Objective: To explore the clinical value of von Willebrand Factor (vWF) and VITRO score (vWF:Ag/platelet count) in assessing disease progression in patients with HBV infection. Methods: Randomly collect relevant clinical data of 308 patients with HBV infection (including 154 cases of chronic hepatitis B, 66 cases of hepatitis B cirrhosis in compensatory period, 88 cases of hepatitis B cirrhosis in decompensated period) from December 1, 2018 to January 5, 2021 in the Second Affiliated Hospital of Chongqing Medical University. The vWF values are measured by a uniform optical method, and all data are included using a uniform standard. Analyze the difference and significance of plasma vWF level and VITRO score in chronic hepatitis B, hepatitis B cirrhosis in the compensatory phase and decompensated phase. Results: The plasma vWF level and VITRO score of the chronic hepatitis B group were (139.47±76.44) and (0.86±0.8), respectively, and the hepatitis B cirrhosis compensated group was (164.95±67.12 and 1.44±1.14), respectively. Hepatitis cirrhosis decompensated group were (317.48±103.32 and 6.81±4.98), respectively; plasma vWF level and VITRO score increased with the progression of HBV infection, and the difference was statistically significant (F=133.669,P=0.000F=137.598,P=0.000).The plasma vWF level and VITRO score in patients with hepatitis B cirrhosis were (185.65±85.07 and 2.3±2.37) in the Child-Pugh A group, (304.74±105.81 and 6.37±5.19) in the B grade group, and (369.48±73.238.28±5.38) in the C grade group; plasma vWF level and VITRO score in patients with hepatitis B cirrhosis increased with the increase of Child-Pugh grade, and the difference was statistically significant (F=60.236, P=0.000F=32.854, P=0.000). The area under the curve (AUC) of plasma vWF level and VITRO score for diagnosing the decompensated stage of hepatitis B cirrhosis were 0.897 [95% confidence interval (CI): 0.855-0.940, P＜0.01], 0.949 [95% CI: 0.916-0.982, P＜0.01). When the vWF level and VITRO score were taken as cut-off values of 238.5% and 1.65, respectively, the sensitivity of diagnosing the decompensated stage of hepatitis B cirrhosis was 79.5% and 94.3%, the specificity was 92.3% and 87.7%, and the positive predictive value was 80.5% and 94.3%, the negative predictive value was 91.9% and 97.5%, and the diagnostic accuracy was 88.6% and 89.3%. Among the patients with decompensated hepatitis B cirrhosis, the level of vWF in the group with gastrointestinal bleeding (367.24±68.29)% was significantly higher than that in the group without gastrointestinal bleeding (286.15±109.69)%, and the difference was statistically significant (P＜0.001) The VITRO score of the group with gastrointestinal bleeding (9.12±5.4) was significantly higher than that of the group without gastrointestinal bleeding (5.36±4.13), and the difference was statistically significant (P＜0.01). The vWF level in the spontaneous peritonitis group was (341.73±87.92)% higher than that in the non-spontaneous peritonitis group (296.32±111.74)%, and the difference was statistically significant (P＜0.05). There was no statistical difference in VITRO score between the two groups. significance. Conclusion: Plasma vWF level and VITRO score can evaluate the progression of liver disease and the degree of decompensation of liver cirrhosis in patients with HBV infection, and have a predictive effect on various complications after decompensation of liver cirrhosis, and have certain guiding significance for early intervention measures.
Disease Progression ; Gastrointestinal Hemorrhage/etiology* ; Hepatitis B/complications* ; Hepatitis B virus ; Hepatitis B, Chronic/diagnosis* ; Humans ; Liver Cirrhosis/virology* ; Peritonitis/complications* ; von Willebrand Factor/analysis*

OBJECTIVETo explore the clinical value of serum procalcitonin (PCT) for predicting spontaneous bacterial peritonitis (SBP) in end-stage liver diseases.

METHODSThe clinical data of 362 ascitic inpatients with end-stage liver diseases who had underwent serum PCT assay in our department from March 2011 to June 2013 were analyzed retrospectively. These patients were then divided into SBP group (n=178) and non-SBP group (n=184). The dynamic changes of the PCT values upon admission and after antibiotic treatment were compared. The receiver operating characteristic curve was drawn to identify the optimal cut-off value of serum PCT in diagnosing SBP.

