Humans ; Liver ; physiopathology ; Liver Cirrhosis ; mortality ; physiopathology ; Liver Failure ; physiopathology ; Liver Function Tests ; Survival Rate

Humans ; Liver Cirrhosis ; diagnosis ; mortality ; physiopathology ; Logistic Models ; Prognosis

BACKGROUND: Hyperdynamic circulation due to reduced peripheral vascular resistance and increased cardiac output, and the development of portal hypertension are the hemodynamic changes observed in patients with liver cirrhosis. Such hemodynamic abnormalities appear in patients with late stage liver cirrhosis. Therefore, hemodynamic indices, which represent hyperdynamic circulation and portal hypertension, are significant for the prognosis of patients with liver cirrhosis. The aim of this study was to determine the hemodynamic indices associated with the prognosis of patients with liver cirrhosis. METHODS: A total of 103 patients diagnosed with liver cirrhosis between December 1999 and June 2003, with a mean follow-up period of 73 weeks, ranging from 7 to 168 weeks, were recruited. Using Child-Pugh classification, the mean arterial pressure, heart rate and hepatic venous pressure gradient (HVPG) were measured. The indices of Doppler ultrasonography, including the portal and splenic venous flows, and the resistance of the hepatic, splenic, and renal arteries were also measured using the arterial pulsatility index (PI). The prognostic values of these indices were determined by their comparison with the patient survivals. RESULTS: Significant hemodynamic indices for a bad prognosis were high HVPG (> or=15 mmHg) and renal arterial PI (> or=1.14) (p< 0.05). A Child-Pugh score > or=10 was important for a poor prognosis (p< 0.05). CONCLUSION: Severe portal hypertension (HVPG> or=15 mmHg) and high renal arterial resistance (PI> or=1.14) were valuable hemodynamic indices for the prognosis of patients with liver cirrhosis. Therefore, it was concluded that the measurement of these hemodynamic indices, in addition to the Child-Pugh classification, is helpful in the prognosis of patients with liver cirrhosis.
Female ; *Hemodynamic Processes ; Humans ; Korea/epidemiology ; Liver Cirrhosis/*mortality/*physiopathology ; Male ; Middle Aged ; Prognosis ; Survival Rate

Adult ; Aged ; Ascites ; blood ; mortality ; physiopathology ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Endotoxins ; blood ; Female ; Humans ; Kidney ; physiopathology ; Liver Cirrhosis ; blood ; mortality ; physiopathology ; Male ; Middle Aged ; Prognosis ; Protein Precursors ; blood

PURPOSE: Little is known about the impact of weekend admission on acute variceal hemorrhage (AVH). Thus, we investigated whether day of admission due to AVH influenced in-hospital mortality. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 294 patients with cirrhosis admitted between January 2005 and February 2009 for the management of AVH. Clinical characteristics were compared between patients with weekend and weekday admission, and independent risk factors for in-hospital mortality were determined by multivariate binary logistic regression analysis. RESULTS: No demographic differences were observed between patients according to admission day or in the clinical course during hospitalization. Seventeen (23.0%) of 74 patients with weekend admission and 48 (21.8%) of 220 with weekday admission died during hospitalization (p=0.872). Univariate and subsequent multivariate analysis showed that initial presentation with hematochezia [p=0.042; hazard ratio (HR), 2.605; 95% confidence interval (CI), 1.038-6.541], in-patient status at the time of bleeding (p=0.003; HR, 4.084; 95% CI, 1.598-10.435), Child-Pugh score (p<0.001; HR, 1.877; 95% CI, 1.516-2.324), and number of endoscopy sessions for complete hemostasis (p=0.001; HR, 3.864; 95% CI, 1.802-8.288) were independent predictors for in-hospital mortality. CONCLUSION: Weekend admission did not influence in-hospital mortality in patients with cirrhosis who presented AVH.
Adult ; Aged ; Aged, 80 and over ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage/etiology/mortality/*physiopathology ; Hospitalization/*statistics & numerical data ; Humans ; Liver Cirrhosis/*complications/mortality/*physiopathology ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Time Factors

The survival of a recent series of 823 cirrhosis patients who were followed up for a mean of 48 months was analyzed. Cirrhosis was ascribed to alcohol (26%), hepatitis virus B (58%), hepatitis virus C (11%) or both (2%), or was cryptogenic (3%). Features of decompensation were observed in 51% of the patients at entry, and newly developed in 44% of compensated patients within 5 yr. The 5-yr survival after decompensation was 25%. The leading causes of death were liver failure (53%), hepatocellular carcinoma (HCC, 23%), and variceal bleeding (10%). Early detection of HCC significantly improved the survival of cirrhosis patients. Biannual ultrasonography increased the detection rate of small HCC. Mortality of variceal hemorrhage was much lower in patients with Child-Pugh scores from 5 to 8 than in those with scores above 8 (5% vs. 52%). Endoscopic prophylaxis significantly decreased the incidence of first variceal hemorrhage, but the effect was insufficient to improve the rate of survival. Mortality of first spontaneous bacterial peritonitis was 18%. These data suggest that the mortality of major complications of liver cirrhosis has considerably decreased during the last two decades, while there was no remarkable improvement in long-term survival. More efficient management of etiologic factors would be required.
Adult ; Aged ; Carcinoma, Hepatocellular/etiology/physiopathology ; Female ; Gastrointestinal Hemorrhage ; Human ; Korea ; Liver Cirrhosis/complications/*diagnosis/mortality/*physiopathology ; Liver Neoplasms/etiology/pathology ; Male ; Middle Aged ; Peritonitis ; Prognosis ; Retrospective Studies ; *Survival Analysis ; Survival Rate

