Patients with cirrhosis who are hospitalized for an acute decompensation (AD) and also have organ failure(s) are at high risk of short-term death. These patients have a syndrome called Acute-on-Chronic Liver Failure (ACLF). ACLF is now considered as a new syndrome that it is distinct from "mere" AD not only because of the presence of organ failure(s) and high short-term mortality but also because of younger age, higher prevalence of alcoholic etiology of cirrhosis, higher prevalence of some precipitants (such as bacterial infections, active alcoholism), and more intense systemic inflammatory response. ACLF is a new syndrome also because severe sepsis or severe alcoholic hepatitis do not account for 100% of the observed cases; in fact, almost 50% of the cases are of "unknown" origin. In other words, severe sepsis, severe alcoholic hepatitis and ACLF of "unknown origin" are subcategories of the syndrome.
Acute-On-Chronic Liver Failure/complications/mortality/*pathology ; Age Factors ; Cytokines/metabolism ; Hepatitis, Alcoholic/complications ; Humans ; Liver Cirrhosis/*complications/diagnosis ; Sepsis/complications ; Severity of Illness Index ; Survival Rate

OBJECTIVETo judge the prognosis in the patients with fulminant hepatic failure and to provide the evidences of correct therapy.

METHODSThe clinical features and the indexes which may affect the prognosis of the patients with fulminant hepatic failure were analyzed. Indexes including prothrombin time (PT), the routine biochemical analysis of liver and kidney functions, the plasma levels of glucose and ammonia, cortisol, lipases, amylase, age, gender and complications were analyzed using the software Statistical Product and Service Solutions (SPSS)15.0. The differences between the died and living patients were compared.

RESULTSThe mortality of the patients was 65% and the highest was 80% for those with HBV and HEV coinfection. The age and gender had no influence on mortality (P value was 0.423 and 0.728 respectively). HBV infection was the main factor which caused fulminant hepatic failure (52%), The next was hepatitis E virus infection (39%). Among the indexes analyzed, the plasma levels of total bilirubin, usea nitrogen, creatinine, glucose, cholesterol and prothrombin time had positive correlations with the prognosis of the patients (P value was 0.005, 0.001, 0.001, 0.005, 0.010 and 0.049 respectively). The incidence rate of hepatic coma, hepatorenal syndrome, and adrenal insufficiency were higher in the died group than that in the living group (P value was 0.005, 0.012 and 0.025 respectively). But prothrombin time was the only factor which had correlation with the prognosis (P=0.035) analyzed by multivariate logistic regression analysis. The scores of MELD were higher in the died group than that in living group (t=18.236, P<0.01) and especially in the patients with hepatic coma and hepatorenal syndrome. The scores of MELD also had positive correlation with the plasma level of TNFa (r=0.585, P<0.01).

CONCLUSIONSThe HBV infection was the main cause of fulminant hepatic failure and HBV and HEV coinfection had the highest mortality. The plasma levels of total bilirubin, cholesterol, glucose , prothrombin time and some complications including hepatic coma, hepatorenal syndrome, and adrenal insufficiency maybe had positive correlations with the prognosis of fulminant hepatic failure. The scores of MELD may predict the prognosis of these patients.

Adult ; Aged ; Female ; Hepatitis B ; complications ; Hepatitis B virus ; Hepatitis E ; complications ; Hepatitis E virus ; Humans ; Liver Failure, Acute ; diagnosis ; mortality ; virology ; Male ; Middle Aged ; Prognosis ; Severity of Illness Index ; Survival Rate ; Young Adult