RESULTSThe positive rate of bacteria culture in ascites was only 4.6% (4/87) in SBP group. The median value of serum PCT was 0.73 and 0.15 ng/ml in SBP group and non-SBP group (Z=-11.9, U=0.000), respectively, before antibiotic treatment. In the SBP group, the median value of serum PCT was 1.73 ng/ml in 13 patients with positive culture findings, which was higher than the overall median value in SBP group. Among patients who were responsive to the antibiotic therapy, the median values of serum PCT were 0.40(n=46), 0.32(n=19), and 0.33 ng/ml(n=25), respectively, 3, 5, and 7 days after the effective antibiotics treatment, which were significantly lower than the pre-treatment levels [0.86(Z=-5.91, U=0.000), 0.72(Z=-3.10, U=0.002), and 0.79 ng/ml(Z=-4.37, U=0.000), respectively]. ROC analysis showed that a serum PCT value of more than 0.462 ng/ml had a sensitivity of 83.7% and a specificity of 94.9%(AUC:0.95, 95%CI:0.93-0.97, P=0.00) in diagnosing SBP in patients with end-stage liver diseases.

CONCLUSIONSAscitic fluid positive rate is low in SBP patients. Serum PCT is a sensitive and specific marker for predicting peritoneal bacteria infection in end-stage liver disease patients with ascites. Higher serum PCT can be expected in these patients with heavier infections, it can also be used to evaluate the effectiveness of anti-bacteria therapies.

Adult ; Aged ; Ascitic Fluid ; microbiology ; Bacterial Infections ; complications ; diagnosis ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Female ; Humans ; Liver Diseases ; complications ; Male ; Middle Aged ; Peritonitis ; complications ; diagnosis ; Protein Precursors ; blood ; Retrospective Studies ; Sensitivity and Specificity

Spontaneous bacterial peritonitis (SBP) is the most common infection in liver cirrhosis patients, and is not a result of surgery or intra abdominal infection. Argon plasma coagulation (APC) is an endoscopic procedure used with a high-frequency electrical current for control of bleeding from gastrointestinal vascular ectasias including angiodysplasia and gastric antral vascular ectasia. This procedure is known to be safe because it uses a noncontact method. Therefore, tissue injury is minimal and up to two to three millimeters. However, we experienced a case of SBP occurring immediately after performance of APC for control of severe bleeding from angiodysplasia in the colon in a patient with liver cirrhosis and hepatocellular carcinoma.
Aged ; Angiodysplasia/complications/*diagnosis ; Anti-Bacterial Agents/therapeutic use ; *Argon Plasma Coagulation ; Bacterial Infections/*diagnosis/drug therapy/microbiology ; Carcinoma, Hepatocellular/complications/diagnosis ; Colonic Diseases/complications/*diagnosis ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/therapy ; Gram-Negative Bacteria/isolation & purification ; Humans ; Liver Cirrhosis/complications/diagnosis ; Liver Neoplasms/complications/diagnosis ; Peritonitis/*diagnosis/drug therapy/microbiology

Debates exist about the appropriate treatment for pancreatic trauma in children. We intended to examine the safety of the operation of pancreatic trauma in children. This is a retrospective study of 13 patients, younger than 15, who underwent surgery for pancreatic trauma, between 1993 and 2011 in Seoul National University Children's Hospital. Medical records were reviewed for mechanism of trauma, clinical characteristics, radiological findings, operation and outcomes. Organ injury scaling from the AAST (American Association for Surgery of Trauma) was used. All injuries were caused by blunt trauma. Patients with grade III, IV, and those who were difficult to distinguish grade II from IV, underwent surgery due to severe peritonitis. Three patients with grade II were operated for reasons of mesenteric bleeding, tumor rupture of the pancreas, and progression of peritonitis. Distal pancreatectomy was performed in 10 patients and subtotal pancreatectomy and pylorus preserving pancreaticoduodenectomy in 1 patient each. The remaining one underwent surgical debridement because of severe adhesions. The location of injury, before and after operation, coincided in 83.3%. The degree of injury, before and after the operation, was identical in all the patients except for those who were difficult to tell apart grade II from grade IV, and those cannot be graded due to severe adhesion. Postoperative complications occurred in 23.1%, which improved with conservative treatment. Patients were discharged at mean postoperative 12(range 8~42) days. Even though patients with complications took longer in time from diagnosis to operation, time of trauma to operation and hospital stay, this difference was not significant. In conclusion, When pancreatic duct injury is present, or patient shows deterioration of clinical manifestation without evidence of definite duct injury, or trauma is accompanied by other organ injury or tumor rupture, operative management is advisable, and we believe it is a safe and feasible method of treatment.
Child* ; Debridement ; Diagnosis ; Hemorrhage ; Humans ; Length of Stay ; Medical Records ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Peritonitis ; Postoperative Complications ; Pylorus ; Retrospective Studies ; Rupture ; Seoul

OBJECTIVEThe study aimed to review the treatment and prognosis of acute obstruction of colorectal cancers and to compare different treatment strategies of those cancers, and to evaluate the risk factors affecting perioperative complications.

