No abstract available.
Humans ; Liver Cirrhosis/*diagnosis/*mortality ; Liver Diseases/*diagnosis/*mortality ; Prognosis ; Severity of Illness Index ; Survival Rate ; Time Factors

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Liver Diseases ; diagnosis ; mortality ; surgery ; Liver Failure ; mortality ; surgery ; Liver Transplantation ; mortality ; Male ; Middle Aged ; Prognosis ; Risk Factors ; Young Adult

OBJECTIVES: Liver biopsy is an essential tool to confirm suspected diagnosis and to guide specific therapy in patients with liver disease. But, the standard percutaneous needle biopsy is contraindicated in patients with coagulopathy and large amount of ascites. The transjugular approach has been developed for these problem cases, but its efficacy and safety has not been adequately tested in korea. METHODS: We retrospectively analysed 21 transjugular liver biopsy cases, and the success rate of procedure, the adequacy of obtained specimen for diagnosis and procedure related complications were reviewed. RESULTS: The major reasons for trasjugular liver biopsy were coagulopathy(71%) and massive ascites(19%). Liver tissue was obtained successfully in 20 of 21 cases. The mean number of specimens was 3.4+/-1.1 per case and the mean size of specimen was 1.8+/-0.7mm. Pathologists reviewed and judged as adequate for diagnosis in 13 cases(65%), helpful in 6 cases(30%), and inadequate in 1 case. Minor complications such as neck pain, hematoma at puncture site, or transient fever occurred in 5 cases (23.8%) but there was no major complication or procedure-related mortality. CONCLUSION: Transjugular liver biopsy is a safe and valuable technique that provides adequate diagnostic informations in about two thirds of patients for whom conventional percutaneous biopsy is contraindicated.
Ascites ; Biopsy* ; Biopsy, Needle ; Diagnosis ; Fever ; Hematoma ; Humans ; Korea ; Liver Diseases ; Liver* ; Mortality ; Neck Pain ; Punctures ; Retrospective Studies

BACKGROUND/AIMS: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase-associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC). METHODS: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups. RESULTS: Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI. CONCLUSIONS: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.
Acute Kidney Injury ; Azotemia ; Creatinine ; Diagnosis ; Diagnosis, Differential ; Hand ; Hepatorenal Syndrome ; Hospital Mortality ; Humans ; Kidney Tubular Necrosis, Acute ; Lipocalins ; Liver Cirrhosis ; Liver Diseases ; Liver ; Necrosis ; Neutrophils ; Prospective Studies

BACKGROUND/AIMS: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase-associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC).METHODS: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups.RESULTS: Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI.CONCLUSIONS: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.
Acute Kidney Injury ; Azotemia ; Creatinine ; Diagnosis ; Diagnosis, Differential ; Hand ; Hepatorenal Syndrome ; Hospital Mortality ; Humans ; Kidney Tubular Necrosis, Acute ; Lipocalins ; Liver Cirrhosis ; Liver Diseases ; Liver ; Necrosis ; Neutrophils ; Prospective Studies

Clostridium perfringens is an anaerobic, gram-positive rod that inhabits the soil and the intestinal tracts of many animals, including humans. C. perfringens is a major cause of food poisoning, traumatic or nontraumatic myonecrosis, clostridial cellulitis, gangrenous cholecystitis, sepsis or bacteremia, and intravascular hemolysis. Massive intravascular hemolysis is a rare complication of C. perfringens septicemia and has a high mortality rate with an extremely rapid progression. Therefore, aggressive treatment is required as soon as the diagnosis is made. In this study, we report a case of massive intravascular hemolysis due to C. perfringens septicemia in a 34-year-old man with liver cirrhosis.
Adult ; Animals ; Bacteremia ; Cellulitis ; Cholecystitis ; Clostridium perfringens ; Diagnosis ; Foodborne Diseases ; Hemolysis* ; Humans ; Liver Cirrhosis ; Mortality ; Sepsis* ; Soil

