Overview of Complications in Cirrhosis

Premkumar, Madhumita; Anand, Anil C.

doi:10.1016/j.jceh.2022.04.021

Cited by 25 publications

(6 citation statements)

References 154 publications

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“…Given the polymorphism of erosive and ulcerative lesions in the stomach in patients with liver cirrhosis (acid-peptic factor, immune complexes, restructuring of venous blood flow in its upper parts), the syndrome of PH is one of the important causes of ulcerative lesions of the stomach [12]. However, we disagree with some authors who believe that cirrhosis of the liver and PH are the cause of symptomatic duodenal ulcers [13].…”

Section: Discussionmentioning

confidence: 72%

Role of erosive and ulcerative gastric lesions in the development of hemorrhagic complications in liver cirrhosis

Kolosovych¹,

Hanol²,

Halil³

2022

Fiziol Zh

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We present the results of the treatment of 135 patients with a hepatic form of portal hypertension (liver cirrhosis) that have been hospitalized in the clinic of the Department of Surgery No. 2 in Bogomolets National Medical University within the period from 2011 to 2020. The aim of our study was to reveal the factors of the development of erosive and ulcerative gastric lesions in liver cirrhosis and their role in the occurrence of hemorrhagic complications. Based on studies of the rheological properties of gastric mucus, it was found that one of the leading factors in the development of erosive and ulcerative stomach lesions in portal hypertension is increased transcapillary filtration in the edematous-ascitic stage of liver cirrhosis. As a result, portal stagnation and reduced colloid mucus-bicarbonate barrier of the stomach led to the development of actual gastric ulcers. Erosive and ulcerative lesions on a part of the gastric mucosa were found in 66 (48.9%) of patients with cirrhosis of the liver, and in 45.2% of cases (28 persons) they were complicated by gastric bleeding development. Pathogenetic treatment of gastric ulcer-erosive bleeding in portal hypertension, against the background of the use of endoscopic hemostasis, should be aimed at strengthening the protective properties of the mucous-bicarbonate barrier of the stomach. Successful results of surgical treatment were achieved in 64.3% of patients. The overall mortality in liver cirrhosis complicated by gastric bleeding from ulcerative lesions of the stomach was 21.4% (6 patients died), and postoperative mortality was 25% (2 patients died).

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Section: Discussionmentioning

confidence: 72%

Role of erosive and ulcerative gastric lesions in the development of hemorrhagic complications in liver cirrhosis

Kolosovych¹,

Hanol²,

Halil³

2022

Fiziol Zh

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“…Cirrhotic patients are known to be at risk of both thrombotic events as well as haemorrhagic events [57,58]. Coagulopathies are also an important clinical manifestation of SARS-CoV-2 infection [59][60][61].…”

Section: Discussionmentioning

confidence: 99%

Type 1 interferon auto-antibodies are elevated in patients with decompensated liver cirrhosis

Greville

Cremen

O'Neill

et al. 2022

Preprint

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Understanding the biological basis of clinical risk factors for severe COVID–19 is required to ensure at–risk patient populations receive appropriate clinical care. Patients with decompensated liver cirrhosis, in particular those classified as Childs–Pugh class B and C, are at increased risk of severe COVID–19 upon infection with SARS–CoV–2. The biological mechanisms underlying this are unknown. We hypothesised this may be due to changes in expression levels of intrinsic antiviral proteins within the serum as well as alterations in the innate immune response to SARS–CoV–2 infection. We identified significant alterations in the serum proteome of patients with more severe liver disease and an increased frequency of auto–antibodies capable of neutralising type I interferons. No difference in SARS–CoV–2 pseudoparticle infection or live SARS–CoV–2 virus infection was observed with serum from decompensated cirrhotic patients. Principal component analysis of the serum proteome identified two main clinical parameters associated with serum proteome changes – aetiology and MELD–Na score. Among patients with MELD-Na scores >20 we detected significant inhibition of IFN–α2b and IFN-α8 signalling but not IFN–β1a, mediated by auto–antibodies. Our results suggest pre–existing neutralising auto–antibodies targeting type I IFN may increase the likelihood of severe COVID–19 in chronic liver disease patients upon SARS–CoV–2 infection and may also be of relevance to other viral infections in this patient population.

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“…Therefore, standard coagulation tests and platelet counts are inadequate for estimating the hemostatic status of ESLD patients and deliver insufficient data for predicting a balance between bleeding and thrombotic complications [ 20 ]. Furthermore, this state of new rebalance can be deranged by the onset of sepsis or any acute insult [ 52 ].…”

Section: Difficulties With Evaluating the Coagulopathies In Esld Pati...mentioning

confidence: 99%

Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease

et al. 2022

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Over the last decades, individualized approaches and a better understanding of coagulopathy complexity in end-stage liver disease (ESLD) patients has evolved. The risk of both thrombosis and bleeding during minimally invasive interventions or surgery is associated with a worse outcome in this patient population. Despite deranged quantitative and qualitative coagulation laboratory parameters, prophylactic coagulation management is unnecessary for patients who do not bleed. Transfusion of red blood cells (RBCs) and blood products carries independent risks for morbidity and mortality, including modulation of the immune system with increased risk for nosocomial infections. Optimal coagulation management in these complex patients should be based on the analysis of standard coagulation tests (SCTs) and viscoelastic tests (VETs). VETs represent an individualized approach to patients and can provide information about coagulation dynamics in a concise period of time. This narrative review will deliver the pathophysiology of deranged hemostasis in ESLD, explore the difficulties of evaluating the coagulopathies in liver disease patients, and examine the use of VET assays and management of coagulopathy using coagulation factors. Methods: A selective literature search with PubMed as the central database was performed with the following.

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Overview of Complications in Cirrhosis

Cited by 25 publications

References 154 publications

Role of erosive and ulcerative gastric lesions in the development of hemorrhagic complications in liver cirrhosis

Role of erosive and ulcerative gastric lesions in the development of hemorrhagic complications in liver cirrhosis

Type 1 interferon auto-antibodies are elevated in patients with decompensated liver cirrhosis

Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease

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