Cutting-Edge Topics in the Management of Liver Cirrhosis and Its Complications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (10 May 2023) | Viewed by 8248

Special Issue Editors


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Guest Editor
General Hospital of Northern Theater Command, Shenyang General Hospital of PLA, Shenyang, China
Interests: pancreatic cancer; pancreatitis; liver diseses; gatrointestinal disesaes

E-Mail Website
Guest Editor
General Hospital of Northern Theater Command,·Shenyang General Hospital of PLA, Shenyang, China
Interests: liver cirrhosis; portal hypertension; portal vein thrombosis; Budd–Chiari syndrome; hepatocellular carcinoma
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Special Issue Information

Dear Colleagues,

Liver cirrhosis causes approximately 1 million deaths per year and was the 11th most common cause of death in 2019. In the compensated stage, most patients with cirrhosis are asymptomatic. However, in the decompensated stage, various decompensated events will develop, such as ascites, gastrointestinal bleeding, hepatic encephalopathy, and jaundice. Compared with the general population, patients with compensated cirrhosis have a 5-fold increased risk of death, and those with decompensated cirrhosis a 10-fold increased risk of death. Given the poor prognosis of patients with cirrhosis, it is important for clinicians to assess the treatment and prognosis of cirrhosis and its complications. We are pleased to announce that the Journal of Clinical Medicine has launched the current Special Issue, entitled “Cutting-Edge Topics in the Management of Liver Cirrhosis and Its Complications”, and is inviting researchers to submit high-quality papers focusing on but not limited to the following topics.

  • Prognostic assessment of liver cirrhosis and its complication;
  • Novel biomarkers or mathematical models for assessing the short- and long-term survival of liver cirrhosis;
  • Role of nutritional status, portal hemodynamic status, cardiac function, and renal function for the prognostic assessment of liver cirrhosis;
  • Impact of therapeutic options on the prognosis of liver cirrhosis, such as direct antiviral drugs, statins, anticoagulants, non-selective beta-blockers in ascites, human albumin infusions, and endoscopic treatment of variceal bleeding, etc.;
  • Treatment of ascites, upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatic hydrothorax, hypersplenism, portal vein thrombosis, hepatocellular carcinoma, and other complications in liver cirrhosis;
  • Invasive procedures or surgery for the treatment and prognosis of liver cirrhosis and its complications, such as endoscopy, transjugular intrahepatic portosystemic shunt, liver transplantation, etc.;
  • Common imaging indicators and prognosis assessment of liver cirrhosis.

Prof. Dr. Xiaozhong Guo
Dr. Xingshun Qi
Guest Editors

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Keywords

  •  treatment
  •  antiviral drugs
  •  non-selective beta-blockers
  •  albumin
  •  surgery
  •  prognosis
  •  complications of cirrhosis
  •  liver cirrhosis

Published Papers (5 papers)

