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1.
Medicine (Baltimore) ; 100(16): e25535, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879696

RESUMO

OBJECTIVE: The effect of probiotics on cognitive function and the risk of falling in cirrhosis patients have not been previously evaluated. We perform this protocol for systematic review and meta-analysis to evaluate the effect of a multistrain probiotic on cognitive function and the risk of falls in patients with cirrhosis. METHODS: An all-round retrieval will be performed in 5 electronic journal databases from their inception to March 2021, which comprise Medline, Pubmed, Embase, ScienceDirect, and the Cochrane Library by 2 independent reviewers. Data extraction was performed independently, and any conflict was resolved before final analysis. Only randomized clinical trials were included in this study. The main endpoints were cognitive function and risk of falls, and the secondary endpoints were fall incidence, health-related quality of life (HRQOL), systemic inflammatory response, gut barrier, bacterial translocation, and fecal microbiota. The risk of bias assessment of the included studies was performed by 2 authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: We hypothesized that the multistrain probiotic improved cognitive function, risk of falls, and inflammatory response in patients with cirrhosis and cognitive dysfunction. CONCLUSION: This study expects to provide credible and scientific clinical evidence for the efficacy and safety of a multistrain probiotic on cognitive function and the risk of falls in patients with cirrhosis. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/JKMTP.


Assuntos
Acidentes por Quedas/prevenção & controle , Disfunção Cognitiva/prevenção & controle , Cirrose Hepática/psicologia , Cirrose Hepática/terapia , Probióticos/uso terapêutico , Cognição , Disfunção Cognitiva/microbiologia , Feminino , Humanos , Cirrose Hepática/microbiologia , Masculino , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Fatores de Risco , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
South Med J ; 114(3): 186-191, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33655314

RESUMO

Frailty is a dynamic condition that results in increased vulnerability to health stressors. Often associated with older adults, frailty is not limited to the geriatric population, although aging and disease burden often go hand in hand. This syndrome is recognized increasingly as an important factor in healthcare costs, rate of adverse outcomes, and overall resource utilization. Frailty may be reversible to a degree, and thus appropriate recognition affords a focus for efficient intervention. Notably, frailty is becoming increasingly relevant in cirrhosis, and has been noted to be an independent predictor of outcomes in patients both before and after liver transplantation. Cirrhosis is currently the 12th leading cause of death in the United States, and its incidence is anticipated to markedly increase in the coming years with the aging of our population. With the anticipated surge in disease prevalence, liver disease care will likely shift from specialist-driven to a multidisciplinary approach between primary care physicians, internists, and hepatologists to adequately care for these patients. This review serves as a guide for clinicians to learn about frailty, its role in cirrhosis, and the current tools to educate patients and families about the importance of nutrition and physical exercise within this population.


Assuntos
Fragilidade/complicações , Gastroenterologia/métodos , Cirrose Hepática/complicações , Equipe de Assistência ao Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Exercício Físico , Feminino , Fragilidade/mortalidade , Fragilidade/terapia , Humanos , Incidência , Cirrose Hepática/mortalidade , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Terapia Nutricional , Prevalência
3.
Medicine (Baltimore) ; 100(9): e24587, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655924

RESUMO

BACKGROUND: Assessing the effectiveness and safety of traditional Chinese medicine on liver fibrosis is the main purpose of this systematic review protocol. METHODS: The following electronic databases will be searched from their respective inception dates to 1st December 2021: PubMed, MEDLINE, the Cochrane Library, Embase, WorldSciNet, Ovid, the Allied and Complementary Medicine Database, the Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database, the Wanfang Database, and the China Biology Medicine Disc. All published randomized controlled trials in English or Chinese related to curative effects of Traditional Chinese medicine on liver fibrosis will be included. The primary outcome is the levels of serum hyaluronic acid, laminin, type III procollagen, and type IV procollagen. There is no secondary outcomes. Two reviewers will conduct the study selection, data extraction, and assessment independently. The assessment of risk of bias and data synthesis will be conducted with Review Manager Software V.5.2. RESULTS: The results will provide a high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION: The conclusion of our study will provide an evidence to judge whether traditional Chinese medicine is an effective intervention for patients with liver fibrosis. REGISTRATION NUMBER: INPLASY202110017.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Cirrose Hepática/terapia , Medicina Tradicional Chinesa/métodos , Adulto , Colágeno Tipo III/sangue , Colágeno Tipo IV/sangue , Feminino , Humanos , Ácido Hialurônico/sangue , Laminina/sangue , Cirrose Hepática/sangue , Masculino , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
N Engl J Med ; 384(9): 808-817, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33657293

