Step by Step: Managing the Complications of Cirrhosis

Pérez, Inés Rubio; Bolte, Ashley C.; Bigelow, William; Dickson, Zachary; Shah, Neeral L.

doi:10.2147/hmer.s278032

Cited by 13 publications

(5 citation statements)

References 121 publications

(170 reference statements)

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“…Dentro las complicaciones de la cirrosis hepática se incluye la ascitis (acumulación de líquido en la cavidad peritoneal) presentada en aproximadamente el 50% de los pacientes, varices esofágicas, hipertensión portal, el síndrome hepatorrenal, el carcinoma hepatocelular, los trastornos en la coagulación, peritonitis bacteriana y finalmente encefalopatía hepática. Todos estos deben ser monitorizados y tomar medidas para prevenir su aparición (Perez et al, 2021).…”

Section: Marco Teóricounclassified

“…Los pacientes con una enfermedad hepática crónica son más propensos a desarrollar infecciones bacterianas, dentro de las más frecuentes está la peritonitis bacteriana, seguida de las infecciones del tracto urinario, piel y neumonía. Están asociadas a una decadencia en la salud de los pacientes con cirrosis aumentando su morbilidad y mortalidad (Perez et al, 2021).…”

Section: Factores Desencadenantesunclassified

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Eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios mínimos

Toaza Gutama,

Orellana Bernal

2023

ConcienciaDigital

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Introducción. la encefalopatía hepática de cambios mínimos es la presentación más leve que se caracteriza por alteraciones subclínicas inespecíficas que no son evidentes mediante la exploración física, la cual se debe a la incapacidad del hígado de eliminar las toxinas originadas en el intestino siendo el amoniaco la principal toxina , en la actualidad se considera que los probióticos representan un gran avance en esta patología, la misma que va actuar disminuyendo la cantidad de microorganismos patógenos facilitando el exceso de amoniaco a nivel cerebral. Objetivo. describir la eficacia de los probióticos como profilaxis secundaria en pacientes con encefalopatía hepática de cambios mínimos. Metodología. es un estudio de revisión bibliográfica tipo narrativa, una revisión amplia de la literatura, sobre la eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios minimos en bases de datos científicas, como Pub Med, Scielo, Biblioteca Cochrane, y Science Direct, mediante parte de la estrategia PRISMA. Resultados. se revisaron 51 estudios, que recopilaron las principales recomendaciones sobre la importancia del diagnóstico del streptococo b hemolitico en el embarazo en bases de datos científicas, como Pub Med, Scielo, Biblioteca Cochrane, y Science Direct, mediante parte de la estrategia PRISMA. Conclusión. el empleo de probióticos ha demostrado tener efectos positivos en el manejo y prevencion de la encefalopatia hepatica de cambios minimos, principalmente cuando se emplean en diferentes combinaciones de varias cepas bacterianas y otros farmacos coadyucantes. Ademas se debe destacar que son economicos y de facil acceso, los estudios planteadoos exponen su eficiacia en el tratamiento de diferentes hepatopatías, así como en la prevención de las complicaciones de la cirrosis, debido a su capacidad para modular la flora intestinal, la permeabilidad intestinal y la respuesta inmune. Área de estudio general: medicina. Área de estudio específica: medicina general.

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Section: Marco Teóricounclassified

Section: Factores Desencadenantesunclassified

Eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios mínimos

Toaza Gutama,

Orellana Bernal

2023

ConcienciaDigital

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“… 2 – 5 Decompensated cirrhosis, an advanced and severe clinical condition, is associated with numerous life-threatening complications, including ascites, variceal gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome (HRS) and severe jaundice. 6 These complications occur at an annual rate of 5–7%, 7 leading to frequent hospitalizations and imposing a significant economic burden.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings

Hasan,

Murti,

Bayupurnama

et al. 2024

DIC

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Background Human albumin (HA) is an effective adjuvant treatment for patients with cirrhosis developing spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and ascites requiring large-volume paracentesis (LVP). However, cost remains a barrier to use, particularly in resource-limited settings. This study aims to assess the cost-effectiveness of HA in patients with cirrhosis with SBP, HRS or ascites requiring LVP in the Indonesian healthcare system as a representative of a resource-limited setting. Methods Three decision-tree models were developed to assess the cost-effectiveness of (1) antibiotics and HA versus antibiotics alone in patients with SBP, (2) terlipressin and HA versus terlipressin alone in patients with HRS, and (3) LVP and HA versus LVP and gelatine for patients with ascites. Clinical utility and economic inputs were pooled from the available literature. Time horizon was 3 months. Outcomes were expressed as incremental cost-effectiveness ratios (ICER) reported as 2021 IDR per quality-adjusted life year (QALY) (exchange rate June 30, 2021: 1 EUR = 17,245 IDR). Willingness-to-pay thresholds considered were: three times the GDP per capita (199,355,561 IDR/QALY; 11,560 EUR/QALY) and one time the GDP per capita (66,451,854 IDR/QALY; 3853 EUR/QALY). Results The ICER for antibiotics and HA ( versus antibiotics alone) for SBP was 80,562,652 IDR per QALY gained (4672 EUR/QALY). The ICER for terlipressin and HA ( versus terlipressin) for HRS was 23,085,004 IDR per QALY gained (1339 EUR/QALY). The ICER for LVP and HA versus LVP and gelatine was 24,569,827 IDR per QALY gained (1425 EUR/QALY). Conclusion Adjunctive HA may be a cost-effective treatment for SBP, HRS and LVP in resource-limited settings.

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“…This complex chronic disease causes over 1 million deaths yearly and is recognized as the primary risk factor for hepatocellular carcinoma (HCC) (2,3). Compensated cirrhosis is often asymptomatic, while decompensated cirrhosis is characterized by complications including portal hypertension, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and bleeding from gastrointestinal varices (4,5). Disease progression and complications are the leading causes of mortality in these patients (2,6), with infections such as SBP causing many deaths (7).…”

Section: Introductionmentioning

confidence: 99%

The Association Between Peripheral Blood Neutrophil-to-Lymphocyte Ratio and Cirrhosis Complications in Adults with Compensated Liver Cirrhosis in Ahvaz, Iran

Hashemi,

Shokrian Tosi,

Hajiani

et al. 2023

Shiraz E-Med J

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Background: The neutrophil-to-lymphocyte ratio (NLR) is an inflammation biomarker in patients with liver cirrhosis. While increased NLR is linked to poor clinical outcomes and mortality in diseases like cancers, its association with cirrhosis complications has been sparsely examined. Objectives: This study aimed to evaluate the association between NLR and cirrhosis complications in patients with compensated liver cirrhosis. Methods: This retrospective cohort study was conducted on 256 patients with compensated liver cirrhosis visiting the Gastroenterology Clinic of Imam Khomeini Hospital, Ahvaz, Iran, in 2020. The peripheral blood lymphocyte and neutrophil counts were evaluated, and the NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Cirrhosis complications were assessed based on clinical and laboratory evaluation during 1 year of follow-up. Results: During the retrospective follow-up period, 59 patients (23.05%) experienced cirrhosis complications such as spontaneous bacterial peritonitis (n = 23), gastrointestinal bleeding (n = 22), and hepatic encephalopathy (n = 14). The baseline NLR, Model for End-Stage Liver Disease (MELD) score and Child-Pugh score were significantly higher in patients who later developed complications than in those who did not (P < 0.0001). The NLR with an optimal cut-off of > 1.95 had a sensitivity of 84.75% and specificity of 93.91% in predicting complications during the 1-year follow-up (AUC = 0.905, P < 0.0001). Conclusions: Our results indicated that the NLR is a simple, non-invasive, and cost-effective marker for predicting short-term complications in patients with compensated liver cirrhosis.

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Step by Step: Managing the Complications of Cirrhosis

Cited by 13 publications

References 121 publications

Eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios mínimos

Eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios mínimos

Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings

The Association Between Peripheral Blood Neutrophil-to-Lymphocyte Ratio and Cirrhosis Complications in Adults with Compensated Liver Cirrhosis in Ahvaz, Iran

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