PURPOSE: Refractory ascites (RA) is closely related to a high morbidity and mortality. In this study, we investigated predictors of RA development in patients with hepatitis B virus (HBV)-related cirrhosis who were hospitalized to control ascitic decompensation, and determined predictors for survival in patients who experienced RA. MATERIALS AND METHODS: We analyzed 199 consecutive patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation between January 1996 and December 2008. RESULTS: Multivariate analyses showed that only serum potassium at admission predicted RA development independently [p=0.013; hazard ratio (HR), 2.800; 95% confidence interval (CI), 1.166-6.722]. During the follow-up period, 16 (8.0%) patients experienced RA within 4.2 (range, 1.0-39.2) months after admission for controlling ascitic decompensation, and they survived a median of 8.7 (range, 3.9-51.3) months. Child-Pugh class and RA type were identified as independent prognostic factors affecting the survival in patients with RA (p=0.045; HR, 8.079; 95% CI, 1.231-67.984 and p=0.013; HR, 14.510; 95% CI, 1.771-118.874, respectively). CONCLUSION: Serum potassium was an independent predictor of RA development in patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation. After RA development, Child-Pugh class and RA type were independent predictors for survival.
Adult ; Aged ; Ascites/complications/*diagnosis/mortality ; Female ; Hepatitis B, Chronic/complications/mortality/*therapy ; Hospitalization ; Humans ; Liver Cirrhosis/complications/mortality/*therapy ; Liver Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Potassium/blood ; Prognosis ; Retrospective Studies ; Treatment Outcome

The prevalence of hepatocellular carcinoma (HCC) has increased in recent years. However, HCC remains poorly characterized in elderly patients, and comprehensive data are limited. This study aimed to investigate the clinical characteristics, prognostic features and survival outcome of elderly HCC patients. We retrospectively analyzed 992 HCC patients treated at Dongsan Hospital from January 2003 to December 2007. The patients were divided into two age groups: < 70 yr (n = 813) and > or = 70 yr (n = 179). Elderly HCC patients, compared to younger patients, had significantly higher incidence of females (31.3% vs 18.9%, P = 0.001), hepatitis C-related disease (HCV antibody positivity 26.3% vs 9.2%, P = 0.001) and comorbid condition (53.6% vs 32.1%), but lower rates of hepatitis B-related disease (HBs antigen positivity 31.3% vs 69.4%, P = 0.001). There were no significant differences in underlying liver function, stage and survival outcomes. Factors significantly influencing the prognosis of HCC were Child-Pugh grade, number of HCC, level of alpha-fetoprotein, presence of metastasis. The survival outcome of older patients with HCC was not different from that of younger patients. There were no differences between groups in independent factors influencing the prognosis of HCC. Therefore, determining the optimal management strategy for elderly HCC patients is important to improve survival and long-term outcomes.
Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Carcinoma, Hepatocellular/etiology/*mortality/*therapy ; Chemoembolization, Therapeutic ; Female ; Hepatitis B/complications/diagnosis ; Hepatitis B Surface Antigens/blood ; Hepatitis C/complications/diagnosis ; Hepatitis C Antibodies/blood ; Humans ; Liver Neoplasms/etiology/*mortality/*therapy ; Male ; Middle Aged ; Palliative Care ; Regression Analysis ; Republic of Korea ; Retrospective Studies ; Survival Analysis ; alpha-Fetoproteins/analysis

No abstract available.
Drug Therapy, Combination ; Hepacivirus ; Hepatitis C, Chronic/complications/*diagnosis/therapy ; Humans ; Interferon Alfa-2a/therapeutic use ; Liver Cirrhosis/*diagnosis/mortality/virology ; *Liver Transplantation ; Living Donors ; Polyethylene Glycols/therapeutic use ; Ribavirin/therapeutic use ; Severity of Illness Index ; Treatment Outcome