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Research

13 pages, 2075 KiB  
Article
Association between Body Composition and the Risk of Portopulmonary Hypertension Assessed by Computed Tomography in Patients with Liver Cirrhosis
by Takao Miwa, Tatsunori Hanai, Kayoko Nishimura, Satoko Tajirika, Yuki Nakahata, Kenji Imai, Atsushi Suetsugu, Koji Takai, Mayumi Yamamoto and Masahito Shimizu
J. Clin. Med. 2023, 12(10), 3351; https://doi.org/10.3390/jcm12103351 - 9 May 2023
Viewed by 1484
Abstract
The aim of this study is to investigate the impact of body composition on the risk of portopulmonary hypertension using computed tomography (CT) in patients with liver cirrhosis. We retrospectively included 148 patients with cirrhosis treated at our hospital between March 2012 and [...] Read more.
The aim of this study is to investigate the impact of body composition on the risk of portopulmonary hypertension using computed tomography (CT) in patients with liver cirrhosis. We retrospectively included 148 patients with cirrhosis treated at our hospital between March 2012 and December 2020. POPH high-risk was defined as main pulmonary artery diameter (mPA-D) ≥ 29 mm or mPA-D to ascending aorta diameter ratio ≥ 1.0, based on chest CT. Body composition was assessed using CT images of the third lumbar vertebra. The factors associated with POPH high-risk were evaluated using logistic regression and decision tree analyses, respectively. Among the 148 patients, 50% were females, and 31% were found to be high-risk cases on evaluation of chest CT images. Patients with a body mass index (BMI) of ≥25 mg/m2 had a significantly higher prevalence of POPH high-risk than those with a BMI < 25 mg/m2 (47% vs. 25%, p = 0.019). After adjusting for confounding factors, BMI (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.10–1.33), subcutaneous adipose tissue index (OR, 1.02; 95% CI, 1.01–1.03), and visceral adipose tissue index (OR, 1.03; 95% CI, 1.01–1.04) were associated with POPH high-risk, respectively. In the decision tree analysis, the strongest classifier of POPH high-risk was BMI, followed by the skeletal muscle index. Body composition may affect the risk of POPH based on chest CT assessment in patients with cirrhosis. Since the present study lacked data on right heart catheterization, further studies are required to confirm the results of our study. Full article
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12 pages, 813 KiB  
Article
Clinical Characteristics and Early Diagnosis of Spontaneous Fungal Peritonitis/Fungiascites in Hospitalized Cirrhotic Patients with Ascites: A Case–Control Study
by Yingying Jiang, Chunlei Fan, Yan Dang, Wenmin Zhao, Lingna Lv, Jinli Lou, Lei Li and Huiguo Ding
J. Clin. Med. 2023, 12(9), 3100; https://doi.org/10.3390/jcm12093100 - 24 Apr 2023
Cited by 1 | Viewed by 1492
Abstract
Background: Spontaneous fungal peritonitis (SFP) and fungiascites is less well-recognized and described in patients with liver cirrhosis. The aims of this study were to determine the clinical characteristics, prognosis, and risk factors of cirrhotic patients with SFP/fungiascites and to improve early differential diagnosis [...] Read more.
Background: Spontaneous fungal peritonitis (SFP) and fungiascites is less well-recognized and described in patients with liver cirrhosis. The aims of this study were to determine the clinical characteristics, prognosis, and risk factors of cirrhotic patients with SFP/fungiascites and to improve early differential diagnosis with spontaneous bacterial peritonitis (SBP). Methods: This was a retrospective case–control study of 54 cases of spontaneous peritonitis in cirrhotic patients (52 SFP and 2 fungiascites) with fungus-positive ascitic culture. Fifty-four SBP cirrhotic patients with bacteria-positive ascitic culture were randomly enrolled as a control group. A nomogram was developed for the early differential diagnosis of SFP and fungiascites. Results: Hospital-acquired infection was the main cause of SFP/fungiascites. Of the 54 SFP/fungiascites patients, 31 (57.41%) patients carried on with the antifungal treatment, which seemed to improve short-term (30-days) mortality but not long-term mortality. Septic shock and HCC were independent predictors of high 30-day mortality in SFP/fungiascites patients. We constructed a predictive nomogram model that included AKI/HRS, fever, (1,3)-β-D-glucan, and hospital-acquired infection markers for early differential diagnosis of SFP/fungiascites in cirrhotic patients with ascites from SBP, and the diagnostic performance was favorable, with an AUC of 0.930 (95% CI: 0.874–0.985). Conclusions: SFP/fungiascites was associated with high mortality. The nomogram established in this article is a useful tool for identifying SFP/fungiascites in SBP patients early. For patients with strongly suspected or confirmed SFP/fungiascites, timely antifungal therapy should be administered. Full article
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12 pages, 1535 KiB  
Article
Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement
by Hao-Huan Tang, Zi-Chen Zhang, Zi-Le Zhao, Bin-Yan Zhong, Chen Fan, Xiao-Li Zhu and Wei-Dong Wang
J. Clin. Med. 2023, 12(1), 158; https://doi.org/10.3390/jcm12010158 - 25 Dec 2022
Cited by 2 | Viewed by 1326
Abstract
Background: This study aimed to evaluate whether a large paraumbilical vein (L-PUV) was independently associated with the occurrence of overt hepatic encephalopathy (OHE) after the implantation of a transjugular intrahepatic portosystemic shunt (TIPS). Methods: This bi-center retrospective study included patients with cirrhotic variceal [...] Read more.