METHODSClinical data of 184 patients with acute obstruction of colorectal cancer undergone operation were analyzed retrospectively.

RESULTSA total of 184 patients with acute obstruction of colorectal cancer was collected in this study, including 58 patients with proximal and 126 patients of distal colorectal cancers. Perioperative death occurred in 2/58 patients (3.4%) with distal colorectal cancer and 6/126 cases (4.8%) of distal colorectal cancer (P > 0.05). The overall perioperative complications in the two groups were not significantly different (P = 0.794). Among the 58 patients with proximal colorectal cancer, one patient underwent colostomy, but among the 126 patients with distal colorectal cancer, 41 patients underwent colostomy, showing a significant difference between the two groups (P = 0.002). ASA scores (grade 3 - 4), elderly age (≥ 70 years) and colon perforation peritonitis were independent prognostic factors associated with perioperative mortality and morbidity. Patients in the self-expandable metallic stent (SEMS) group had a significantly shorter hospital stay (25.4 ± 8.3) d than that in the emergency surgery group (32.8 ± 16.4) d, (P = 0.039).

CONCLUSIONSEndoscopic stent implantation provides an acceptable modality of palliation for acute proximal large bowel obstruction caused by malignancies. In acute colorectal cancer obstruction, SEMS can provide a minimally invasive management compared with surgical intervention.

Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; complications ; diagnosis ; surgery ; Colostomy ; Endoscopy ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Intestinal Perforation ; etiology ; Intraoperative Complications ; Length of Stay ; Male ; Middle Aged ; Palliative Care ; methods ; Peritonitis ; etiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents ; Young Adult

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) has been known to greatly influence the survival rate of patients with liver cirrhosis. However, the factors that affect the survival rate in patients with SBP need to be clarified. METHODS: This study enrolled 95 liver cirrhosis patients diagnosed with SBP. The laboratory findings of their serum and ascitic fluid were examined and the characteristics of the isolated microorganisms in their peritoneal fluid were analyzed. RESULTS: The proportion of patients with culture-positive SBP was 41.1%, and 47 microorganisms were isolated from the ascitic fluid. The proportions of cultured bacteria that were Gram negative and Gram positive were 57.4% and 40.4%, respectively. The proportions of Escherichia coli, Klebsiella species, and Streptococcus species were 25.5%, 19.1%, and 19.1%, respectively. Enterococcus species represented 12.8% of the microorganisms cultured. The overall survival rates at 6, 12, and 24 months were 44.5%, 37.4%, and 32.2%, respectively. There was no relationship between the bacterial factors and the survival rate in SBP. Multivariate analysis revealed that the presence of hepatocellular carcinoma (HCC; P=0.001), higher serum bilirubin levels (> or =3 mg/dL, P=0.002), a prolonged serum prothrombin time (i.e., international normalized ratio >2.3, P<0.001), renal dysfunction (creatinine >1.3 mg/dL, P<0.001), and lower glucose levels in the ascitic fluid (<50 mg/dL, P<0.001) were independent predictive factors of overall survival rate. CONCLUSIONS: HCC, higher serum bilirubin levels, a prolonged serum prothrombin time, renal dysfunction, and lower ascitic glucose levels are associated with higher mortality rates in cirrhotic patients with SBP.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Ascitic Fluid/metabolism/microbiology ; Bilirubin/blood ; Carcinoma, Hepatocellular/complications/diagnosis ; Creatinine/blood ; Female ; Glucose/analysis ; Gram-Negative Bacteria/isolation & purification ; Gram-Positive Bacteria/isolation & purification ; Humans ; Liver Cirrhosis/complications/*mortality ; Liver Neoplasms/complications/diagnosis ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Peritonitis/complications/*diagnosis/drug therapy ; Prognosis ; Prothrombin Time ; Survival Rate

BACKGROUND: Procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) are inflammatory markers used to diagnose severe bacterial infections. We evaluated the diagnostic role of these markers and compared their accuracy for spontaneous bacterial peritonitis (SBP) associated with chronic severe hepatitis B (CSHB). METHODS: PCT and CRP concentrations, WBC count, and other hematological parameters were measured in serum from 84 well-characterized patients with CSHB, of whom 42 had SBP. Receiver operating characteristics (ROC) curve analysis was performed to assess the diagnostic accuracy. RESULTS: PCT and CRP concentrations were significantly higher in the CSHB patients with SBP (n=42) than CSHB patients without SBP (n=42). PCT and CRP concentrations were more accurate than WBC count for the diagnosis of CSHB-associated SBP. The optimal cutoff value of PCT was 0.48 ng/mL. The PCT concentration was significantly correlated with the CRP concentration and WBC count. CONCLUSIONS: Serum PCT and CRP seems to be better markers than WBC for the diagnosis of CSHB patients with SBP.
Age Factors ; Area Under Curve ; Bacterial Infections/complications/*diagnosis ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Calcitonin/*blood ; Female ; Hepatitis B, Chronic/*complications ; Humans ; Leukocyte Count ; Leukocytes/cytology ; Male ; Middle Aged ; Peritonitis/complications/*diagnosis ; Protein Precursors/*blood ; ROC Curve ; Sex Factors ; Temperature

