OBJECTIVETo analyze the relationship between hepatorenal syndrome (HRS) and plasma ammonia.

METHODSPlasma ammonia, liver and renal function of 465 patients with liver cirrhosis in our hospital, from June 2007 to March 2009, were analyzed. 80 renal dysfunction patients and 80 healthy controls were recruited in the control group. In addition, 40 patients with HRS were followed up.

RESULTSUsing urea as the diagnosis standard of HRS, the morbidity rate of HRS was 39.6%, which was higher than that using creatinine as the diagnosis standard of HRS (Chi-square test = 97.33, P less than 0.01). using urea and creatinine as the diagnosis standard of HRS, the ammonia level of HRS groups was (57.39+/-48.83)mumol/L, (64.80+/-47.25)mumol/L, which were higher than that in the non-HRS groups (t = -3.07, t = -3.67, P less than 0.01). The ammonia level of patients with renal dysfunction was (26.59+/-14.34)mumol/L, which was lower than that in HRS group, non-HRS group (P less than 0.01), but there was no statistical significance between the patients with renal dysfunction and the healthy peoples [(22.36+/-8.72)mumol/L] (t = 1.52, P more than 0.05). The followed-up analysis of 40 patients with HRS indicated that plasma ammonia level was positively correlated with urea and creatinine, and correlation coefficients were 0.874 and 0.834 (P less than 0.05).

CONCLUSIONHepatic encephalopathy is liver-kidney-intestine-brain syndrome. HRS plays an important role in the development of hepatic encephalopathy.

Adult ; Aged ; Ammonia ; blood ; Biomarkers ; blood ; Blood Urea Nitrogen ; Case-Control Studies ; Creatinine ; blood ; Female ; Hepatic Encephalopathy ; etiology ; prevention & control ; Hepatorenal Syndrome ; blood ; diagnosis ; epidemiology ; Humans ; Liver Cirrhosis ; blood ; complications ; Liver Function Tests ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND/AIMS: Protein-calorie malnutrition is a common complication in cirrhosis. Protein restriction for the treatment of hepatic encephalopathy (HE) may cause disease progression and poor prognosis. Therefore, we evaluated important clinical parameters for nutritional state in cirrhotic patients with or without HE to predict the development of HE. METHODS: Twenty-two cirrhotic patients were divided into two groups; group A-13 patients without HE and group B-9 patients with HE. Clinical and biochemical parameters, serum proteins {serum albumin, insulin-like growth factor-1 (IGF-1), transferrin, leptin, etc}, immunologic parameters and anthropometry were measured. RESULTS: Child-Pugh score and Model for End-stage Liver Disease (MELD) scale were higher in group B (p<0.01). After correction of various factors affecting nutritional assessment, especially of Child-Pugh score and MELD scale, leptin was higher in group B (p<0.05). There was no difference in anthropometric measurements. Transferrin correlated inversely with MELD scale in group A (p<0.01). IGF-1 correlated inversely with total lymphocyte count in group B (p<0.05). Leptin correlated with Child-Pugh scores, total lymphocyte count and mid-arm muscle cirumference in group A (p<0.05, p<0.05 and p<0.05, respectively), and correlated inversely with CD8 in group B (p<0.05). CONCLUSIONS: Leptin level is higher in patients with HE, and further studies for parameters of nutrition to predict HE in many cirrhotic patients will be needed.
Aged ; Anthropometry ; Biological Markers/*blood ; Female ; Hepatic Encephalopathy/blood/diagnosis/*etiology ; Humans ; Insulin-Like Growth Factor I/analysis ; Leptin/blood ; Liver Cirrhosis/blood/*complications ; Male ; Middle Aged ; *Nutritional Status ; Transferrin/analysis