BACKGROUNDS/AIMS: The occurrence of acute hepatitis A is increasing and its progression to fulminant hepatic failure (FHF) is frequent. We investigated the frequency and clinical outcomes of fulminant hepatitis A and also analyzed the predictive factors of spontaneous survival. METHODS: A total of 568 patients presented with acute hepatitis A from January 2003 to June 2008, of which the 35 (6.2%) patients with FHF were divided into two groups: spontaneous survival and transplant/death. These two groups were compared according to various clinical features including the MELD score and King's College Hospital (KCH) criteria. RESULTS: The rate of FHF development increased over time among patients with acute hepatitis A: 0% in 2003, 3.4% in 2004, 3.2% in 2005, 6.0% in 2006, 7.7% in 2007, and 13.0% in 2008. Twenty patients (57.1%) showed spontaneous survival, 13 (37.1%) received liver transplantation, and 5 (14.3%) died during hospitalization. The two groups of spontaneous survival (N=20) and transplant/death (N=15) showed significant differences in prothrombin time at admission and at its worst value, albumin at its worst value, and hepatic encephalopathy grade at admission and at its worst value. The MELD score was lower in the spontaneous-survival group than in the transplant/death group (27.0+/-7.8 vs. 37.0+/-7.1, mean+/-SD; P=0.001). However, KCH criteria did not differ significantly between the two groups. On multivariate analysis, HEP grade was the only significant predictive factor, being negatively correlated with spontaneous survival (OR=0.068, P=0.025). CONCLUSIONS: FHF due to hepatitis A has increased in recent years, and in our cohort the HEP grade was closely associated with spontaneous survival.
Acute Disease ; Adult ; Female ; Hepatitis A/*complications/diagnosis ; Humans ; Liver Failure, Acute/*diagnosis/etiology/*mortality ; Liver Transplantation ; Male ; Multivariate Analysis ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome

A retrospective review of 4,721 human immunodeficiency virus (HIV)-infected patients, followed at St. Luke's Roosevelt Hospital Center, New York City, was conducted from January 1, 2005 to December 31, 2009. HIV-Hepatitis B virus (HBV) co-infection rate was 218/4,721, 4.6%. Among co-infected patients, 19 patients (19/218, 8.7%) died; 13 patients (13/19, 68.4%) died from non-acquired immune deficiency syndrome (AIDS) defining including 2 patients with liver failure. More non-survivors (5 patients, 5/19, 26.3%) had liver cirrhosis than those who survived (8 patients, 8/199, 4.0%; P = 0.002). There were more patients with positive HBV e antigen (HBeAg) among non-survivors, (12 patients, 12/19, 63.2%) than among survivors (74 patients, 74/199, 37.2%; P = 0.047). HIV-HBV co-infection is associated with increased overall mortality. Therefore, use of dual active antiretrovirals, particularly, tenofovir (TDF) based regimen for optimal suppression of HIV-HBV and immune restoration with prevention of high risk behaviors may contribute to improved outcomes.
Adenine/analogs & derivatives/therapeutic use ; Adult ; Anti-HIV Agents/therapeutic use ; Coinfection/drug therapy/mortality ; Female ; HIV Infections/complications/*diagnosis/drug therapy ; Hepatitis B/complications/*diagnosis/drug therapy ; Hepatitis B e Antigens/blood ; Humans ; Liver Cirrhosis/etiology ; Male ; Middle Aged ; New York City ; Organophosphonates/therapeutic use ; Retrospective Studies

