Hepatology,
Journal Year:
2023,
Volume and Issue:
79(2), P. 460 - 481
Published: Feb. 24, 2023
Patients
with
cirrhosis
develop
complex
alterations
in
primary
hemostasis
that
include
both
hypocoagulable
and
hypercoagulable
features.
This
includes
thrombocytopenia,
multiple
of
platelet
function,
increased
plasma
levels
von
Willebrand
factor.
Contrary
to
the
historical
view
dysfunction
might
be
responsible
for
an
bleeding
tendency,
current
theory
posits
a
rebalanced
patients
cirrhosis.
Severe
thrombocytopenia
is
not
indicative
risk
undergoing
invasive
procedures
does
dictate
per
se
need
pre-procedural
prophylaxis.
A
more
comprehensive
individualized
assessment
should
combine
hemostatic
impairment,
severity
decompensation
systemic
inflammation,
presence
additional
factors
may
impair
such
as
acute
kidney
injury
bacterial
infections.
Although
there
are
multiple,
function
cirrhosis,
their
net
effect
yet
fully
understood.
More
investigations
evaluating
association
between
bleeding/thrombosis
improve
stratification
decompensated
Besides
hemostasis,
factor
Ag
ADP-induced,
whole-blood
aggregation
normalized
by
count
(VITRO
score
PLT
ratio)
promising
biomarkers
predict
hepatic
survival
compensated
patients.
Further
into
vivo
interplay
platelets,
circulating
blood
elements,
endothelial
cells
help
advance
our
understanding
cirrhotic
coagulopathy.
Here,
we
review
changes
platelets
potential
clinical
implications.
United European Gastroenterology Journal,
Journal Year:
2025,
Volume and Issue:
unknown
Published: Jan. 23, 2025
Venous
thromboembolism
(VTE)
is
a
recognized
complication
of
acutely
ill
patients,
but
its
incidence
and
risk
factors
in
those
with
cirrhosis
are
uncertain.
We
retrospectively
studied
consecutive
cohort
patients
non-electively
admitted
to
our
medical
unit
determine
the
rates
symptomatic
VTE
during
hospitalization.
Firstly,
we
explored
associations
baseline,
clinical
laboratory
characteristics
using
logistic
regression.
Secondly,
developed
prediction
model
that
could
predict
in-hospital
VTE.
included
687
(median
age
61
years
old;
68%
male;
Child-Pugh
A/B/C,
13%/40%/47%).
During
hospitalization,
34
(4.9%)
experienced
Multivariate
analysis
showed
male
sex
(OR:
2.56,
p
=
0.05),
AKI
3.1,
0.001),
bacterial
infections
2.6,
0.008),
Pugh
score
1.6.
<
family
history
thrombosis
0.04),
reduced
mobility
4.6,
C-reactive
protein
1.1,
0.005)
were
independent
predictors
combined
these
variables
(CirrhosisThrombosisModel)
accurately
discriminated
between
high-
low-risk
patients.
The
AUROC
CiThroModel
was
significantly
higher
than
Padua
(0.882
vs.
0.742).
After
validating
bootstrapping,
adjusted
maintained
optimal
discrimination
ability
(0.862)
calibration.
formula
calculate
-9.00
+
0.82
[Male
sex]
1.14
[AKI]
0.98
[Infection]
0.48
*
Child
[VTE
history]
1.54
[Reduced
mobility]
0.15
PCR/10.
seems
valuable
tool
for
identifying
hospitalized
at
(https://majinzin.shinyapps.io/vterisk/).
Clinical and Molecular Hepatology,
Journal Year:
2022,
Volume and Issue:
29(Suppl), P. S286 - S301
Published: Dec. 28, 2022
Non-alcoholic
fatty
liver
disease
(NAFLD)
is
currently
the
fastest
growing
indication
to
transplantation
(LT)
in
Western
Countries,
both
for
end
stage
and
hepatocellular
carcinoma.
NAFLD/non-alcoholic
steatohepatitis
(NASH)
often
expression
of
a
systemic
metabolic
syndrome;
therefore,
NAFLD/NASH
patients
require
multidisciplinary
approach
proper
pre-surgical
evaluation,
which
important
achieve
post-transplant
outcome
comparable
that
other
indications
LT.
are
also
at
higher
risk
cardiovascular
events,
diabetes,
dyslipidemia,
obesity,
renal
impairment
recurrent
NASH.
Lifestyle
modifications,
included
diet
physical
activity,
key
improve
survival
quality
life
after
transplantation.
A
tailored
immunosuppressive
regimen
may
be
proposed
selected
patients.
Development
new
drugs
treatment
NASH
awaited.
Liver International,
Journal Year:
2023,
Volume and Issue:
unknown
Published: June 27, 2023
The
identification
of
systemic
inflammation
(SI)
as
a
central
player
in
the
orchestration
acute-on-chronic
liver
failure
(ACLF)
has
opened
new
avenues
for
understanding
pathophysiological
mechanisms
underlying
this
disease
condition.
ACLF,
which
develops
patients
with
acute
decompensation
cirrhosis,
is
characterized
by
single
or
multiple
organ
and
high
risk
short-term
(28-day)
mortality.