PURPOSE: The present study aimed to investigate the role of hepatic venous pressure gradient (HVPG) for prediction of long-term mortality in patients with decompensated cirrhosis. MATERIALS AND METHODS: Clinical data from 97 non-critically-ill cirrhotic patients with HVPG measurements were retrospectively and consecutively collected between 2009 and 2012. Patients were classified according to clinical stages and presence of ascites. The prognostic accuracy of HVPG for death, survival curves, and hazard ratios were analyzed. RESULTS: During a median follow-up of 24 (interquartile range, 13-36) months, 22 patients (22.7%) died. The area under the receiver operating characteristics curves of HVPG for predicting 1-year, 2-year, and overall mortality were 0.801, 0.737, and 0.687, respectively (all p<0.01). The best cut-off value of HVPG for predicting long-term overall mortality in all patients was 17 mm Hg. The mortality rates at 1 and 2 years were 8.9% and 19.2%, respectively: 1.9% and 11.9% with HVPG < or =17 mm Hg and 16.2% and 29.4% with HVPG >17 mm Hg, respectively (p=0.015). In the ascites group, the mortality rates at 1 and 2 years were 3.9% and 17.6% with HVPG < or =17 mm Hg and 17.5% and 35.2% with HVPG >17 mm Hg, respectively (p=0.044). Regarding the risk factors for mortality, both HVPG and model for end-stage liver disease were positively related with long-term mortality in all patients. Particularly, for the patients with ascites, both prothrombin time and HVPG were independent risk factors for predicting poor outcomes. CONCLUSION: HVPG is useful for predicting the long-term mortality in patients with decompensated cirrhosis, especially in the presence of ascites.
Adult ; Aged ; Ascites/mortality ; Female ; Hepatic Veins/*physiopathology ; Humans ; Kaplan-Meier Estimate ; Liver Cirrhosis/blood/complications/diagnosis/*mortality/*physiopathology ; Liver Failure/diagnosis/*mortality/physiopathology ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Venous Pressure

BACKGROUND/AIMS: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis. METHODS: We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months. RESULTS: Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84). CONCLUSIONS: Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.
Adult ; Aged ; Area Under Curve ; Cohort Studies ; Female ; Hepatic Veins/*physiopathology ; Humans ; Liver Cirrhosis/diagnosis/*mortality/physiopathology ; Liver Failure/diagnosis/*mortality/physiopathology ; Male ; Middle Aged ; Models, Biological ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Regression Analysis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Venous Pressure

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

OBJECTIVEBy clarifying the natural history of chronic hepatitis B, to evaluate its long-term therapeutic outcome, antiviral drugs efficacy and economic significance.

METHODSA cohort of 183 (mean age of 31.75?.03 years, male/female ratio: 152:31) chronic hepatitis B patients with biopsy-proven and 247 cases of general population as control were followed up by retrospective cohort study. The follow-up time was 11.81?.08 years. This study was focused on long-term clinical outcome including the rate of liver cirrhosis, hepatocellular carcinoma and death, the long-term effect of antiviral drugs and prognostic factors.

RESULTSIn chronic hepatitis B patients, 22 (12.02%) developed liver cirrhosis, 12 (6.56%) hepatocellular carcinoma, and 20 (10.93%) died. The cumulative survival probabilities were 97.27%, 91.62%, and 84.47% in 5, 10, and 15 years, respectively. The cumulative probabilities of HCC were 0.00%, 3.19%, and 11.56% in 5, 10, and 15 years, respectively. In 247 control subjects, 6 (2.43%) died, none of them developed cirrhosis or HCC. The rates of death, liver cirrhosis, and HCC in hepatitis B patients were markedly different (P<0.005) compared with controls. The overall mortality of hepatitis B patients was 4.50 folds of the general population. Cox multiple regression analysis showed that old age, severe histological injury, and the positive HBeAg were closely related to liver cirrhosis, while old age, severe histological injury, and male were major factors leading to death. The independent variable of predicted HCC was not found.

CONCLUSIONSThe long-term outcome of hepatitis B is poor.

Adolescent ; Adult ; Aging ; physiology ; Carcinoma, Hepatocellular ; epidemiology ; etiology ; Cohort Studies ; Female ; Follow-Up Studies ; Hepatitis B e Antigens ; physiology ; Hepatitis B, Chronic ; complications ; epidemiology ; mortality ; Humans ; Liver Cirrhosis ; epidemiology ; etiology ; Liver Failure ; physiopathology ; Liver Neoplasms ; epidemiology ; etiology ; Male ; Middle Aged ; Regression Analysis ; Retrospective Studies ; Risk Factors ; Sex ; Survival Rate