Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

Xu, Xiangbo; Liu, Bang; Lin, Su; Li, Bimin; Wu, Yue; Li, Yiling; Zhu, Qiang; Yang, Yida; Tang, Shanhong; Meng, Fanping; Chen, Yu; Yuan, Shanshan; Shao, Lichun; Bernardi, Mauro; Yoshida, Eric M.; Qi, Xingshun

doi:10.1007/s12325-020-01466-z

Cited by 10 publications

(10 citation statements)

References 40 publications

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“…Patients with more severe stages of AKI, i.e., stages 2 and 3, had the higher odds of mortality compared to those with stages 1A. This is similar to a study conducted by Xu et al [21]. The variations among mortality rates maybe as a result of differences in the study populations, the underlying precipitating factors of AKI, etiology and severity of liver disease, stage of AKI, and resources available for managing the patients.…”

Section: Discussionsupporting

confidence: 85%

“…The variations among mortality rates maybe as a result of differences in the study populations, the underlying precipitating factors of AKI, etiology and severity of liver disease, stage of AKI, and resources available for managing the patients. Vasoactive drugs such as terlipressin have been found to improve the outcome of patients with liver cirrhosis and AKI, especially those precipitated by gastrointestinal bleeding [21]. None of the patients in this study was administered with terlipressin or any other vasoactive drugs because of nonavailability at the study site.…”

Section: Discussionmentioning

confidence: 99%

“…Those with no prehospitalization creatinine values, sCr ≥ 133umol/l, were considered as having AKI at the time of admission. The staging of AKI in this study was adopted from a study published by Xu et al [21]. AKI stage 1 was defined as a rise in sCr ≥ 26:5 μmol/l or ≥1.5 to 2-fold from baseline, including AKI stages 1A (sCr ≥ 133 μmol/l) and 1B (sCr ≥ 133 μmol/l ); AKI stage 2 was defined as a rise in sCr ≥ 2 to 3-fold from baseline; AKI stage 3 was defined as a rise in sCr ≥ 3-fold from baseline or sCr ≥ 353:6 μmol/l with an acute increase in sCr ≥ 26:5 μmol/l or initiation of renal replacement therapy.…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury in Patients with Liver Cirrhosis: Prevalence, Predictors, and In-Hospital Mortality at a District Hospital in Ghana

Duah

Duah²,

Ampofo-Boobi³

et al. 2022

BioMed Research International

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Background. Acute kidney injury (AKI) is one of the most severe complications of cirrhosis and portends an ominous prognosis with an estimated mortality of about 50% in a month and 65% within a year. Infection and hypovolemia have been found to be the main precipitating factors of AKI in liver cirrhosis. Early detection and treatment of AKI may improve outcomes. AKI in patients with liver cirrhosis in Ghana and their impact on inpatient mortality are largely unknown. This study was aimed at determining the prevalence, precipitating factors, predictors, and in-hospital mortality of AKI in patients with liver cirrhosis admitted to a district hospital in Ghana. Methods. Consecutive hospitalized patients with liver cirrhosis from 1 January 2018 to 30 April 2020 were recruited. Patient’s demographic data and clinical features were collected using a standardized questionnaire. Biochemical and haematological tests as well as abdominal ultrasound scans were done for all patients. All patients were then followed up until discharge or death. Results. There were 117 (65.4%) males out of the 179 patients with a mean age of 49.94 and 45.84 years for those with and without AKI, respectively. The prevalence of AKI was 27.9% (50/179). Out of 50 participants with AKI, 64.0% (32/50) died, contributing 41.0% of all in-patient mortality amongst participants. There was a significant association between AKI and death ( p ≤ 0.001 ). The major precipitating factors of AKI were infections (60.0%), hypovolemia (20.0%) due to gastrointestinal bleeding and gastroenteritis, and refractory ascites (16.0%). Alkaline phosphatase, INR, model for end-stage liver disease sodium, sodium, and blood urea nitrogen were independent predictors of AKI. Conclusion. AKI was common among patients with liver cirrhosis with high in-patient mortality. Identification of these precipitants and independent predictors of AKI may lead to prompt and targeted treatment with reduction in patient mortality.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury in Patients with Liver Cirrhosis: Prevalence, Predictors, and In-Hospital Mortality at a District Hospital in Ghana

