Clinical course and mortality by etiology of liver cirrhosis in Sweden: a population based, long‐term follow‐up study of 1317 patients

Nilsson, Emma; Anderson, Harald; Sargenti, Konstantina; Lindgren, Stefan; Prytz, Hanne

doi:10.1111/apt.15255

Cited by 41 publications

(42 citation statements)

References 27 publications

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“…In cirrhosis, there is a deficiency in the synthesis of vitamin K-dependent coagulation factors, II, VII, IX and X, which result from the decrease in hepatocyte production capacity and from the decrease in vitamin absorption in the intestinal lumen due to the antibiotic treatment which reduces the bacterial flora that produces it, the decrease in vitamin K synthesis or cholestasis (15).…”

Section: Discussionmentioning

confidence: 99%

The risk of bleeding and encephalopathy in surgical patients with liver cirrhosis

Banu¹,

Salvatore²,

Merlo³

et al. 2019

JMMS

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Liver cirrhosis is a disease with an increasing incidence. Surgical procedures in patients with cirrhosis are also increasing, due to a longer life expectancy in these patients and also to the improvement of therapeutic and diagnostic resources.Digestive hemorrhage in the cirrhotic patient requires emergency medical intervention (intensive therapy, endoscopic or even surgical approaches), being at the same time a factor that precipitates episodes of encephalopathy, i.e. the conventional complication of cirrhosis. Hepatic encephalopathy represents one of the most severe clinical events of cirrhosis, being associated with high morbidity and mortality. The causes of hepatic encephalopathy are briefly presented in this paper. Therapeutic approaches currently available consist in the administration of non-absorbable disaccharides such as lactulose and non-absorbable antibiotics such as rifaximin. New therapeutic perspectives are under evaluation, e.g. ammonia scavengers and the modulation of gut microbiota.Clotting disorders in patients with liver cirrhosis are more severe as the disease progresses and involves complex mechanisms, as presented in this review. The correction of possible disorders of hemostasis should be promptly made as a sine qua non condition prior to surgery.

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Section: Discussionmentioning

confidence: 99%

The risk of bleeding and encephalopathy in surgical patients with liver cirrhosis

Banu¹,

Salvatore²,

Merlo³

et al. 2019

JMMS

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“…Significant abnormalities of liver function lead to liver functional failure, even the death of multiple organ failure [8]. According to statistics, the number of deaths caused by liver cirrhosis is about 500, 000~700,000/year, accounting for 2.7% of all deaths in the world [2,9,10]. Therefore, liver cirrhosis has become a public health issue with a great concern.…”

Section: Introductionmentioning

confidence: 99%

Hepatoprotective effects and mechanisms of Ixeris denticulate water extract on liver cirrhosis in experimental rat

Zhu

Liu

Chen

et al. 2020

BMC Complement Med Ther

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Background: To explore the protective effect and mechanisms of Ixeris denticulate water extract (IDWE) in the development of liver cirrhosis in experimental rat. Methods: Sixty rats were randomly divided into five groups: control group, model group and IDWE (2, 4 and 8 g/ kg) treatment groups. Alanine transferase (ALT), aspartate transaminase (AST), albumin (ALB), tumor necrosis factoralpha (TNF-α), Interleukin (IL)-6 and IL-8 in serum and superoxide dismutase (SOD), malondialdehyde (MDA) in liver tissue were evaluated, respectively. The liver index, liver morphology and liver histopathological analysis were detected as a supportive data. The liver protein expression of Bcl-2 and Bax were assessed by western blot, and NF-κB p65 protein expression was determined by immunohistochemistry analysis. Results: The result showed that a significantly decrease in the levels of serum AST, ALT and serum inflammatory factors TNF-α, IL-6 and IL-8 in IDWE-treated rats. The levels of serum ALB and SOD in liver tissue were markedly increased after IDWE treated, compared with model rats. Furthermore, IDWE-treated group also exhibited a downregulated protein expression of NF-κB p65 and Bax, up-regulated Bcl-2 protein expression. Conclusions: IDWE could effectively alleviate the course of liver cirrhosis in rat model, which may be a potent hepatoprotective agent in clinical therapy in the future.

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“…Patients with cirrhosis have a complicated natural history characterised by admissions and readmissions over time . These admissions and readmissions in cirrhosis are prevalent and are a major cause of healthcare expenditure .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with cirrhosis have a complicated natural history characterised by admissions and readmissions over time. [1][2][3] These admissions and readmissions in cirrhosis are prevalent and are a major cause of healthcare expenditure. 1,2,[4][5][6] However, prediction models using clinical biomarkers alone are largely suboptimal, with relatively low c-statistics in population-based and cohort studies.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

et al. 2020

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Summary Background Admissions in cirrhosis are expensive and often unpredictable based on purely clinical variables. Admissions could be related to complications associated with gut microbial changes, which can improve prognostication. However, the cost‐effectiveness remains unclear. Aims Determine cost‐effectiveness of adding gut microbiota analysis to clinical parameters in prediction and subsequent reduction of admissions in cirrhosis. Methods Using a Markov model of 1000 cirrhosis patients over 90 days, we modelled microbiota testing using 16srRNA ($250/sample), low‐depth ($350/sample) and high‐depth ($650/sample) metagenomics added to standard‐of‐care (SOC) for prevention of admissions using standard outcome costs and rates of development. We generated quality of life years (QALY) and Incremental cost‐effectiveness ratios (ICER) for the base scenarios and performed sensitivity analyses by varying costs for outcomes (transplant, death, admission) and admission rates (40%, range 25%‐60%). Results Using fixed costs of outcomes and outcome rates, microbiota analysis was cost‐saving ($47K‐$97K) at $250 and $350/sample if admissions were reduced by 5% over SOC and >10% with $650/sample. When costs of liver transplant, death and admissions were varied, these cost‐savings remained robust provided there was >2.1% reduction (range 1.3%‐3.2%) for $250/sample, >2.9% (range 1.8%‐4.4%) for $350/sample and >5.4% (range 3.3%‐8.2%) for $650/sample. These cost‐savings remained robust even when the assumed admission rate was varied for all sample cost values. Conclusions Gut microbiota analysis is cost‐effective for predicting and potentially preventing 90‐day admissions in cirrhosis over current SOC. This cost‐saving remained robust even after sensitivity analyses that varied the background admission rates.

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Clinical course and mortality by etiology of liver cirrhosis in Sweden: a population based, long‐term follow‐up study of 1317 patients

Cited by 41 publications

References 27 publications

The risk of bleeding and encephalopathy in surgical patients with liver cirrhosis

The risk of bleeding and encephalopathy in surgical patients with liver cirrhosis

Hepatoprotective effects and mechanisms of Ixeris denticulate water extract on liver cirrhosis in experimental rat

Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

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