Selective intestinal decontamination (SID) with norfloxacin has been widely used for the prophylaxis of spontaneous bacterial peritonitis (SBP) because of a high recurrence rate and preventive effect of SID for SBP. However, it does select resistant gut flora and may lead to SBP caused by unusual pathogens such as quinolone-resistant gram-negative bacilli or gram-positive cocci. Enterococcus hirae is known to cause infections mainly in animals, but is rarely encountered in humans. We report the first case of SBP by E. hirae in a cirrhotic patient who have previously received an oral administration of norfloxacin against SBP caused by Klebsiella pneumoniae and presented in septic shock.
Administration, Oral ; Ampicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ascitic Fluid/microbiology ; Enterococcus/*isolation & purification ; Gram-Positive Bacterial Infections/complications/drug therapy/*microbiology ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Peritonitis/*diagnosis/drug therapy/microbiology ; Sepsis/*etiology

OBJECTIVETo investigate the levels of lipopolysaccharide binding protein (LBP) in serum and ascites of cirrhotic patients, and determine their diagnostic value for spontaneous bacterial peritonitis (SBP).

METHODSCirrhotic patients were divided into groups according to diagnosis of SBP, ascites without SBP, no ascites. To explore the significance of LBP in clinically suspect SBP cases, the ascites without SBP group was sub-divided into two groups according to the symptoms of abdominal pain or elevated white blood cell (WBC) count, and abdominal pain combined with elevated WBC count. Two control groups were composed of patients with intraperitoneal pus and a group of healthy, non-cirrhotic individuals. The LBP levels in serum and ascites were determined by enzyme-linked immunosorbent assay (ELISA). The ascites routine, ascites culture and albumin assay were carried out in the Second Affiliated Hospital of Chongqing Medical University. Data between the two groups were compared using the t-test or nonparametric test of independent samples, and the areas under the curve were compared using the Z test. Results The levels of LBP in serum and pus were significantly higher in the intraperitoneal pus group than in the cirrhosis group with ascites (P less than 0.01).

RESULTSThe level of serum LBP was significantly higher in the cirrhosis group with SBP than in the cirrhosis group without SBP but with ascites and the cirrhosis group with no ascites (P less than 0.01). There was no significant difference in the level of ascites LBP in the cirrhosis group with SBP and the cirrhosis group without SBP but with ascites (P more than 0.05). In the clinically suspect cases with SBP, the levels of LBP in serum and ascites were significantly higher than those in the cirrhosis group without SBP but with ascites (228.00 mug/ml vs. 80.95 mug/ml and 22.50 mug/ml vs. 11.45 mug/ml, P less than 0.05). Determination of serum LBP had a higher sensitivity than the determination of ascites LBP or ascites WBC.

CONCLUSIONGram-negative bacteria infection in the intra-abdominal cavity causes serum and body fluid levels of LBP to increase significantly. Patients with cirrhosis complicated with SBP have significantly elevated levels of serum LBP. The serum and ascites LBP levels are significantly elevated in SBP patients with suspected clinical diagnosis. Measurements of both the serum LBP and ascites LBP may have diagnostic value for SBP.

Acute-Phase Proteins ; metabolism ; Adult ; Aged ; Ascites ; diagnosis ; microbiology ; Ascitic Fluid ; chemistry ; Bacterial Infections ; complications ; diagnosis ; Carrier Proteins ; blood ; metabolism ; Case-Control Studies ; Female ; Humans ; Liver Cirrhosis ; complications ; microbiology ; Male ; Membrane Glycoproteins ; blood ; metabolism ; Middle Aged ; Peritonitis ; complications ; diagnosis ; microbiology

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.
Adult ; Anti-Bacterial Agents/therapeutic use ; Ascites/diagnosis/metabolism/therapy ; Ascitic Fluid/chemistry ; Cephalosporins/therapeutic use ; Chlamydia Infections/complications/*diagnosis/drug therapy ; Chlamydia trachomatis/genetics/*isolation & purification ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Peritonitis/*diagnosis/etiology/radiography ; Peritonitis, Tuberculous/diagnosis ; Serum Albumin/metabolism ; Tomography, X-Ray Computed