Its
poor
outcome
closely
associated
severity
inflammatory
response.
In
review,
we
describe
key
features
SI
acutely
decompensated
cirrhosis
including
presence
blood
white
cell
count
increased
levels
mediators
circulation.
We
also
discuss
main
triggers
(i.e.
pathogen-
damage-associated
molecular
patterns),
effectors
neutrophils,
monocytes
lymphocytes),
humoral
(acute
phase
proteins,
cytokines,
chemokines,
growth
factors
bioactive
lipid
mediators)
that
influence
response
drive
mortality
ACLF.
role
immunological
exhaustion
and/or
immunoparalysis
context
exacerbated
responses
predispose
ACLF
to
secondary
infections
re-escalation
end-organ
dysfunction
are
reviewed.
Finally,
several
potential
immunogenic
therapeutic
targets
debated.
United European Gastroenterology Journal,
Journal Year:
2024,
Volume and Issue:
12(2), P. 194 - 202
Published: Feb. 20, 2024
Abstract
It
is
essential
to
identify
the
subgroup
of
patients
who
experience
poorer
outcomes
in
order
adapt
clinical
management
effectively.
In
context
liver
disease,
earlier
identification
occurs,
greater
range
therapeutic
options
that
can
be
offered
patients.
past,
with
acute
decompensation
(AD)
chronic
disease
were
treated
as
a
homogeneous
group,
emphasis
on
identifying
those
at
highest
risk
death.
last
15
years,
differentiation
has
emerged
between
acute‐on‐chronic
failure
syndrome
(ACLF)
and
AD,
primarily
due
indications
latter
linked
less
favorable
short‐term
prognosis.
Nevertheless,
definition
ACLF
varies
among
different
knowledge
societies,
making
it
challenging
assess
its
true
impact
compared
AD.
Therefore,
purpose
this
review
provide
detailed
analysis
emphasizing
critical
importance
field
advanced
disease.
We
will
discuss
differences
Eastern
Western
approaches,
particularly
relation
occurrence
onset.
Common
characteristics,
such
dynamic
nature
course,
highlighted.
Finally,
we
focus
two
key
implications
arising
from
these
considerations:
prevention
before
onset
strategies
once
develops,
including
transplantation
withdrawal
care.
United European Gastroenterology Journal,
Journal Year:
2023,
Volume and Issue:
11(9), P. 815 - 824
Published: Oct. 4, 2023
The
clinical
course
of
acutely
decompensated
cirrhosis
(AD)
is
heterogeneous.
Presepsin
(PSP)
a
plasmatic
biomarker
that
reflects
Toll-like
receptor
activity
and
systemic
inflammation.
We
conducted
prospective
study
to:
(1)
measure
PSP
in
AD
(2)
assess
whether
can
predict
the
development
acute-on-chronic
liver
failure
(ACLF).Patients
with
were
prospectively
recruited
at
admission
underwent
determination
PSP.
In
part
1,
we
compared
versus
controls
(stable
compensated
cirrhosis).
2,
followed
patients
for
1
year
evaluated
predictors
ACLF.One
hundred
seventy
three
included
(median
MELD:
18;
CLIF-C
score:
54).
Compared
controls,
had
higher
levels
(674
ng/L
vs.
310
157
ng/L;
p
<
0.001).
AD,
Child-Pugh
C
acute
kidney
injury
associated
During
follow-up,
52
developed
ACLF
time
from
recruitment:
66
days).
PSP,
score,
stage
independently
ACLF.
A
predictive
model
combining
these
variables
(Padua
2.0)
accurately
identified
risk
(AUROC
0.864;
95%
CI
0.780-0.947;
sensitivity
82.9%,
specificity
76.7%).
lower
based
on
<50,
>674
could
discriminate
between
two
groups
significantly
different
Finally,
who
did
not
develop
ACLF,
baseline
was
those
progressed
toward
unstable
stable
cirrhosis.The
Padua
2.0
be
used
to
identify
high
If
results
are
validated
by
external
cohorts,
become
new
improve
stratification
AD.
Hepatology International,
Journal Year:
2024,
Volume and Issue:
18(3), P. 817 - 832
Published: March 9, 2024
End-stage
liver
disease
(ESLD)
is
a
life-threatening
clinical
syndrome
and
when
complicated
with
infection
the
mortality
markedly
increased.
In
patients
ESLD,
bacterial
or
fungal
can
induce
aggravate
occurrence
progression
of
decompensation.
Consequently,
infections
are
among
most
common
complications
deterioration.
There
an
overwhelming
need
for
standardized
protocols
early
diagnosis
appropriate
management
ESLD
by
infections.
Asia
Pacific
region
has
largest
number
patients,
due
to
hepatitis
B
growing
population
alcohol
NAFLD.
Concomitant
not
only
add
organ
failure
high
but
also
financial
healthcare
burdens.
This
consensus
document
assembled
up-to-date
knowledge
experience
from
colleagues
across
Asia–Pacific
region,
providing
data
on
principles
as
well
evidence-based
current
working
practices
treatment