RESUMO

BACKGROUND: Infection and increased systemic inflammation cause organ dysfunction and death in patients with decompensated cirrhosis. Preclinical studies provide support for an antiinflammatory role of albumin, but confirmatory large-scale clinical trials are lacking. Whether targeting a serum albumin level of 30 g per liter or greater in these patients with repeated daily infusions of 20% human albumin solution, as compared with standard care, would reduce the incidences of infection, kidney dysfunction, and death is unknown. METHODS: We conducted a randomized, multicenter, open-label, parallel-group trial involving hospitalized patients with decompensated cirrhosis who had a serum albumin level of less than 30 g per liter at enrollment. Patients were randomly assigned to receive either targeted 20% human albumin solution for up to 14 days or until discharge, whichever came first, or standard care. Treatment commenced within 3 days after admission. The composite primary end point was new infection, kidney dysfunction, or death between days 3 and 15 after the initiation of treatment. RESULTS: A total of 777 patients underwent randomization, and alcohol was reported to be a cause of cirrhosis in most of these patients. A median total infusion of albumin of 200 g (interquartile range, 140 to 280) per patient was administered to the targeted albumin group (increasing the albumin level to ≥30 g per liter), as compared with a median of 20 g (interquartile range, 0 to 120) per patient administered to the standard-care group (adjusted mean difference, 143 g; 95% confidence interval [CI], 127 to 158.2). The percentage of patients with a primary end-point event did not differ significantly between the targeted albumin group (113 of 380 patients [29.7%]) and the standard-care group (120 of 397 patients [30.2%]) (adjusted odds ratio, 0.98; 95% CI, 0.71 to 1.33; P = 0.87). A time-to-event analysis in which data were censored at the time of discharge or at day 15 also showed no significant between-group difference (hazard ratio, 1.04; 95% CI, 0.81 to 1.35). More severe or life-threatening serious adverse events occurred in the albumin group than in the standard-care group. CONCLUSIONS: In patients hospitalized with decompensated cirrhosis, albumin infusions to increase the albumin level to a target of 30 g per liter or more was not more beneficial than the current standard care in the United Kingdom. (Funded by the Health Innovation Challenge Fund; ATTIRE EudraCT number, 2014-002300-24; ISRCT number, N14174793.).


Assuntos
Albuminas/uso terapêutico , Cirrose Hepática/terapia , Albumina Sérica , Adulto , Albuminas/administração & dosagem , Albuminas/efeitos adversos , Ascite/etiologia , Ascite/terapia , Feminino , Hospitalização , Humanos , Infusões Intravenosas , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Cirrose Hepática Alcoólica/sangue , Cirrose Hepática Alcoólica/terapia , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/etiologia , Falha de Tratamento
5.
Scand J Gastroenterol ; 56(4): 453-457, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33590789

