Liver Transplantation in Acute-on-Chronic Liver Failure

Kulkarni, Anand V.; Reddy, K. Rajender

doi:10.1016/j.cld.2023.03.015

Cited by 5 publications

(2 citation statements)

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“…High serum bilirubin level suggests advanced liver disease and is a marker of short-term mortality in hospitalized patients (35,36). SOFA score has been validated to predict poor prognosis in patients admitted to ICU and is a component of ACLF scoring systems (30,37,38). Given that we included ICU patients in this study, the results confirm that SOFA score is strongly associated with the prediction of HE resolution (39).…”

Section: Discussionmentioning

confidence: 99%

Antibiotics With or Without Rifaximin for Acute Hepatic Encephalopathy in Critically Ill Patients With Cirrhosis: A Double-Blind, Randomized Controlled (ARiE) Trial

Kulkarni,

Avadhanam,

Karandikar

et al. 2023

Am J Gastroenterol

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Introduction: Critically ill cirrhosis (CIC) patients admitted to the intensive care unit (ICU) are usually on broad-spectrum antibiotics due to suspected infection or as a hospital protocol. It is unclear if additional rifaximin has any synergistic effect with broad-spectrum antibiotics in ICU patients with acute overt hepatic encephalopathy (OHE). Methods: In this double-blind trial, patients with OHE admitted to ICU were randomized to receive antibiotics (ab) alone or antibiotics with rifaximin (ab+r). Resolution (or 2 grade reduction) of HE, time to resolution of HE, in-hospital mortality, nosocomial infection, and changes in endotoxin levels were compared between the two groups. Sub-group analysis of patients with decompensated cirrhosis (DC) and acute-on-chronic liver failure (ACLF) was performed. Results: Baseline characteristics and severity scores were similar among both groups (92 in each group). Carbapenems and cephalosporin with beta-lactamase inhibitors were the most commonly used antibiotics. On Kaplan-Meier analysis 44.6% (41/92; 95% CI, 32-70.5) in antibiotics only arm and 46.7% (43/92; 95%CI, 33.8-63) in antibiotics+rifaximin arm achieved the primary objective (P=0.84).Time to achieve the primary objective (3.65±1.82 days and 4.11±2.01 days; P=0.27) and in-hospital mortality were similar among both groups (62% vs. 50%;P=0.13). Seven percent and 13% in the ab and ab+r groups developed nosocomial infections (P=0.21). Endotoxin levels were unaffected by rifaximin. Rifaximin led to lower in-hospital mortality (HR: 0.39 [95%CI,0.2-0.76]) in patients with DC but not in patients with ACLF (HR: 0.99 [95%CI,0.6-1.63]) due to reduced nosocomial infections. Discussion: Reversal of overt HE in those on antibiotics was comparable to those on antibiotics+rifaximin.

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Section: Discussionmentioning

confidence: 99%

Antibiotics With or Without Rifaximin for Acute Hepatic Encephalopathy in Critically Ill Patients With Cirrhosis: A Double-Blind, Randomized Controlled (ARiE) Trial

Kulkarni,

Avadhanam,

Karandikar

et al. 2023

Am J Gastroenterol

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“…However, the scarcity of donor livers and the associated high costs have led to a cessation in pursuit of this option in numerous patients with ALI. 7,8 Consequently, there is an imperative need for the development of novel therapeutic approaches.…”

Section: Introductionmentioning

confidence: 99%