi Takeyoshi Department of Thoracic and Visceral Organ Surgery Gunma University Graduate School of Medicine3-39-15 Showa-machiMaebashiGunma 371-8511 Japan intensive Care unit Gunma University Hospital3-39-15 Showa-machiMaebashiGunma 371-8511 Japan

AIM:To investigate the usefulness of direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX therapy)for warm hepatic ischemia-reperfusion(I/R)injury after total hepatic vascular exclusion (THVE)using a porcine model. METHODS:Eleven Mexican hairless pigs weighing 22-38 kg were subjected to THVE for 120 min and then observed for 360 *** animals were divided into two groups randomly:the DHP-PMX group(n=5)underwent DHP-PMX at a flow rate of 80 mL/min for 120 min(beginning 10 min before reperfusion),while the control group did not(n=6).The rate pressure product (RPP):heart rate×end-systolic arterial blood pressure, hepatic tissue blood flow(HTBF),portal vein blood flow (PVBF),and serum aspartate aminotransferase(AST) levels were compared between the two groups. RESULTS:RPP and HTBF were significantly(Ptherapy reduced the hepatic warm I/R injury caused by THVE in a porcine model.

关键词：再灌注损伤缺血再灌注多粘菌素血液灌流肝功能纤维血流量谷草转氨酶

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COVID-19合并胃肠道出血一例报告

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Gastroenterology Report 2021年第1期9卷 85-87,I0003页

作者： Yan-Ling Wang Jin-Song Mu Xiao-Bao Qi Wen-Hui Zhang liver Cirrhosis Diagnosis and Treatment Center 5th Medical Center of PLA General Hospital of ChinaBeijingP.R.China intensive Care unit 5th Medical Center of PLA General Hospital of ChinaBeijingP.R.China

The coronavirus disease 2019(COVID-19)outbreak that was first reported in Wuhan,China has spread globally,causing unprecedented health and economic damage[1].Although its clinical manifestations are mainly fever and respiratory symptoms,in some cases,gastrointestinal(GI)symptoms were the first manifestations[2].Here we present a case of an elderly patient with COVID-19 who developed massive GI bleeding during treatment.

关键词：胃肠道出血 respiratory clinical

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