RESUMO

OBJECTIVES: Coronavirus disease 2019 (COVID-19) is an ongoing major health emergency, but its occurrence and clinical impact on patients withliver cirrhosis is unknown. Therefore, we conducted a population-based study of 2.6 million Danish citizens investigating the occurrence and impact of COVID-19 in patients with liver cirrhosis. MATERIALS AND METHODS: A prospective population-based cohort study was conducted in the Capital Region of Denmark and Region Zealand in the study period between 1 March 2020 up until 31 May 2020, with the only eligibility criteria being a reverse-transcriptase polymerase chain reaction for presence of viral genomic material confirming COVID-19. The patients were subsequently stratified according to presence of pre-existing liver cirrhosis. RESULTS: Among 575,935 individuals tested, 1713 patients had a diagnosis of cirrhosis. COVID-19 occurredsignificantly lessamongpatients with cirrhosis (n = 15; 0.9%, p < .01) compared with the population without cirrhosis (n = 10,593; 1.8%). However, a large proportion (n = 6;40.0%) required a COVID-19 related hospitalization which was correlated with higher values of alanine aminotransferase (p < .01) and lactate dehydrogenase (p = .04). In addition, one-in-three (n = 2; 13.3%) required intensive therapy. Four patients died (26.7%) and mortality was associated with higher MELD scores, co-existing type 2 diabetes, and bacterial superinfections. CONCLUSION: In conclusion, patientswith cirrhosis may have a lower risk of COVID-19; but a higher risk of complications hereto and mortality.


Assuntos
Cirrose Hepática , Testes de Função Hepática , /isolamento & purificação , Alanina Transaminase/sangue , /prevenção & controle , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , L-Lactato Desidrogenase/sangue , Cirrose Hepática/sangue , Cirrose Hepática/epidemiologia , Cirrose Hepática/terapia , Testes de Função Hepática/métodos , Testes de Função Hepática/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade , Medição de Risco , Fatores de Risco
6.
Rinsho Ketsueki ; 62(1): 20-24, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33551420

RESUMO

Patients with refractory ascites that develops >3 months after allogenic stem cell transplantation typically have a poor prognosis. We present the case of a 61-year-old man who developed refractory massive ascites approximately 3 months after cord blood transplantation (CBT) and showed complete and spontaneous remission from ascites after 18 months. The patient complained of severe bloating and needed weekly paracentesis to manage the fluid levels. Laboratory tests indicated that the ascites was caused by liver fibrosis. After the patient underwent Keisuke-Matsusaki cell-free and concentrated ascites reinfusion therapy (KM-CART), we were able to decrease the frequency of paracentesis treatments. We planned a transjugular liver biopsy, but the patient contracted pneumocystis pneumonia before the procedure could be performed. Although the pneumonia improved, the ascites worsened again. However, weekly paracentesis spontaneously stopped the progression of ascites and eventually resolved it completely, resulting in the patient's survival.


Assuntos
Ascite , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Leucemia Mieloide Aguda , Ascite/etiologia , Ascite/terapia , Humanos , Leucemia Mieloide Aguda/terapia , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Paracentese
7.
BMC Infect Dis ; 21(1): 29, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413185

RESUMO

BACKGROUND: Serum levels of procalcitonin (PCT) are considered a useful biomarker for the diagnosis of bacterial infection or inflammation. There are few reports of high PCT levels in end-stage liver disease regardless of bacterial infection. Here, we present a case of extremely high PCT levels (> 100 ng/mL) in a patient with severe cirrhosis combined with hepatic carcinoma. CASE PRESENTATION: A 65-year-old man developed end-stage cirrhosis with hepatic carcinoma. Radiographic imaging showed a massive hepatocellular carcinoma with multiple loci lack of indications of resection. Hence, transcatheter hepatic arterial chemoembolization was performed three times over a period of 4 months. Before and after interventional therapies, the biochemistry laboratory results were only slightly abnormal except for persistently high PCT concentrations (> 100 ng/mL), irrespective of the evidence for bacterial infection or sepsis. CONCLUSIONS: This case suggests that continuously high levels of PCT (> 100 ng/mL) may be present in advanced liver disease, particularly in complex situations such as decompensated cirrhosis and liver cancer, in the absence of severe infection or sepsis. This knowledge could expand the significance of PCT in liver disease.


