KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

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doi:10.3350/cmh.2018.1005

Cited by 52 publications

(29 citation statements)

References 401 publications

(481 reference statements)

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“…The results were similar to those of previous studies conducted in Korea (39%–41%), which were lower than those of the Western studies (−60%) 2930. The three most common isolates from ascitic fluid cultures in Korea were E. coli , Streptococcus , and Klebsiella 303132333435…”

Section: Discussionsupporting

confidence: 86%

Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients

et al. 2018

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BackgroundSpontaneous bacterial peritonitis (SBP) is a serious infectious complication in patients with liver cirrhosis. However, information about prognosis of SBP in hepatocellular carcinoma (HCC) patients is limited. We investigated the clinical course of SBP in HCC patients.MethodsThis study enrolled patients diagnosed with SBP between 2005 and 2017. Medical records of patients were reviewed and clinical course was compared between the non-HCC and HCC groups.ResultsIn total, 123 SBP cases including 49 HCC cases were enrolled. Men were predominant (48/74, 64.9% vs. 34/49, 69.4%; P = 0.697); median age was 58 years in both non-HCC and HCC groups (P = 0.887). The most common etiology was alcohol (32/74, 43.2%) in non-HCC group and hepatitis B (30/49, 61.2%) in HCC group (P = 0.009). Antibiotic resistance rate was higher in non-HCC than in HCC group (29.7% vs. 12.2%; P = 0.028); in-hospital mortality did not differ between the groups (25/74, 33.8% vs. 13/49, 26.5%; P = 0.431). Development rate of hepatorenal syndrome did not differ between non-HCC and HCC group (14/74, 18.9% vs. 10/49, 20.4%; P = 1.000), but hepatic encephalopathy was less common in HCC group (26/74, 35.2% vs. 9/49, 18.3%; P = 0.008). The most important predictor of in-hospital mortality in patients with HCC was white blood cell count above 11,570 cells/mm3 (odds ratio, 6.629; 95% confidence interval, 1.652–26.590; P = 0.008).ConclusionPrognosis of SBP in HCC patients is relatively less severe. This result may be related with reduced antibiotics resistance and lower development rates of other complications, such as hepatic encephalopathy. Degree of systemic inflammation may be the most important factor for in-hospital mortality.

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Section: Discussionsupporting

confidence: 86%

Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients

et al. 2018

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“…However, it is recognized that liver surface nodularity in imaging study of post-Fontan patients may not be associated with liver dysfunction [19]. Therefore, in order to provide a more specific diagnosis of cirrhosis in this study, the presence of cirrhosis was determined by the concurrent presence of liver surface nodularity and signs of portal hypertension, including presence of splenomegaly (defined as size greater than 12 cm in the largest bipolar diameter at the splenic hilum), presence of ascites, and/or presence of portosystemic collateral vessels (i.e., varices), in imaging study [2,[31][32][33].…”

Section: Evaluation Of Cirrhosismentioning

confidence: 99%

Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance

Yoon

Lee

Cho

et al. 2020

Cancers

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Liver cirrhosis and hepatocellular carcinoma (HCC) are serious late complications that can occur after the Fontan procedure. This study aimed to investigate the cumulative incidence of cirrhosis and HCC and to identify specific features distinguishing HCC from benign arterial-phase hyperenhancing (APHE) nodules that developed after the Fontan operation. We retrospectively enrolled 313 post-Fontan patients who had been followed for more than 5 years and had undergone ultrasound or computed tomography (CT) of the liver between January 2000 and August 2018. Cirrhosis was diagnosed radiologically. The estimated cumulative incidence rates of cirrhosis at 5, 10, 20, and 30 years after the Fontan operation were 1.3%, 9.2%, 56.6%, and 97.9%, respectively. Multiphasic CT revealed that 18 patients had APHE nodules that were ≥1 cm in size and showed washout in the portal venous phase (PVP)/delayed phase, which met current noninvasive HCC diagnosis criteria. Among them, only seven patients (38.9%, 7/18) were diagnosed with HCC. After cirrhosis developed, the annual incidence of HCC was 1.04%. The appearance of washout in the PVP (p = 0.006), long time elapsed since the initial Fontan operation (p = 0.04), large nodule size (p = 0.03), and elevated serum α-fetoprotein (AFP) level (p < 0.001) were significantly associated with HCC. In conclusion, cirrhosis is a frequent late complication after Fontan operation, especially after 10 years, and HCC is not a rare complication after cirrhosis development. Diagnosis of HCC should not be based solely on the current imaging criteria, and washout on PVP and clinical features might be helpful to differentiate HCC nodules from benign APHE nodules.

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“…Dilutional hyponatremia is related to hypoalbuminemia and portal hypertension in cirrhotic patients. Its complications include spontaneous bacterial peritonitis, hepatorenal syndrome and HE [ 18 ]. Therefore, our study could suggest that hyponatremia may not only predict liver function, but may also be a risk factor that aggravates HE after endoscopy with sedation.…”

Section: Discussionmentioning

confidence: 99%

Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients

Jeong

Jung

Seo

et al. 2020

European Journal of Gastroenterology &Amp; Hepatology

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Background This study was conducted to determine which type and dose of sedative drugs should be given to cirrhotic patients with compensation or decompensation during esophagogastroduodenoscopy (EGD) to prevent hepatic encephalopathy (HE) after sedation. Methods We reviewed the medical records of cirrhotic patients consecutively admitted to the hospital and conducted a number connection test (NCT) before and 2 h after EGD with moderate sedation. Sedation was performed using either propofol alone, midazolam alone, or combined propofol + midazolam. Results Sixty-seven patients were admitted for a screening EGD. The NCT before and after sedation were not significantly different in the propofol alone (pre-NCT = 47.3 ± 19.71 seconds vs. post-NCT = 49.4 ± 21.79 seconds, P = 0.6389). In the midazolam alone (pre-NCT = 50.3 ± 20.56 vs. post-NCT = 63.7 ± 33.17, P = 0.0021) and in the combined propofol + midazolam (pre-NCT = 47.4 ± 20.99 vs. post-NCT = 60.0 ± 30.79, P = 0.0002), NCT were significantly delayed. The propofol alone group received 52.3 ± 16.31 mg (0.82 ± 0.29 mg/kg). In 45 (67.2%) decompensated patients, only the propofol alone was not significantly different between pre-NCT (49.2 ± 22.92) and post-NCT (52.3 ± 24.90) ( P = 0.4548). Serum sodium level was significantly correlated with delta-NCT (r = 0.3594, P = 0.0028). Conclusion Propofol alone could be the best sedation strategy for cirrhotic patients with compensation or decompensation without aggravation of covert or overt HE. Hyponatremia could be a risk factor for developing or worsening HE after EGD with sedation.

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KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

Cited by 52 publications

References 401 publications

Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients

Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients

Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance

Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients

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