The End-Organ Impairment in Liver Cirrhosis: Appointments for Critical Care

Figueiredo, António; Romero-Bermejo, Francisco José; Perdigoto, Rui; Marcelino, Paulo

doi:10.1155/2012/539412

Cited by 16 publications

(11 citation statements)

References 98 publications

(95 reference statements)

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“…recently demonstrated that EMR2 is a potential biomarker for SIRS and it is associated with the extent of organ failure26. Child C or decompensated end-stage liver disease often leads to multiple organ failure427. Although oxidative burst (production of reactive oxygen) of neutrophils is a major host defense mechanism to kill invading microorganisms, its excessive activities had been shown to be associated with SIRS and the extent of organ failure1828.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with cirrhosis are susceptible to a variety of complications, and their life expectancy can be markedly reduced, especially in those with acute on chronic liver failures23. Infections, especially bacterial infections, account for the major causes for decompensating liver cirrhosis4 or acute on chronic liver failure, and contribute towards high morbidity and mortality of these patients56.…”

mentioning

confidence: 99%

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Increased EMR2 expression on neutrophils correlates with disease severity and predicts overall mortality in cirrhotic patients

Huang

Jeng

et al. 2016

Sci Rep

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Patients with liver cirrhosis are susceptible to infections with high short-term mortalities. One CD97-related EGF-TM7 molecule, EMR2 (EGF-like molecule containing mucin-like hormone receptor 2), had been shown to regulate human neutrophil function, potentiate systemic inflammation. Nevertheless, EMR2 could also suppress neutrophil survival. Studying the role of EMR2 on neutrophil would be intriguing. 48 healthy volunteers and 100 cirrhotic patients were enrolled. Neutrophils were isolated from peripheral blood and cell surface markers were measured by flow cytometry.EMR2 expression levels correlated with CTP scores and increased further in patients with infections. These EMR2-expressed neutrophils were with activated phenotype, but with deranged functions like increased resting oxidative burst and impaired phagocytosis ability. Ligation of EMR2 could increase the phagoburst capacity but not the phagocytosis ability. Furthermore, neutrophils with higher EMR2 expression were more apoptotic and lost the LPS-induced neutrophil survival. Finally, EMR2 expressions on neutrophils correlated with infections and their levels greater than 25 had an AUC = 0.708 for predicting mortality. In conclusion, EMR2 expression levels correlated with CTP scores and increased further in cirrhotic patients with infections. These high EMR2-expressed neutrophils had activated phenotype but with deranged functions. Higher levels of these EMR2-expressed neutrophils correlated with infectious complications and predict mortality.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Increased EMR2 expression on neutrophils correlates with disease severity and predicts overall mortality in cirrhotic patients

Huang

Jeng

et al. 2016

Sci Rep

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“…This condition is defined as an advanced stage of progressive fibrosis of the liver that is identifiable by disruption of the lobular architecture and hepatic vasculature [2].…”

Section: Introductionmentioning

confidence: 99%

Alterations in neutrophil extracellular traps is associated with the degree of decompensation of liver cirrhosis

Agraz‐Cibrián

Segura-Ortega

Delgado‐Rizo

et al. 2016

J Infect Dev Ctries

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Introduction: Liver cirrhosis (LC) constitutes one of the main 10 causes of death worldwide. LC has a characteristic asymptomatic compensated phase followed by a progressive decompensated phase, in which diverse complications are presented. LC patients are highly prone to bacterial infections. The neutrophils in these patients present defects in the production of oxygen radicals, which are essential for bacteria elimination as in the activation of neutrophil extracellular traps (NETs). The main objective of this work was to determine the NETs and neutrophil activation markers in LC patients. Methodology: Neutrophil purification was done with Ficoll Histopaque from a sample of the peripheral blood of patients with compensated and decompensated LC. Neutrophils were activated with Phorbol 12-myristate 13-acetate to evaluate the release of NETs by means of fluorescence microscopy and fluorometry, while expression of activation markers (CD69, CD80, perforin, and CAP-18) was evaluated by flow cytometry. Results: A significant decrease in the release capability of NETs was observed as the level of LC in the patient increased. When comparing serum levels in inflammatory cytokines among the different study groups, significant differences were observed. No significant differences were detected on neutrophil activation markers; nevertheless, there was a correlation between diminution of CD69 and CD80 expression in decompensated patients. Conclusions: We demonstrated that LC patients with neutrophil extracellular trap release deficiencies could have an increased rate of complications.

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“… 100 The pathophysiological backgrounds of the responders to high-dose furosemide+HSS should be further cautiously investigated for adequate patient selection. While elevated serum BNP level is considered to reflect left ventricular myocardial dysfunction (impaired systolic function and/or diastolic relaxation), 101 – 103 an elevated serum ANP level is attributable to increased atrial volume or pressure. 101 , 103 , 104 The latter may reflect increased blood volume in liver cirrhosis (overflow state), 104 although a study by Tuttolomondo et al 99 did not concomitantly evaluate RAAS or SNS.…”

Section: Experimental Treatmentsmentioning

confidence: 99%

Management of refractory cirrhotic ascites: challenges and solutions

Fukui¹,

Kawaratani²,

Kaji³

et al. 2018

HMER

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Among the various risky complications of liver cirrhosis, refractory ascites is associated with poor survival of cirrhotics and persistently worsens their quality of life (QOL). Major clinical guidelines worldwide define refractory ascites as ascites that cannot be managed by medical therapy either because of a lack of response to maximum doses of diuretics or because patients develop complications related to diuretic therapy that preclude the use of an effective dose of diuretics. Due to the difficulty in receiving a liver transplantation (LT), the ultimate solution for refractory ascites, most cirrhotic patients have selected the palliative therapy such as repeated serial paracentesis, transjugular intrahepatic portosystemic shunt, or peritoneovenous shunt to improve their QOL. During the past several decades, new interventions and methodologies, such as indwelling peritoneal catheter, peritoneal-urinary drainage, and cell-free and concentrated ascites reinfusion therapy, have been introduced. In addition, new medical treatments with vasoconstrictors or vasopressin V2 receptor antagonists have been proposed. Both the benefits and risks of these old and new modalities have been extensively studied in relation to the pathophysiological changes in ascites formation. Although the best solution for refractory ascites is to eliminate hepatic failure either by LT or by causal treatment, the selection of the best palliative therapy for individual patients is of utmost importance, aiming at achieving the longest possible, comfortable life. This review briefly summarizes the changing landscape of variable treatment modalities for cirrhotic patients with refractory ascites, aiming at clarifying their possibilities and limitations. Evolving issues with regard to the impact of gut-derived systemic and local infection on the clinical course of cirrhotic patients have paved the way for the development of a new gut microbiome-based therapeutics. Thus, it should be further investigated whether the early therapeutic approach to gut dysbiosis provides a better solution for the management of cirrhotic ascites.

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The End-Organ Impairment in Liver Cirrhosis: Appointments for Critical Care

Cited by 16 publications

References 98 publications

Increased EMR2 expression on neutrophils correlates with disease severity and predicts overall mortality in cirrhotic patients

Increased EMR2 expression on neutrophils correlates with disease severity and predicts overall mortality in cirrhotic patients

Alterations in neutrophil extracellular traps is associated with the degree of decompensation of liver cirrhosis

Management of refractory cirrhotic ascites: challenges and solutions

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