Assuntos
Biomarcadores/sangue , Carcinoma Hepatocelular/sangue , Cirrose Hepática/sangue , Neoplasias Hepáticas/sangue , Pró-Calcitonina/sangue , Idoso , Infecções Bacterianas/diagnóstico , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Doença Hepática Terminal/sangue , Doença Hepática Terminal/patologia , Doença Hepática Terminal/terapia , Humanos , Cirrose Hepática/patologia , Cirrose Hepática/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , Sepse/diagnóstico
9.
J Biol Regul Homeost Agents ; 35(1): 25-33, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33472728

RESUMO

We aimed to explore the effects of probiotics on intestinal flora, inflammation and degree of liver cirrhosis in rats with liver cirrhosis, and to verify the Wnt/ß-catenin signaling pathway that regulates this process. A total of 30 SD rats were randomly divided into 3 groups, namely, control group (n=10), model group (n=10) and probiotic group (n=10). Rats in the model group were used to construct liver cirrhosis models using carbon tetrachloride (CCL4) method, and those in the probiotic group were administered with probiotic preparations by gavage for 8 weeks. Then the feces of rats in each group were taken to detect the composition of intestinal flora, and changes in the content of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein 1 (MCP-1) and interferon-gamma (IFN-γ), in peripheral blood collected were examined by enzyme-linked immunosorbent assay (ELISA). Next, changes in the degree of liver cirrhosis were analyzed by hematoxylin and eosin (H&E) staining, and the expression levels of the Wnt/ß-catenin signaling pathway-related molecules, including ß-catenin, glycogen synthase kinase (GSK)-3ß and Frizzled-2, in liver tissues in each group were detected via polymerase chain reaction (PCR) and Western blotting (WB). Compared with rats in the control group, those in the model group had a disordered structure of hepatic lobule and hyperplasia of a large number of fibrous tissues. In contrast to those in the model group, the liver lobule structure was greatly improved, the edema cells were obviously reduced, and the hyperplasia of collagen fibers was remarkably alleviated in the probiotic group. Moreover, the degree of liver cirrhosis in the probiotic group was significantly reduced compared with that in the model group. Moreover, the rats in the model group exhibited a higher Bifidobacterium level in the intestinal tract, while those in the probiotic group displayed higher levels of microorganisms in the intestinal tract, such as Lachnospiraceae, Ruminococcaceae, Actinbacteria, Slackia and Pasteurellaceae. In comparison with that in the control group, the level of salt-tolerant Lactobacillus in the intestinal tract of rats in the model group was significantly decreased, while that in the probiotic group was partially increased (P=0.023). Meanwhile, some intestinal flora of rats in the control group, model group and probiotic group were closely correlated. Specifically, highly positive correlations were found between Bacteroidetes and Paraeggerthella (r=0.423, P=0.034) and between Firmicutes and Lactobacillus (r=0.318, P=0.027), but strongly negative associations were detected between Firmicutes and Paraeggerthella (r=-0.691, p=0.004) and between Paraeggerthella and Lactobacillus (r=-0.384, P=0.047). In addition, the levels of inflammatory cytokines TNF-α IL-6, MCP-1 and IFN-γ in the plasma of rats in the model group were markedly higher than those in the control group (P<0.05), whereas such levels in the probiotic group were decreased compared with those in the model group (P<0.05). PCR results revealed that the expression levels of ß-catenin and Frizzled-2 in the model group were higher than those in the control group, whereas they were lower in the probiotic group than those in the model group (P<0.05). Furthermore, the model group had a decreased level of GSK-3ß in comparison with the control group, but the probiotic group had a higher level of GSK-3ß than the model group (P<0.05). WB results were consistent with PCR results. Probiotics can affect intestinal flora, inflammation and degree of liver cirrhosis in rats with liver cirrhosis, and its mechanism may be related to the Wnt/ß-catenin signaling pathway.


