Cirugía en el paciente cirrótico: características clínicas y complicaciones en una cohorte de pacientes chilenos

Abstract

Surgical complications in cirrhotic patients. Analysis of 102 cases Background: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. Aim: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. Patients and Methods: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. Results: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%.The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. Conclusions: In these patients, surgical complications were common, although with low mortality.

Acute hemorrhagic necrotizing enterocolitis caused by non-O1/non-O139 Vibrio cholerae infection

“…According to an epidemiological survey in Taiwan, about half of the patients infected with non-O1/non-O139 V cholerae manifested bacteremia. [ 9 ] Without exception, these patients all had a history of hepatitis B cirrhosis, like the patient in the present report. The relevant mechanisms of the frequent occurrence of invasive V cholerae infections in patients with cirrhosis remain obscure; there are many hypotheses, such as decreased serum bactericidal activity, impaired filtration function in the cirrhotic liver, or increased serum iron levels, [ 10 ] but the precise role of the defect in each mechanism requires further studies.…”

“…According to an epidemiological survey in Taiwan, about half of the patients infected with non-O1/non-O139 V cholerae manifested bacteremia [9] . Without exception, these patients all had a history of hepatitis B cirrhosis, like the patient in the present report.…”

“…The prognosis for cirrhotic patients with V cholerae bacteremia was poor based on the epidemiological survey, in which 47% patients died. [ 9 ] On the basis of bacteremia, patients may show various invasive infections, such as liver abscess, [ 11 ] necrotizing fasciitis, [ 12 ] meningitis, [ 13 ] peritonitis, [ 14 ] cellulitis and others. Zhou et al reported that the incidence of acute peritonitis was only 6.0%.…”

“…Unlike other cases where patients only manifest acute gastroenteritis, these cirrhotic patients may present with severe toxic shock, with symptoms such as hypotension and increased serum procalcitonin. The prognosis for cirrhotic patients with V cholerae bacteremia was poor based on the epidemiological survey, in which 47% patients died [9] . On the basis of bacteremia, patients may show various invasive infections, such as liver abscess, [11] necrotizing fasciitis, [12] meningitis, [13] peritonitis, [14] cellulitis and others.…”