BACKGROUND/AIMS: Hepatic or splenic lesions in hematologic patients are not defined well because they are not easy to evaluate due to limitations of invasive procedures. Management typically depends on the clinical diagnosis with few microbiological data. METHODS: We reviewed the medical records of consecutive hematologic patients with hepatic or splenic lesions in the infectious diseases unit from April 2009 to December 2010 at the Catholic Hematopoietic Stem Cell Transplantation Center in Korea. RESULTS: Twenty-six patients were identified. Their mean age was 46.0 +/- 14.7 years, and 16 (61.5%) were male. Underlying diseases were acute myelogenous leukemia (n = 15, 57.7%) and myelodysplastic syndrome (n = 6, 23.1%). Among the nine nontuberculous infectious lesions, two bacterial, six fungal, and one combined infection were identified. The numbers of confirmed, probable, and possible tuberculosis (TB) cases were one, three, and four, respectively. Two patients had concurrent pulmonary TB. QuantiFERON-TB Gold In-Tube (QFT-GIT, Cellestis Ltd.) was positive in seven cases, among which six were diagnosed with TB. The sensitivity and specificity of QFT-GIT were 75% and 81.3%. Nine (34.6%) were defined as noninfectious causes. CONCLUSIONS: Causes of hepatic or splenic lesion in hematologic patients were diverse including TB, non-TB organisms, and noninfectious origins. TB should be considered for patients not responding to antibacterial or antifungal drugs, even in the absence of direct microbiological evidence. QFT-GIT may be useful for a differential diagnosis of hepatosplenic lesions in hematologic patients.
Abscess/*diagnosis/microbiology/mortality/therapy ; Adult ; Anti-Infective Agents/therapeutic use ; Chi-Square Distribution ; Female ; Hematologic Diseases/*complications/mortality ; Humans ; *Interferon-gamma Release Tests ; Liver Abscess/*diagnosis/microbiology/mortality/therapy ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Splenic Diseases/*diagnosis/microbiology/mortality/therapy ; Time Factors ; Tuberculosis/*diagnosis/microbiology/mortality/therapy

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

Alcoholic liver disease (ALD) is a leading cause of cirrhosis, liver cancer, and acute and chronic liver failure and as such causes significant morbidity and mortality. While alcohol consumption is slightly decreasing in several European countries, it is rising in others and remains high in many countries around the world. The pathophysiology of ALD is still incompletely understood but relates largely to the direct toxic effects of alcohol and its main intermediate, acetaldehyde. Recently, novel putative mechanisms have been identified in systematic scans covering the entire human genome and raise new hypotheses on previously unknown pathways. The latter also identify host genetic risk factors for significant liver injury, which may help design prognostic risk scores. The diagnosis of ALD is relatively easy with a panel of well-evaluated tests and only rarely requires a liver biopsy. Treatment of ALD is difficult and grounded in abstinence as the pivotal therapeutic goal; once cirrhosis is established, treatment largely resembles that of other etiologies of advanced liver damage. Liver transplantation is a sound option for carefully selected patients with cirrhosis and alcoholic hepatitis because relapse rates are low and prognosis is comparable to other etiologies. Still, many countries are restrictive in allocating donor livers for ALD patients. Overall, few therapeutic options exist for severe ALD. However, there is good evidence of benefit for only corticosteroids in severe alcoholic hepatitis, while most other efforts are of limited efficacy. Considering the immense burden of ALD worldwide, efforts of medical professionals and industry partners to develop targeted therapies in ALF has been disappointingly low.
Acetaldehyde ; Adrenal Cortex Hormones ; Alcohol Drinking ; Alcoholics* ; Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; End Stage Liver Disease ; Fibrosis ; Genome, Human ; Hepatitis, Alcoholic ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases, Alcoholic* ; Liver Transplantation ; Malnutrition ; Mortality ; Prognosis ; Recurrence ; Risk Factors ; Tissue Donors

Hemophagocytic lymphohistiocytosis (HLH) is a condition caused by excessive activation and expansion of T lymphocytes and macrophagic histiocytes that exhibit hemophagocytic activity. It is a life-threatening condition, and the reported mortality rates reach 20% to 30%. It is usually associated with infection, malignancy, or autoimmune disease, but rarely with rheumatoid arthritis (RA). We recently experienced a case of HLH with rapid progression resulting in mortality in a 38-year-old female patient with long-standing RA. She visited the clinic for evaluation of a common cold-like illness. She had hypotension, liver enzyme elevation, and pancytopenia. After admission, her hypotension continued and disseminated intravascular coagulation and metabolic acidosis developed and progressed with the appearance of azotemia. Despite supportive management, she died on the fifth hospital day. HLH should be considered as a differential diagnosis when patients with RA show acute illness with fever, cytopenia, hepatic failure, and coagulopathy.
Acidosis ; Adult ; Arthritis ; Arthritis, Rheumatoid* ; Autoimmune Diseases ; Azotemia ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Female ; Fever ; Histiocytes ; Humans ; Hypotension ; Liver ; Liver Failure ; Lymphohistiocytosis, Hemophagocytic* ; Mortality ; Pancytopenia ; T-Lymphocytes