OBJECTIVE: To explore the changes in polymorphonuclear neutrophils (PMN) function in peripheral blood of patients with sepsis and liver injury and its prognostic value. METHODS: A prospective observational study was conducted. The patients who met the criteria of Sepsis-3 admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from March to August in 2019 were enrolled as the research objects, and the patients were divided into sepsis without liver injury group and sepsis with liver injury group; non-sepsis patients who were hospitalized at the same time were enrolled as non-sepsis group; and the healthy people in the physical examination center were enrolled as healthy control group. The gender, age, white blood cell (WBC), PMN and procalcitonin (PCT) were recorded when the patients were admitted to ICU as well as the people on the day of physical examination. The acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated. The 28-day mortality was recorded. The quantitative level of neutrophil extracellular traps (NETs) which reflected by circulating free DNA (cf-DNA/NETs) in peripheral plasma was determined by PicoGreen fluorescence quantitative detection; the qualitative level of NETs was detected by immunofluorescence staining. PMN was extracted from the healthy control group, sepsis without liver injury group and sepsis with liver injury group and cultured in vitro, the quantitative level of cf-DNA/NETs in cell supernatant was determined by PicoGreen fluorescence quantitative detection. The patients were divided into two groups according to 28-day outcome of sepsis patients with liver injury. Receiver operating characteristic (ROC) curve was plotted, and the area under ROC curve (AUC) was calculated to analyze the prognostic value of NETs in sepsis patients with liver injury. RESULTS: Finally, 21 sepsis patients without liver injury, 15 sepsis patients with liver injury, 20 with non-sepsis and 20 with healthy examination were enrolled. There was no significant difference in gender or age among the four groups, indicating that the patients in each group were comparable. The levels of cf-DNA/NETs in peripheral blood, WBC and PMN of the sepsis with and without liver injury groups were significantly higher than those of the healthy control group and non-sepsis group, PCT, APACHE II score, SOFA score and 28-day mortality were significantly higher than those of the non-sepsis group, and the levels of cf-DNA/NETs in peripheral blood, PCT and 28-day mortality of the sepsis with liver injury group were significantly higher than those of the sepsis without liver injury group [cf-DNA/NETs (μg/L): 481.60±275.86 vs. 169.76±57.05, PCT (μg/L): 11.29 (1.79, 67.10) vs. 1.11 (0.19, 4.09), 28-day mortality: 73.3% (11/15) vs. 38.1% (8/21), all P < 0.05]. The results of PMN in vitro showed that there was no NETs in normal culture of healthy control group, and a small amount of NETs was detected in sepsis with and without liver injury groups. After stimulation of PMN stimulator phorbol-12-myristate-13-acetic acid (PMA), more NETs were produced in neutrophils of three groups compared with normal culture. Quantitative analysis showed that the level of cf-DNA/NETs in cell supernatant of the sepsis with liver injury group was significantly higher than that of the sepsis without liver injury group (μg/L: 1 872.29±258.44 vs. 1 313.55±147.45, P < 0.01). In 15 sepsis patients with liver injury, 4 patients survived for 28 days (26.7%) and 11 died (73.3%). The cf-DNA/NETs level of the dead group on the day of admission was significantly higher than that of the survival group (μg/L: 582.36±160.05 vs. 241.17±96.14, P < 0.05). ROC curve analysis showed that the AUC of NETs level in peripheral blood for predicting 28-day death of sepsis patients with liver injury was 0.932 [95% confidence interval (95%CI) was 0.787-1.000]; when the best cut-off value was 266.81 μg/L, the sensitivity was 90.9%, the specificity was 75.0%, and the approximate index was 0.659. CONCLUSIONS The function of NETs in sepsis patients with liver injury has been further changed. The level of peripheral blood NETs has a certain guiding value for the prognosis of sepsis patients with liver injury.
APACHE ; Hepatic Insufficiency/diagnosis* ; Humans ; Liver ; Neutrophils ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; ROC Curve ; Retrospective Studies ; Sepsis/diagnosis*