Assuntos
Microbioma Gastrointestinal , Cirrose Hepática , Probióticos , Animais , Glicogênio Sintase Quinase 3 beta/genética , Inflamação , Cirrose Hepática/terapia , Ratos , Ratos Sprague-Dawley , Via de Sinalização Wnt , beta Catenina
12.
Arch Med Res ; 52(1): 25-37, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33334622

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, with an estimated rising prevalence, in concert with the epidemics of obesity and type 2 diabetes. The pathogenesis of NAFLD is not fully elucidated. Besides weight gain and insulin resistance, many other factors seem to contribute, including adipokines, gut microbiota and genetic predisposition. The disease starts as hepatic steatosis, which may proceed to nonalcoholic steatohepatitis (NASH); if fibrosis is added, the risk of cirrhosis and/or hepatocellular carcinoma is augmented. Liver biopsy is considered the gold standard for the diagnosis and staging of NAFLD; the early use of reliable and easily applied diagnostic tools, such as noninvasive biomarkers, is needed to identify patients at different-preferably early-stages of disease however. Whilst lifestyle modification is the first step to manage NAFLD, there is poor compliance, leading to the need of drug therapy. Accordingly, a variety of medications is under investigation. Given the multifaceted pathophysiology of NAFLD, probably, a combination of approaches in an individualized basis may be a more appropriate management. This review summarizes evidence on the epidemiology, pathogenesis, diagnosis and treatment of NAFLD.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Biomarcadores/análise , Biomarcadores/sangue , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Humanos , Estilo de Vida , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Cirrose Hepática/etiologia , Cirrose Hepática/terapia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/terapia , Prevalência , Fatores de Risco , Terapias em Estudo/métodos , Terapias em Estudo/tendências
13.
Int J Mol Sci ; 21(24)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33348908

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is a continuum of liver abnormalities often starting as simple steatosis and to potentially progress into nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis and hepatocellular carcinoma. Because of its increasing prevalence, NAFLD is becoming a major public health concern, in parallel with a worldwide increase in the recurrence rate of diabetes and metabolic syndrome. It has been estimated that NASH cirrhosis may surpass viral hepatitis C and become the leading indication for liver transplantation in the next decades. The broadening of the knowledge about NASH pathogenesis and progression is of pivotal importance for the discovery of new targeted and more effective therapies; aim of this review is to offer a comprehensive and updated overview on NAFLD and NASH pathogenesis, the most recommended treatments, drugs under development and new drug targets. The most relevant in vitro and in vivo models of NAFLD and NASH will be also reviewed, as well as the main molecular pathways involved in NAFLD and NASH development.


Assuntos
Modelos Animais de Doenças , Fibrose/patologia , Cirrose Hepática/patologia , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/complicações , Animais , Progressão da Doença , Fibrose/etiologia , Fibrose/terapia , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/terapia
14.
Rev. esp. enferm. dig ; 112(11): 826-831, nov. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198765

RESUMO

INTRODUCCIÓN: la calidad de la asistencia prestada a los pacientes cirróticos se puede medir analizando una serie de indicadores. Los estudios publicados hasta la actualidad muestran una tasa de adherencia a las indicaciones de las guías clínicas del 40-80 %. OBJETIVO: valorar la calidad de la asistencia prestada en un hospital docente de tercer nivel. MÉTODOS: estudio observacional retrospectivo en pacientes cirróticos controlados durante un semestre en consultas externas. Se han revisado 324 historias clínicas recogiendo 14 indicadores de calidad de cinco dominios diferentes y se ha estudiado la adherencia global y en relación a la experiencia del médico responsable. RESULTADOS: excelentes (más del 90 % de adherencia) en indicadores relacionados con documentación de la etiología de la cirrosis y profilaxis de la hemorragia digestiva por varices; aceptables (60-90 %) en despistaje del carcinoma hepatocelular y valoración de la gravedad de la enfermedad; y malos (menos del 50 %) en vacunaciones. Los residentes obtuvieron significativamente mejores resultados que los adjuntos en etiología, valoración de la gravedad y dos indicadores de profilaxis de hemorragia digestiva. Por su parte, los adjuntos presentaron mejores resultados en el despistaje de carcinoma hepatocelular. CONCLUSIONES: a pesar de haber obtenido excelentes resultados en algunos indicadores, muchos deben ser mejorados, especialmente las vacunaciones. La calidad asistencial prestada por los residentes es igual o incluso mejor que la prestada por los adjuntos. Analizar la calidad asistencial es esencial para medir y mejorar la atención prestada a los pacientes cirróticos, y puede ser una herramienta muy eficaz para supervisar a los especialistas en formación


