Renal dysfunction in chronic liver disease

Slack, Andy; Yeoman, Andrew D.; Wendon, Julia

doi:10.1186/cc8855

Cited by 107 publications

(49 citation statements)

References 55 publications

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“…The presence of renal dysfunction is also known to increase the risk of bleeding1819. We included serum creatinine as a marker for the renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

K time & maximum amplitude of thromboelastogram predict post-central venous cannulation bleeding in patients with cirrhosis

Pandey

Saluja

Gaurav

et al. 2017

Indian Journal of Medical Research

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Background & objectives:Coagulation and haemostasis are dynamic processes. The haemostatic changes in liver disease affect all aspects of coagulation. The prothrombin time (PT)/international normalized ratio (INR) was developed to monitor oral anticoagulant therapy and the activated partial thromboplastin time to investigate inheritable single factor deficiencies. Viscoelastic tests such as thromboelastogram (TEG) give information about dynamics of clot formation (coagulation factor and anticoagulant activity), clot strength (platelets and fibrinogen) and clot stability (finbrinolysis and factor XIII). Administration of blood products before invasive procedures is still guided by INR and platelet count in patients of liver disease. This study was aimed to evaluate the validity of TEG to predict post-procedural bleed after central venous cannulation in patients with cirrhosis.Methods:Ninety patients aged 20-70 yr diagnosed with liver cirrhosis requiring elective central venous catheter (CVC) insertion were studied. Platelet count, INR, serum creatinine, TEG and Child-Turcotte-Pugh (CTP) score were recorded before the procedure. Right-sided internal jugular vein was cannulated. On the basis of presence or absence of post-procedural bleed, patients were divided into bleeding and non-bleeding groups. The CTP score, component of TEG (R - reaction time, K - coagulation time, MA - maximum amplitude and α - angle) and laboratory parameters of both the groups were compared.Results:Bleeding was seen more when CTP scores were ≥10 (P=0.05). The K time of 3.05 min or more on thromboelastograph was a significant predictor of bleeding [area under the curve (AUC) 0.694, P=0.047]. MA of 48.8 mm or more was a significant predictor of non-bleeding. INR ≥2.6 was a significant predictor of bleeding (AUC 0.765, P=0.005). K time had a low-positive predictive value of 20 per cent and the positive and negative likelihood ratios of 1.87 and 0.48, respectively.Interpretation & conclusions:Our results show that the cut-off value for INR ≥2.6 and K time ≥3.05 min predict bleeding and MA ≥48.8 mm predicts non-bleeding in patients with cirrhosis undergoing central venous pressure catheter cannulation.

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“…The presence of renal dysfunction is also known to increase the risk of bleeding1819. We included serum creatinine as a marker for the renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

K time & maximum amplitude of thromboelastogram predict post-central venous cannulation bleeding in patients with cirrhosis

Pandey

Saluja

Gaurav

et al. 2017

Indian Journal of Medical Research

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“…Mouse serum metabolites identified in this study and their biological relevance (including citations for refs (51−61)); bacteria-specific metabolites found in serum of S. aureus , S. pneumoniae , E. coli and P. aeruginosa infected C57BL/6 mice by PLS-DA; OPLS-DA loadings derived from Gram-positive and Gram-negative bacterial infections. This material is available free of charge via the Internet at .…”

mentioning

confidence: 99%

Gram-negative and Gram-Positive Bacterial Infections Give Rise to a Different Metabolic Response in a Mouse Model

et al. 2012

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Metabolomics has become an important tool to study host-pathogen interactions and to discover potential novel therapeutic targets. In an attempt to develop a better understanding of the process of pathogenesis and the associated host response we have used a quantitative 1H NMR approach to study the metabolic response to different bacterial infections. Here we describe that metabolic changes found in serum of mice that were infected with Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli and Pseudomonas aeruginosa can distinguish between infections caused by Gram-positive and Gram-negative bacterial strains. By combining the results of the mouse study with those of bacterial footprinting culture experiments, bacterially secreted metabolites could be identified as potential bacterium-specific biomarkers for P. aeruginosa infections but not for the other strains. Multivariate statistical analysis revealed correlations between metabolic, cytokine and physiological responses. In TLR4 and TLR2 knockout mice, host-response pathway correlated metabolites could be identified and allowed us for the first time to distinguish between bacterial- and host-induced metabolic changes. Since Gram-positive and Gram-negative bacteria activate different receptor pathways in the host, our results suggest that it may become possible in the future to use a metabolomics approach to improve on current clinical microbiology diagnostic methods.

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“…Uremia, in turn results in platelet dysfunction, abnormalities of hemostasis, and bleeding. [2324] This, coupled with anemia associated with renal disease, secondary to decreased erythropoietin production could account for increased blood component consumption observed in our study. [25]…”

Section: Discussionmentioning

confidence: 84%

Preoperative predictors of blood component transfusion in living donor liver transplantation

Makroo

Walia

Aneja

et al. 2013

Asian J Transfus Sci

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Context:Extensive bleeding associated with liver transplantation is a major challenge faced by transplant surgeons, worldwide.Aims:To evaluate the blood component consumption and determine preoperative factors that predict the same in living donor liver transplantation (LDLT).Settings and Design:This prospective study was performed for a 1 year period, from March 2010 to February 2011.Materials and Methods:Intra- and postoperative utilization of blood components in 152 patients undergoing LDLT was evaluated and preoperative patient parameters like age, gender, height, weight, disease etiology, hemoglobin (Hb), hematocrit (Hct), platelet count (Plt), total leukocyte count (TLC), activated partial thromboplastin time (aPTT), international normalized ratio (INR), serum bilirubin (T. bilirubin), total proteins (T. proteins), albumin to globulin ratio (A/G ratio), serum creatinine (S. creatinine), blood urea (B. urea), and serum electrolytes were assessed to determine their predictive values. Univariate and stepwise discriminant analysis identified those factors, which could predict the consumption of each blood component.Results:The average utilization of packed red cells (PRCs), cryoprecipitates (cryo), apheresis platelets, and fresh frozen plasma was 8.48 units, 2.19 units, 0.93 units, and 2,025 ml, respectively. Disease etiology and blood component consumption were significantly correlated. Separate prediction models which could predict consumption of each blood component in intra and postoperative phase of LDLT were derived from among the preoperative Hb, Hct, model for end-stage liver disease (MELD) score, body surface area (BSA), Plt, T. proteins, S. creatinine, B. urea, INR, and serum sodium and chloride.Conclusions:Preoperative variables can effectively predict the blood component requirements during liver transplantation, thereby allowing blood transfusion services in being better prepared for surgical procedure.

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Renal dysfunction in chronic liver disease

Cited by 107 publications

References 55 publications

K time & maximum amplitude of thromboelastogram predict post-central venous cannulation bleeding in patients with cirrhosis

K time & maximum amplitude of thromboelastogram predict post-central venous cannulation bleeding in patients with cirrhosis

Gram-negative and Gram-Positive Bacterial Infections Give Rise to a Different Metabolic Response in a Mouse Model

Preoperative predictors of blood component transfusion in living donor liver transplantation

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