Background: This study aimed to evaluate whether a large paraumbilical vein (L-PUV) was independently associated with the occurrence of overt hepatic encephalopathy (OHE) after the implantation of a transjugular intrahepatic portosystemic shunt (TIPS). Methods: This bi-center retrospective study included patients with cirrhotic variceal bleeding treated with a TIPS between December 2015 and June 2021. An L-PUV was defined in line with the following criteria: cross-sectional areas > 83 square millimeters, diameter ≥ 8 mm, or greater than half of the diameter of the main portal vein. The primary outcome was the 2-year OHE rate, and secondary outcomes included the 2-year mortality, all-cause rebleeding rate, and shunt dysfunction rate. Results: After 1:2 propensity score matching, a total of 27 patients with an L-PUV and 54 patients without any SPSS (control group) were included. Patients with an L-PUV had significantly higher 2-year OHE rates compared with the control group (51.9% vs. 25.9%, HR = 2.301, 95%CI 1.094–4.839, p = 0.028) and similar rates of 2-year mortality (14.8% vs. 11.1%, HR = 1.497, 95%CI 0.422–5.314, p = 0.532), as well as variceal rebleeding (11.1% vs. 13.0%, HR = 0.860, 95%CI 0.222–3.327, p = 0.827). Liver function parameters were similar in both groups during the follow-up, with a tendency toward higher shunt patency in the L-PUV group (p = 0.067). Multivariate analysis indicated that having an L-PUV (HR = 2.127, 95%CI 1.050–4.682, p = 0.037) was the only independent risk factor for the incidence of 2-year OHE. Conclusions: Having an L-PUV was associated with an increased risk of OHE after a TIPS. Prophylaxis management should be considered during clinical management. Full article
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17 pages, 2151 KiB  
Article
Effects of Short-Term Human Albumin Infusion for the Prevention and Treatment of Hyponatremia in Patients with Liver Cirrhosis
by Zhaohui Bai, Wentao Xu, Lu Chai, Xiaojie Zheng, Nahum Méndez-Sánchez, Cyriac Abby Philips, Gang Cheng and Xingshun Qi
J. Clin. Med. 2023, 12(1), 107; https://doi.org/10.3390/jcm12010107 - 23 Dec 2022
Cited by 2 | Viewed by 1874
Abstract
Background: Human albumin (HA) infusion is potentially effective for the management of hyponatremia in liver cirrhosis, but the current evidence is very limited. Methods: In this retrospective study, 2414 cirrhotic patients who were consecutively admitted to our hospital between January 2010 [...] Read more.
Background: Human albumin (HA) infusion is potentially effective for the management of hyponatremia in liver cirrhosis, but the current evidence is very limited. Methods: In this retrospective study, 2414 cirrhotic patients who were consecutively admitted to our hospital between January 2010 and June 2014 were included in the Hospitalization outcome cohort, and 339 cirrhotic patients without malignancy who were consecutively admitted to our department between December 2014 and April 2021 were included in the Long-term outcome cohort. The development and improvement of hyponatremia were compared between patients who received HA infusion during hospitalizations and did not. Logistic and Cox regression analyses were performed to evaluate the association of development and improvement of hyponatremia during hospitalizations with the outcomes. Odds ratios (ORs) and hazard ratios (HRs) were calculated. Results: In the two cohorts, HA infusion significantly decreased the incidence of hyponatremia and increased the rate of improvement of hyponatremia in cirrhotic patients during hospitalizations. In the Hospitalization outcome cohort, the development of hyponatremia during hospitalizations was significantly associated with increased in-hospital mortality (OR = 2.493, p < 0.001), and the improvement of hyponatremia during hospitalizations was significantly associated with decreased in-hospital mortality (OR = 0.599, p = 0.014). In the Long-term outcome cohort, the development of hyponatremia during hospitalizations was significantly associated with decreased long-term survival (HR = 0.400, p < 0.001), and the improvement of hyponatremia during hospitalizations was not significantly associated with long-term survival (HR = 1.085, p = 0.813). Conclusions: HA infusion can effectively prevent the development of hyponatremia and improve hyponatremia in cirrhotic patients during hospitalizations, which may influence the patients’ outcomes. Full article
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7 pages, 509 KiB  
Communication
Effects of Rifaximin on Circulating Albumin Structures and Serum Ammonia Levels in Patients with Liver Cirrhosis: A Preliminary Study
by Takao Miwa, Tatsunori Hanai, Kenji Imai, Koji Takai, Makoto Shiraki, Hideki Hayashi, Shogo Shimizu, Yoichi Nishigaki, Eiichi Tomita and Masahito Shimizu
J. Clin. Med. 2022, 11(24), 7318; https://doi.org/10.3390/jcm11247318 - 9 Dec 2022
Cited by 4 | Viewed by 1444
Abstract
Circulating albumin structures, including their oxidized and reduced forms, are involved in hepatic encephalopathy (HE) development. However, the effects of rifaximin, a key drug in HE treatment, on the circulating albumin structure in patients with liver cirrhosis remain unclear. In this multicenter prospective [...] Read more.
Circulating albumin structures, including their oxidized and reduced forms, are involved in hepatic encephalopathy (HE) development. However, the effects of rifaximin, a key drug in HE treatment, on the circulating albumin structure in patients with liver cirrhosis remain unclear. In this multicenter prospective study, eight patients with hyperammonemia (≥80 μg/dL) were enrolled. The circulating albumin structure was evaluated using the ratio of oxidized albumin (human nonmercaptalbumin, HNA). Patients were administered 400 mg rifaximin 3 times/day for 3 months, and laboratory data were assessed at baseline and during observation. Among the eight patients, three were men; the median age and body mass index were 70 years and 26.4 kg/m2, respectively. The median HNA and serum ammonia levels at baseline were 41% and 143 μg/dL, respectively. After rifaximin therapy, HNA showed a decreasing tendency (median; from 41% to 36%, p = 0.321), but serum albumin levels showed no significant change (from 3.5 g/dL to 3.5 g/dL, p = 1.00); serum ammonia levels significantly reduced (median: 143 μg/dL to 76 μg/dL, p = 0.015). Thus, rifaximin reduces serum ammonia levels and may improve circulating albumin structure in patients with cirrhosis. Further large-scale studies are required to confirm these preliminary results. Full article
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