No disponible


Assuntos
Humanos , Masculino , Feminino , Qualidade da Assistência à Saúde/estatística & dados numéricos , Cirrose Hepática/terapia , Estudos Retrospectivos , Atenção Terciária à Saúde , Garantia da Qualidade dos Cuidados de Saúde , Estatísticas não Paramétricas , Cirrose Hepática/diagnóstico por imagem , Ultrassonografia , Endoscopia , Índice de Gravidade de Doença , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia
17.
PLoS One ; 15(9): e0238712, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915828

RESUMO

BACKGROUND AND AIMS: The Veterans Health Administration (VA) cares for over 80,000 Veterans with cirrhosis annually. Given the importance of understanding patient reported outcomes in this complex population, we aimed to assess the associations between attitudes towards care, disease knowledge, and health related quality of life (HRQoL) in a national sample. METHODS: In this cross-sectional study, we mailed paper surveys to a random sample of Veterans with cirrhosis, oversampling those with decompensated disease. Surveys included the Veterans RAND 12-Item Health Survey (measuring HRQoL) and questions about demographics, characteristics of care, satisfaction with care ("attitudes towards care"), and symptoms of cirrhosis. Those who reported being "unsure" about whether they had decompensation events were defined as "unsure about cirrhosis symptoms" ("disease knowledge"). We used multivariable regression models to assess the factors associated with HRQoL. RESULTS: Of 1374 surveys, 551 (40%) completed surveys were included for analysis. Most Veterans (63%) were "satisfied" or "very satisfied" with VA liver care. Patients often self-reported being unsure about whether they had experienced hepatic decompensation events (34%). Overall average physical (PCS) and mental (MCS) component scores of HRQoL were 30±11 and 41±12. In multivariable regression models, hepatic decompensation (PCS:ß = -3.8, MCS:ß = -2.2), medical comorbidities (ß = --2.0, ß = -1.7), and being unsure about cirrhosis symptoms (ß = -1.9, ß = -3.3) were associated with worse HRQoL, while age (ß = 0.1, ß = 0.2) and satisfaction with care (ß = 0.6; ß = 1.6) were associated with significantly better HRQoL. CONCLUSIONS: Hepatic decompensation, lower satisfaction with care, and being unsure about cirrhosis symptoms were associated with reduced QOL scores in this national cohort.


Assuntos
Depressão/epidemiologia , Cirrose Hepática/epidemiologia , Serviços de Saúde para Veteranos Militares , Veteranos , Idoso , Ascite/patologia , Estudos Transversais , Depressão/patologia , Feminino , Humanos , Cirrose Hepática/patologia , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Pacientes , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários
18.
Rev Med Suisse ; 16(701): 1462-1465, 2020 Aug 05.
Artigo em Francês | MEDLINE | ID: mdl-32833370

RESUMO

Decompensated cirrhosis corresponds to the end stage of chronic liver disease. It is associated with poor outcomes, in particular, in patients who are not candidate for a liver transplantation. Those patients require frequent hospital admissions to manage complications. In those situations, the adequacy of a potential intensive care unit admission is regularly discussed among care providers. This article reviews elements to be considered in such situations: available tools, decision timing and modulating factors such as trigger for admission.