BACKGROUND: Gallstones have been one of the most common gastrointestinal diseases to surgeons which open cholecystectomy has been the standard operation for the past one hundred years. Recently, operations with a laparoscope have become popular and are spreading worldwide. METHODS: A clinical analysis of 200 cases who had been treated by laparoscopic cholecystectomy for gallstone disease in Seoul Red Cross Hospital for 4 years from July 1993 to June 1997 was done according to age, sex, advantage, and complication. RESULTS: The results were as follows. 1) Among the 200 cases, there were 69 male patients and 131 female patients, with a female to male ratio of 1.9:1. The most prevalent age group was the 6th decade with 59 cases (29.5%) and the 7th decade with 43 cases (21.5%), the 5th decade with 41 cases (20.5%) and the 4th decade with 29 cases (14.5%) in order of frequency. 2) The associated diseases were hypertension with 25 cases (12.5%), diabetes mellitus with 12 cases (6.0%), cardiopulmonary disease with 11 cases (5.5%), and hepatitis with 10 cases (5.0%) in order of frequency. 3) The cases of previous abdominal operations were 75 cases (37.5%). The most frequent operations were appendectomy with 33 cases (16.5%), C-section with 12 cases (6.0%), laparoscopic tubal ligation with 11 cases (5.5%), salphingo- oophorectomy with 8 cases (4.0%) and T.A.H with 8 cases (4.0%) in order of frequency. 4) The most frequent pathologic diagnosis was chronic cholecystitis with 187 cases (93.5%). 5) The operation time ranged from 30-180 minutes with an average of 81 minutes. The operation time for the first 10 cases was 77 minutes, but it was been reduced to 58 minutes in the last 10 cases. 6) Conversion to an open cholecystectomy during the operation was done in 6 cases (3.0%), and the cause of conversion were uncontrolled bleeding with 2 cases (1.0%), severe adhesion with 2 cases (1.0%) and GB empyema with 2 cases (1.0%). 7) Postoperative analgesics were needed in 81 cases (40.5%) on the operative day, 71 cases (35.5%) on the 1st postoperative day, 26 cases (12.5%) on the 2nd postoperative day, 6 cases (3.0%) on the 3rd postoperative day, and 3 cases (1.5%) on the 4th postoperative day, and the use of analgesics was reduced as times went by. 8) The length of hospital stay ranged from 2 to 10 day with an average of 4.13 day, and 74 cases (37.0%) experienced a 3 to 6 day hospitalization, which was the most common hospital stay. 9) The total postoperative complication rate was 5.0% (n=10) with 2 cases (1.0%) of wound infection and 2 cases (1.0%) of ileus, and there was no postoperative mortality.
Analgesics ; Appendectomy ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Diabetes Mellitus ; Diagnosis ; Empyema ; Female ; Gallstones ; Gastrointestinal Diseases ; Hemorrhage ; Hepatitis ; Hospitalization ; Humans ; Hypertension ; Ileus ; Laparoscopes ; Length of Stay ; Male ; Mortality ; Ovariectomy ; Postoperative Complications ; Red Cross ; Seoul ; Sterilization, Tubal ; Wound Infection

The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.
Acute Disease ; Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Cholestasis/epidemiology/etiology ; Demography ; Hepatitis A/complications/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/epidemiology/etiology ; Liver Transplantation ; Middle Aged ; Morbidity ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Young Adult

BACKGROUND/AIMS: Adefovir dipivoxil (ADV) is a nucleotide analogue that is effective against lamivudine-resistant hepatitis B virus (HBV). The aim of this study was to determine the long-term clinical outcomes after ADV rescue therapy in decompensated patients infected with lamivudine-resistant HBV. METHODS: In total, 128 patients with a decompensated state and lamivudine-resistant HBV were treated with ADV at a dosage of 10 mg/day for a median of 33 months in this multicenter cohort study. RESULTS: Following ADV treatment, 86 (72.3%) of 119 patients experienced a decrease in Child-Pugh score of at least 2 points, and the overall end-stage liver disease score decreased from 16+/-5 to 14+/-10 (mean +/- SD, P<0.001) during the follow-up period. With ADV treatment, 67 patients (56.3%) had undetectable serum HBV DNA (detection limit, 0.5 pg/mL). Virologic breakthrough occurred in 38 patients (36.1%) and 9 patients had a suboptimal ADV response. The overall survival rate was 89.9% (107/119), and a suboptimal response to ADV treatment was associated with both no improvement in Child-Pugh score (> or =2 points; P=0.001) and high mortality following ADV rescue therapy (P=0.012). CONCLUSIONS: Three years of ADV treatment was effective and safe in decompensated patients with lamivudine-resistant HBV.
Adenine/*analogs & derivatives/therapeutic use ; Adult ; Aged ; Antiviral Agents/*therapeutic use ; Cohort Studies ; DNA, Viral/blood ; Drug Resistance, Viral ; Female ; Hepatitis B/complications/*drug therapy ; Hepatitis B e Antigens/blood ; Hepatitis B virus/genetics ; Humans ; Lamivudine/*therapeutic use ; Liver Cirrhosis/*diagnosis/etiology/mortality ; Male ; Middle Aged ; Odds Ratio ; Organophosphonates/*therapeutic use ; Retrospective Studies ; Severity of Illness Index ; Survival Rate