BACKGROUND/AIMS: Dilutional hyponatremia associated with liver cirrhosis is caused by impaired free water clearance. Several studies have shown that serum sodium levels correlate with survival in cirrhotic patients. Little is known, however, regarding the relationship between the degree of dilutional hyponatremia and development of cirrhotic complications. The aim of this study was to evaluate the association between the serum sodium level and the severity of complications in liver cirrhosis. METHODS: Data of inpatients with cirrhotic complications were collected retrospectively. The serum sodium levels and severity of complications of 188 inpatients were analyzed. RESULTS: The prevalence of dilutional hyponatremia, classified as serum sodium concentrations of < or =135 mmol/L, < or =130 mmol/L, and < or =125 mmol/L, were 20.8%, 14.9%, and 12.2%, respectively. The serum sodium level was strongly associated with the severity of liver function impairment as assessed by Child-Pugh and MELD scores (p<0.0001). Even a mild hyponatremia with a serum sodium concentration of 131-135 mmol/L was associated with severe complications. Sodium levels less than 130 mmol/L indicated the existence of massive ascites (OR, 2.685; CI, 1.316-5.477; p=0.007), grade III or higher hepatic encephalopathy (OR, 5.891; CI, 1.490-23.300; p=0.011), spontaneous bacterial peritonitis (OR, 2.562; CI, 1.162-5.653; p=0.020), and hepatic hydrothorax (OR, 5.723; CI, 1.889-17.336; p=0.002). CONCLUSIONS: Hyponatremia, especially serum levels < or =130 mmol/L, may indicate the existence of severe complications associated with liver cirrhosis
Adult ; Aged ; Ascites/blood/etiology ; Biological Markers/blood ; Female ; Hepatic Encephalopathy/blood/etiology ; Humans ; Hydrothorax/blood/etiology ; Hyponatremia/blood/*etiology/mortality ; Kaplan-Meiers Estimate ; Liver Cirrhosis/blood/*complications/mortality/physiopathology ; Liver Function Tests ; Logistic Models ; Male ; Middle Aged ; Peritonitis/blood/etiology ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sodium/*blood ; Time Factors

Cirrhosis with portal hypertension is a common disease which has a significant impact on the quality of patients' life. Esophagogastric devascularization (EGDV) has been demonstrated to be an effective method to treat portal hypertension, however certain complications are associated with it. The purpose of this study was to evaluate the effectiveness and clinical outcome of the selective EGDV (sEGDV) for the treatment of portal hypertension. The study was conducted prospectively from Jan. 1 2011 to Dec. 31, 2012, and 180 patients were randomized to the sEGDV group (n=90) or the non-sEGDV (n-sEGDV) group (n=90). Patients' demographics, preoperative lab test results and operative details were comparable between the two groups. Postoperative and short-term complications were analyzed in two groups. There was statistically significant difference (P<0.01) in the PVF reduction between the two groups. Post-operative complications showed no statistically significant difference between the two groups in the incidence of bleeding, ascites, acute portal vein thrombosis, fever and hepatic encephalopathy. Mortality between two groups was comparable. The incidence of splenic fossa effusion after the surgery was lower in sEGDV group than in n-sEGDV group. There were no significant differences in the short-term follow-up data such as esophageal varices and portal hypertensive gastropathy (P>0.05). It is suggested that sEGDV is a safe, simple and effective surgical procedure. It has both the advantages of the shunt and devascularization because it preserves body's voluntary diversion. With the advantage of low incidence of postoperative complications, it is an ideal surgical approach for the treatment of portal hypertension.
Adult ; Esophagus ; blood supply ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; pathology ; physiopathology ; Hepatic Encephalopathy ; pathology ; physiopathology ; Humans ; Hypertension, Portal ; pathology ; physiopathology ; surgery ; In Vitro Techniques ; Male ; Middle Aged ; Postoperative Complications ; pathology ; physiopathology ; Prospective Studies ; Stomach ; blood supply ; surgery ; Thrombosis ; etiology ; pathology ; physiopathology

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Hepatic Encephalopathy ; blood ; diagnosis ; etiology ; Humans ; Insulin-Like Growth Factor Binding Protein 1 ; Insulin-Like Growth Factor Binding Proteins ; blood ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Neuropsychological Tests ; Pregnancy Proteins ; blood