Assuntos
Cuidados Críticos , Hospitalização , Unidades de Terapia Intensiva , Cirrose Hepática/terapia , Transplante de Fígado , Humanos , Cirrose Hepática/cirurgia
19.
J Vasc Interv Radiol ; 31(9): 1382-1391.e2, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32792277

RESUMO

PURPOSE: To investigate from a population health perspective the effects of transjugular intrahepatic portosystemic shunt (TIPS) creation on recurrent variceal bleeding and survival in patients with cirrhosis. MATERIALS AND METHODS: Patients with cirrhosis who presented to outpatient and acute-care hospitals in California (2005-2011) and Florida (2005-2014) with variceal bleeding comprised the study cohort. Patients entered the study cohort at their first presentation for variceal bleeding; all subsequent hospital encounters were then evaluated to determine subsequent interventions, complications, and mortality data. RESULTS: A total of 655,577 patients with cirrhosis were identified, of whom 42,708 (6.5%) had at least 1 episode of variceal bleeding and comprised the study cohort. The median follow-up time was 2.61 years. A TIPS was created in 4,201 (9.8%) of these patients. There were significantly greater incidences of coagulopathy (83.9% vs 72.8%; P < .001), diabetes (45.5% vs 38.8%; P < .001), and hepatorenal syndrome (15.3% vs 12.5%; P < .001) in TIPS recipients vs those without a TIPS. Following propensity-score matching, TIPS recipients were found to have improved overall survival (82% vs 77% at 12 mo; P < .001) and a lower rate of recurrent variceal bleeding (88% vs 83% recurrent bleeding-free survival at 12 months,; P < .001) than patients without a TIPS. Patients with a TIPS had a significant increase in encounters for hepatic encephalopathy vs those without (1.01 vs 0.49 per year; P < .001). CONCLUSIONS: TIPS improves recurrent variceal bleeding rates and survival in patients with cirrhosis complicated by variceal bleeding. However, TIPS creation is also associated with a significant increase in hepatic encephalopathy.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/prevenção & controle , Cirrose Hepática/terapia , Derivação Portossistêmica Transjugular Intra-Hepática , California/epidemiologia , Comorbidade , Bases de Dados Factuais , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Florida/epidemiologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/mortalidade , Encefalopatia Hepática/epidemiologia , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Masculino , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/mortalidade , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
J Vasc Interv Radiol ; 31(8): 1256-1262.e3, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32654961

RESUMO

PURPOSE: To evaluate feasibility, procedural outcomes, and safety aspects of implantation of the alfapump system for management of refractory ascites by interventional radiology (IR) methods. MATERIALS AND METHODS: The multicenter open-label prospective MOSAIC study included 29 patients (mean age 60.0 y ± 9.9; range, 32-72 y, 17 [56.7%] male) with cirrhotic refractory ascites who received an alfapump system implanted by IR. The fully subcutaneous alfapump system consists of a pump and 2 silicone catheters, whose distal ends are inserted in the peritoneum and the bladder, respectively. The device moves ascites from the peritoneum to the bladder, reducing the requirement of paracentesis. Pumped volume and speed can be customized as required. The implant procedure was performed under general or local anesthesia. Both catheters were placed under ultrasound guidance. The pump was inserted in a subcutaneous pocket on the upper abdomen. Incidence and severity of procedure-related serious adverse events up to 3 months after implantation were recorded. RESULTS: Technical success was achieved in 29 (100%) IR implant procedures. The pump was usually implanted on the right abdomen (76.7%). In 5 patients, deviation from the Instructions for Use was required. Adverse events (requirement of additional incisions, postoperative bleed) occurred in 3 patients. At 3 months after implantation, 3 possibly procedure-related serious adverse events (ascites leakage, bacterial peritonitis, postoperative bleeding) had occurred. Two explantations (2/29; 6.8%) (cellulitis, pump pocket infection) and 4 reinterventions (pump or catheter replacement) were required, corresponding to an adverse event incidence rate of 9/29 (31.0%). CONCLUSIONS: Placement of the alfapump using IR methods is both feasible and technically successful.


Assuntos
Ascite/terapia , Cateteres , Drenagem/instrumentação , Fontes de Energia Elétrica , Cirrose Hepática/terapia , Radiografia Intervencionista , Adulto , Idoso , Ascite/diagnóstico por imagem , Ascite/epidemiologia , Canadá/epidemiologia , Remoção de Dispositivo , Drenagem/efeitos adversos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Incidência , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
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