ABSTRACT
Liver transplantation (LT) is a lifesaving treatment. Because of the shortage of donor organs, some patients will not survive long enough to receive a transplant. The identification of LT candidates at increased risk of short-term mortality without transplantation may affect listing decisions. Functional capacity, determined with cardiopulmonary exercise testing (CPET), is a measure of cardiorespiratory reserve and predicts perioperative outcomes. This study examined the association between functional capacity and short-term survival before LT and the potential for CPET to predict 90-day mortality without transplantation. A total of 176 patients who were assessed for nonacute LT underwent CPET. Ninety days after the assessment, 10 of the 164 patients who had not undergone transplantation were deceased (mortality rate = 6.1%). According to a comparison of survivors and nonsurvivors, the Model for End-Stage Liver Disease score, UK Model for End-Stage Liver Disease (UKELD) score, age, anaerobic threshold, and peak oxygen uptake (VO(2)) were significant univariate predictors of 90-day mortality without transplantation, but only the UKELD score and peak VO(2) retained significance in a multivariate analysis. The mean peak VO(2) was significantly lower for nonsurvivors versus survivors (15.2 ± 3.3 versus 21.2 ± 5.3 mL/minute/kg, P < 0.001). According to a receiver operating characteristic (ROC) curve analysis, peak VO(2) performed well as a diagnostic test (area under the ROC curve = 0.84, 95% confidence interval = 0.76-0.92, sensitivity = 0.90, specificity = 0.74, P < 0.001). The optimal cutoff value for predicting mortality was ≤17.6 mL/minute/kg. The positive predictive value of a peak VO(2) ≤ 17.6 mL/minute/kg for 90-day mortality was greatest for patients with high UKELD scores: 38% of the patients with a UKELD score ≥ 57 and a peak VO(2) ≤ 17.6 mL/minute/kg died, whereas only 6% of the patients with a UKELD score ≥ 57 and a peak VO(2) > 17.6 mL/minute/kg died (P = 0.03). In conclusion, patients assessed for LT with an impaired functional capacity have poorer short-term survival; this is particularly true for individuals with worse liver disease severity.
Subject(s)
End Stage Liver Disease/mortality , Health Status , Liver Transplantation , Oxygen Consumption , Waiting Lists/mortality , Adult , Aged , Area Under Curve , End Stage Liver Disease/diagnosis , End Stage Liver Disease/physiopathology , End Stage Liver Disease/surgery , England , Exercise Test , Female , Humans , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , ROC Curve , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time FactorsABSTRACT
The novel coronavirus-related coronavirus disease 2019 (COVID-19) pandemic has been relentless in disrupting and overwhelming healthcare the world over. Clinical outcomes of COVID-19 in patients with chronic comorbidities, especially in those with metabolic syndrome, are well documented. Chronic liver disease and cirrhosis patients are a special sub-group, among whom the management of COVID-19 is challenging. Understanding the pathophysiology of COVID-19 in patients with cirrhosis and portal hypertension improves our identification of at-risk patients for disease progression that will further help compartmentalize generalized and specialized treatment options in this special patient group. In this exhaustive review, we critically review the impact of COVID-19 on the liver and in chronic liver disease and cirrhosis patients. We further discuss common features associated with the pathophysiology of COVID-19 and cirrhosis, based on the renin-angiotensin system and deliberate current literature on guidelines for the treatment of COVID-19 and extrapolate the same to the cirrhosis population to provide a concise and stepwise, evidence-based management for cirrhosis patients with severe and critical COVID-19. There are no specific management guidelines for cirrhosis patients with COVID-19 and current recommendations for treatment are as per guidelines for general population. Nevertheless, specific issues like avoiding corticosteroids in decompensated patients with variceal bleeding, suspected sepsis, high grade hepatic encephalopathy and acute kidney injury, use of early mechanical ventilation strategies in those with severe ascites and hepatopulmonary syndrome, avoidance of remdesivir in advanced liver disease, and application of liver-specific severity scores for prognostication and identification of futility need to be highlighted.
ABSTRACT
Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy. Physical examination revealed abdominal tenderness and distension with shifting dullness. Urticarial skin rash was noted on the face, neck, chest and abdomen. Routine biochemistry was normal apart from peripheral eosinophilia. Imaging confirmed moderate ascites. Diagnostic paracentesis showed exudative ascites with numerous eosinophils. Histology of the upper and lower gastrointestinal tract showed infiltration of the oesophageogastroduodenal and rectosigmoid mucosa with eosinophils. The patient significantly improved following a course of steroids and six-food elimination diet.
Subject(s)
Ascites/diagnosis , Eosinophilia/diagnosis , Gastroenteritis/diagnosis , Abdominal Pain/etiology , Adult , Ascites/complications , Diarrhea/etiology , Eosinophilia/complications , Female , Gastroenteritis/etiology , Gastrointestinal Tract/pathology , Humans , Paracentesis/methods , Postpartum Period , Vomiting/etiologyABSTRACT
OBJECTIFS : La symptomatologie du bas appareil urinaire [SBAU] a fait l'objet de nombreuses etudes dans beaucoup de pays mais tres peu dans notre milieu. Le but de cette etude etait d'evaluer la prevalence de la SBAU dans notre milieu ainsi que la pathologie tumorale prostatique associee. MeTHODES : Il s'agit d'une etude transversale realisee a l'occasion d'une campagne de depistage volontaire des tumeurs prostatiques. Les parametres etudies etaient l'age des patients; le statut professionnel; le score IPSS; le score de gene; le resultat du toucher rectal et le celui des dosages de PSA. etait considere porteur d'une HBP symptomatique tout patient avec un score IPSS superieur a 8; un score de gene superieur ou egal a 3 et une HBP au toucher rectal. Tous les patients avec un toucher rectal suspect et ou des PSA eleves beneficiaient d'une biopsie prostatique. Nous avons enfin note la prise en charge.ReSULTATS : Nous avions recrute 329 patients ages de 45 a 79 ans [moyenne 56 ans]. La moyenne d'age des patients porteurs d'une hypertrophie benigne de la prostate etait de 61.6 ans. 181 patients [56.9] avaient un score IPSS jugee moderee a severe; 200 patients [60;8] avaient un score de gene superieur a 3. Il y avait une correlation entre l'IPSS et l'age; l'IPSS et le score de gene. 184 patients etaient porteurs d'une HBP dont 118 avaient une HBP symptomatique parmi lesquels 17 avaient ete operes; 66 avaient eu un traitement medical et 35 avaient ete perdus de vue. 10 patients avaient un cancer de la prostate. CONCLUSION : La SBAU de l'homme est frequente dans notre milieu. Elle survient dans une population plus jeune que celle decrite dans la litterature. Peu de patients en parlent a leur Medecin malgre les risques de complications pouvant grever le pronostic vital. Il est par consequent important d'informer les patients et de sensibiliser les medecins sur la SBAU et les pathologies associees