β-blockers in advanced cirrhosis: More friend than enemy

Yoon, Ki Tae; Liu, Hongqun; Lee, Samuel S.

doi:10.3350/cmh.2020.0234

Cited by 31 publications

(33 citation statements)

References 76 publications

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“…Nevertheless, notably, OLT patients showed significantly lower immunogenicity than patients with cirrhosis (OR, 0.54; 95% CI, 0.47-0.62). This indicates that the use of immunosuppressive agents in the presence of other associated comorbidities including renal insufficiency (either primary or secondary to underlying liver disease) [37][38][39][40][41], should offset the benefit of OLT, that is, restored hepatic functional reserve and normalised portal pressure in achieving a humoral response to the SARS-CoV-2 vaccination.…”

Section: Discussionmentioning

confidence: 99%

Humoral Immunogenicity to SARS-CoV-2 Vaccination in Liver Transplant Recipients: A Systematic Review and Meta-Analysis

Yoo¹,

Yon²,

Lee³

et al. 2022

Int. J. Biol. Sci.

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Solid organ transplant recipients generally show reduced immunogenicity to various vaccines. We aimed to assess the immunogenicity of the immune response among orthotopic liver transplant (OLT) recipients after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. A systematic search was performed to evaluate immunogenicity or adverse events reported after SARS-CoV-2 vaccination. The pooled analysis of 20 studies showed a humoral immune response rate of 0.70 (95% confidence interval [CI], 0.63-0.77) after SARS-CoV-2 vaccination among OLT recipients. The immunogenicity among OLT recipients was significantly lower compared to the overall population and healthy controls, with odds ratios (ORs) of 0.80 and 0.69. However, it was significantly higher than that of patients receiving other organ transplants, especially kidneys, with an OR of 1.50. Male sex, old age, chronic kidney disease, obesity, and multiple or high immunosuppressant doses significantly increased the risk of unresponsiveness in patients with OLT. The overall incidence of any adverse event after vaccination was 0.68 (95% CI, 0.55-0.81), similar to that of control. OLT recipients had an overall humoral immune response rate of 70% after SARS-CoV-2 vaccination, which is lower than that of healthy controls but favourable compared to those of other solid organ transplant recipients.

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Section: Discussionmentioning

confidence: 99%

Humoral Immunogenicity to SARS-CoV-2 Vaccination in Liver Transplant Recipients: A Systematic Review and Meta-Analysis

Yoo¹,

Yon²,

Lee³

et al. 2022

Int. J. Biol. Sci.

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“…Liver cirrhosis (LC), the final stage of chronic liver diseases with progressive liver fibrosis, is known to originate from various etiologies, including chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, alcoholic liver disease, non‐alcoholic fatty liver disease (NAFLD), autoimmune liver disease, and metabolism‐related genetic disorders 1,2 . Disease progression to LC presents a serious public health burden on the health‐care system, despite considerable advances in therapy and care 3–5 . First, LC itself could substantially increase the risk of morbidity and mortality 1,6 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Disease progression to LC presents a serious public health burden on the health-care system, despite considerable advances in therapy and care. [3][4][5] First, LC itself could substantially increase the risk of morbidity and mortality. 1,6 Second, compared with patients presenting other chronic diseases such as congestive heart failure and chronic obstructive pulmonary disease, those with LC tend to undergo a greater number of hospitalizations, longer lengths of stay (LOSs) at hospitals, more readmissions, and poorer outcomes.…”

Section: Introductionmentioning

confidence: 99%

Real‐world clinical features, health‐care utilization, and economic burden in decompensated cirrhosis patients: A national database

Lee

Kim

2022

J of Gastro and Hepatol

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Background: Patients with decompensated cirrhosis are well known to experience morbidity and mortality. Aim: We assessed clinical characteristics, health-care utilization, and economic burden according to the type, number, and combination of decompensation-related complications. Methods: We used recent nationally representative sample data from 2016 to 2018, covering approximately 13% of hospitalized patients in South Korea annually. Decompensation-related complications included ascites, hepatic encephalopathy (HE), gastroesophageal variceal (GEV) bleeding, and hepatorenal syndrome (HRS). Results: Among 14 601 patients with decompensated cirrhosis, 11 201 (76.7%) experienced ≥ 1 decompensation-related complications, and approximately three-quarters underwent hospitalization. The most prevalent decompensation-related complications were ascites (54.8%), GEV bleeding (33.2%), HE (27.4%), and HRS (3.6%). Patients with GEV bleeding exhibited the highest hospitalization rate (95.7%), and patients with HE or HRS underwent hospitalization for 4 weeks/year due to decompensated cirrhosis. Hospitalization costs were 1.9 times higher in patients with HRS than in those with ascites alone ($9022 vs $4673; P < 0.01). Once patients developed decompensation-related complications, 41.3% had ≥ 2 types of decompensation-related complications. As the number of decompensation-related complications increased from 0 to ≥ 3, health-care utilization and economic burden significantly increased in a stepwise manner; patients with ascites, GEV bleeding, and HE visited medical institutions 2.2 times more (11 vs 5/year; P < 0.01) and incurred 6.4 times greater medical expenditure ($11 060 vs $1728/year; P < 0.01) than those with ascites only. Conclusion: A substantial proportion of patients had multiple decompensation-related complications and socioeconomic burdens for decompensated cirrhosis considering admission rate, hospital stay, and costs increased markedly, depending on the number of decompensation-related complications.

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“…This induces the upregulation of systemic inflammatory mediators, leading to compromised extrahepatic organ perfusion, including the kidney (28)(29)(30)(31)(32). In patients with bacterial translocation, pathogen-associated molecular patterns, such as endotoxins and bacterial DNA, activates monocytes, which leads to the release of pro-inflammatory cytokines such as tumor necrosis factor-alpha, interleukin 6, and interleukin 1 beta (33,34).…”

Section: Pathophysiology Of Hepatorenal Syndromementioning

confidence: 99%

Current knowledge about biomarkers of acute kidney injury in liver cirrhosis

Lee

Seo

2022

Clin Mol Hepatol

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Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis.Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population.This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetylβ-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsythe gold standard-has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes.

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β-blockers in advanced cirrhosis: More friend than enemy

Cited by 31 publications

References 76 publications

Humoral Immunogenicity to SARS-CoV-2 Vaccination in Liver Transplant Recipients: A Systematic Review and Meta-Analysis

Humoral Immunogenicity to SARS-CoV-2 Vaccination in Liver Transplant Recipients: A Systematic Review and Meta-Analysis

Real‐world clinical features, health‐care utilization, and economic burden in decompensated cirrhosis patients: A national database

Current knowledge about biomarkers of acute kidney injury in liver cirrhosis

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