We report on a 55-year-old man with alcoholic liver cirrhosis who presented with status epilepticus. Laboratory analysis showed markedly elevated blood ammonia. Brain magnetic resonance imaging (MRI) showed widespread cortical signal changes with restricted diffusion, involving both temporo-fronto-parietal cortex, while the perirolandic regions and occipital cortex were uniquely spared. A follow-up brain MRI demonstrated diffuse cortical atrophy with increased signals on T1-weighted images in both the basal ganglia and temporal lobe cortex, representing cortical laminar necrosis. We suggest that the brain lesions, in our case, represent a consequence of toxic effect of ammonia.
Ammonia/blood ; Atrophy/pathology ; Brain Diseases/blood/*diagnosis/*etiology ; Hepatic Encephalopathy/*complications ; Humans ; Liver Cirrhosis, Alcoholic/*complications ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Necrosis/pathology ; Status Epilepticus/pathology

OBJECTIVETo determine and analyze plasma ammonia concentration difference of the portal vein system and ramifications of rabbits and consequently guide selection of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) so that reduce shunt-induced hepatic encephalopathic incidence. To evaluate clinical significance of transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) and to analyse hemodynamics of both branches of the portal vein and to observe long-term results in the prevention of encephalopathy.

METHODSBlood samples in different portal vein branches of rabbits were collected and the plasma ammonia concentration was assayed and compared. The left branch of portal vein was used as the puncture site to perform TILPS and to keep away from the right branch of portal vein blood that contains nutrition and toxin.

RESULTSPlasma ammonia content was superior in the mesenteric vein and higher than the portal vein branch, the splenic vein, and the vena cava. The right portal vein was above the left. Encephalopathy did not occur in all patients within 3 months. Of the 341 patients undergoing TILPS, encephalopathy occurred in only 5 patients (1.47%) and shunt abnormalities in 19 patients (5.57%) verified by venography during overall follow-up period.

CONCLUSIONSSelective left branch of the portal vein portosystemic shunt can decrease encephalopathy obviously and protect liver function.

Adult ; Aged ; Ammonia ; blood ; Animals ; Female ; Follow-Up Studies ; Hepatic Encephalopathy ; blood ; etiology ; prevention & control ; Humans ; Male ; Middle Aged ; Portal Vein ; surgery ; Portasystemic Shunt, Transjugular Intrahepatic ; adverse effects ; Rabbits ; Treatment Outcome

OBJECTIVETo analyze the prognostic factors for patients with acute-on-chronic liver failure, and to build a scoring system for assessment of the prognosis of liver failure.

METHODS480 patients with acute-on-chronic liver failure in our hospital from January 2006 to June 2008 were enrolled in this study. The patients were divided into improved group and deteriorated group. The clinical data were analyzed by using chi square test, independent-Samples T Test and Binary logistic regression.

RESULTSThe factors that significantly affected the prognosis of Acute-on-chronic Liver Failure included age, hepatitis or liver cirrhosis, Staging, Hyponatremias, alpha-fetoprotein (AFP), the prothrombin time activity (PTA), total bilirubin (TBil), creatinine (Cr), albumin (ALB) and Hepatic encephalopathy, ascites, alimentary tract hemorrhage (P less than 0.05, P less than 0.01). PTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage were independent risk factors of prognosis.

CONCLUSIONPTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage are important to build a scoring system to assess the prognosis of Acute-on-chronic Liver Failure and may be useful to guide clinical treatment.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomarkers ; blood ; Child ; Child, Preschool ; Chronic Disease ; Female ; Hepatic Encephalopathy ; complications ; Hepatitis, Viral, Human ; complications ; epidemiology ; Humans ; Hyponatremia ; complications ; Infant ; Liver Failure, Acute ; blood ; etiology ; pathology ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Prothrombin Time ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Young Adult