The information on mortality from echinococcosis is important not only for a better understanding of the severity of the disease, but also for evaluating the effectiveness of public health interventions. The aim of this research was to study the causes of mortality from echinococcosis. We have collected and analyzed the materials of 1,470 patients in 10 age - groups in the Republic of Armenia (from 2000 to 2016). To find out the causes of mortality from echinococcosis, we have analyzed the medical histories and protocols of postmortem examinations of 19 deaths from echinococcosis and 17 deaths due to other indirect causes not associated with the parasite. The average annual death rate from echinococcosis is 0.007 per 10,000 population, and the mortality is 1.29 (per 100 patients). The highest mortality occurs in people aged 70–79. Mortality from echinococcosis is also recorded among the unoperated children. The rupture of the parasitic cyst and hepatic insufficiency are major among the direct causes of mortality. Sometimes the hydatid cysts unrecognized during the life were first diagnosed at autopsy. Insufficient qualification of doctors in the field of helminthology, as well as the latent course of the disease or manifestation of minor symptoms in echinococcosis over a long period often led to medical errors. Further decline in mortality can be achieved by early diagnosis, timely hospitalization and treatment before the development of severe complications worsening the prognosis and outcomes of surgical intervention.
Armenia ; Autopsy ; Child ; Early Diagnosis ; Echinococcosis ; Echinococcus granulosus ; Echinococcus multilocularis ; Hepatic Insufficiency ; Hospitalization ; Humans ; Medical Errors ; Mortality ; Parasites ; Prognosis ; Public Health ; Rupture

Acute fatty liver of pregnancy are relatively rare but extremely dangerous, because they may quickly develop into a fulminant disease and become a serious life-threatening disorder for mother and fetus in the third trimester. Therefore, early diagnosis, prompt delivery and intensive supportive care the cornerstones in the management of acute fatty liver of pregnancy. Clinical findings in acute fatty liver of pregnancy vary because it may occur with varying degrees of clinical severity and in conjunction with other third trimester symptoms, making early diagnosis difficult. However, careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. We have experienced a case of acute fatty liver of pregnancy presenting as early hepatic encephalopathy, renal failure which developed during the third trimester. We diagnosed acute fatty liver of pregnancy based on clinical presentation and laboratory abnormalities. Despite of prompt delivery and adequate supportive care management, this severe complication of pregnancy has had an adverse outcome for mother.
Biopsy ; Early Diagnosis ; Fatty Liver ; Female ; Fetus ; Hepatic Encephalopathy ; Humans ; Liver ; Mothers ; Physical Examination ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Third ; Renal Insufficiency

Acute liver failure is a rare but fatal condition characterized by rapid deterioration of liver function resulting in coagulopathy and altered mentation in patients without known liver disease. The three most common causes of liver failure in Korea are hepatitis B virus, exposure to certain herbs, and hepatitis A virus. Because the cause of liver failure is the most important prognostic factor, the etiology of liver failure should be evaluated as the initial step in the assessment of affected patients. Patients with acute liver failure should be intensively monitored and treated for various secondary conditions that may occur or have already developed, including cerebral edema, seizures, hemodynamic instability, renal failure, infection, bleeding, and metabolic disturbances. Although treatment with N-acetylcysteine has shown a survival benefit in patients with mild hepatic encephalopathy, the overall mortality rate associated with acute liver failure is high unless patients undergo liver transplantation, prompting patients and physicians to be prepared for transplantation. Therefore, patients who are suspected to have, or who have been diagnosed with, acute liver failure should be transferred to a transplant facility and be prepared for liver transplantation while they undergo intensive monitoring and medical treatment.
Acetylcysteine ; Brain Edema ; Diagnosis ; Hemodynamics ; Hemorrhage ; Hepatic Encephalopathy ; Hepatitis A virus ; Hepatitis B virus ; Humans ; Korea ; Liver ; Liver Diseases ; Liver Failure ; Liver Failure, Acute* ; Liver Transplantation ; Mortality ; Renal Insufficiency ; Seizures

A 10-year-old-girl who underwent Roux-en-Y cystojejunostomy under the diagnosis of choledochal cyst at another hospital at the age of 3 months was referred to our hospital due to abdominal pain. Abdominal ultrasonography (USG) and computed tomography (CT) showed the type I choledochal cyst and multiple gall bladder stones. Severe inflammation and adhesion made difficulty of radical resection and only partial resection of choledochal cyst with Roux-en-Y hepaticojejunostomy could be performed. She complained of intermittent abdominal pain, fever, nausea and vomiting 2 1/2 years after the second operation. Follow-up abdominal CT scan showed the polypoid nodular lesion in the remnant choledochal cyst and suspicious metastatic lesion in the segment 7 of the liver. The duodenum was obstructed by the mass arising from the remnant choledochal cyst. The USG-guided liver biopsy revealed the moderately differentiated adenocarcinoma. A secondary palliative gastrojejunostomy was performed to relieve the obstruction of duodenum. She died of hepatic insufficiency 4 months later of third operation.
Abdominal Pain ; Adenocarcinoma ; Biopsy ; Choledochal Cyst* ; Diagnosis ; Drainage* ; Duodenum ; Fever ; Follow-Up Studies ; Gastric Bypass ; Hepatic Insufficiency ; Inflammation ; Liver ; Nausea ; Neoplasm Metastasis* ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Bladder Calculi ; Vomiting