Duah

Duah²,

Ampofo-Boobi³

et al. 2022

BioMed Research International

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“…In the second part, we retrospectively selected patients with cirrhosis and with acute gastrointestinal bleeding (AGIB) who received terlipressin and/or somatostatin/octreotide from our multicenter study (registration number: NCT03846180), which has been further updated after some publications (11)(12)(13)(14). Notably, in this part, the eligible patients were consecutively admitted to 13 centers from 8 provinces or municipalities in China between January 2010 and December 2018, and patients who underwent transjugular intrahepatic portosystemic shunt, splenectomy, surgical shunt, or liver transplantation were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Effect of Body Mass Index on the Prognosis of Liver Cirrhosis

Yin

Shao³

et al. 2021

Front. Nutr.

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Objective: At present, the association of body mass index (BMI) with the prognosis of liver cirrhosis is controversial. Our retrospective study aimed to evaluate the impact of BMI on the outcome of liver cirrhosis.Methods: In the first part, long-term death was evaluated in 436 patients with cirrhosis and without malignancy from our prospectively established single-center database. In the second part, in-hospital death was evaluated in 379 patients with cirrhosis and with acute gastrointestinal bleeding (AGIB) from our retrospective multicenter study. BMI was calculated and categorized as underweight (BMI <18.5 kg/m2), normal weight (18.5 ≤ BMI < 23.0 kg/m2), and overweight/obese (BMI ≥ 23.0 kg/m2).Results: In the first part, Kaplan–Meier curve analyses demonstrated a significantly higher cumulative survival rate in the overweight/obese group than the normal weight group (p = 0.047). Cox regression analyses demonstrated that overweight/obesity was significantly associated with decreased long-term mortality compared with the normal weight group [hazard ratio (HR) = 0.635; 95% CI: 0.405–0.998; p = 0.049] but not an independent predictor after adjusting for age, gender, and Child–Pugh score (HR = 0.758; 95%CI: 0.479–1.199; p = 0.236). In the second part, Kaplan–Meier curve analyses demonstrated no significant difference in the cumulative survival rate between the overweight/obese and the normal weight groups (p = 0.094). Cox regression analyses also demonstrated that overweight/obesity was not significantly associated with in-hospital mortality compared with normal weight group (HR = 0.349; 95%CI: 0.096-1.269; p = 0.110). In both of the two parts, the Kaplan–Meier curve analyses demonstrated no significant difference in the cumulative survival rate between underweight and normal weight groups.Conclusion: Overweight/obesity is modestly associated with long-term survival in patients with cirrhosis but not an independent prognostic predictor. There is little effect of overweight/obesity on the short-term survival of patients with cirrhosis and with AGIB.

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“…Of these studies, only two small-scale have studies used the new AKI diagnostic criteria [ 14 , 20 ]. In the most recent study in China, large-scale retrospective results using ICA criteria were published [ 21 ]. However, the incidence rates of ICA-AKI and conventional AKI in cirrhotic patients with acute gastrointestinal bleeding were 7.1% and 5.0%, respectively, which are very low compared with those in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Impact of acute kidney injury on mortality in patients with acute variceal bleeding

Kim

Lee

et al. 2021

BMC Gastroenterol

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Background The effect of acute kidney injury (AKI) on patients with acute variceal bleeding (AVB) using the recently proposed International Club of Ascites (ICA) criteria is unclear. This study aimed to evaluate the incidence of AKI using the ICA criteria and factors associated with the outcomes in cirrhotic patients with AVB. Methods This retrospective cohort study included data of cirrhotic patients with AVB from two centers in Korea. The association of the ICA criteria for AKI with 6-week mortality was analyzed through univariate and multivariate analyses using the Cox proportional hazard model. Results In total, there were 546 episodes of AVB in 390 patients, of which 425 and 121 episodes were due to esophageal and gastric variceal bleeding, respectively. Moreover, 153 patients fulfilled the ICA criteria for AKI, and 64, 30, 39, and 20 patients were diagnosed with stages 1a, 1b, 2, and 3, respectively. Conversely, 97 patients developed AKI within 42 days as per the conventional criteria. The 6-week mortality rate was significantly higher in patients with ICA-AKI than in patients without ICA-AKI; the occurrence of ICA-AKI was an independent factor for predicting the 6-week mortality. Conclusion The ICA criteria could help diagnose renal dysfunction earlier, and presence of AKI is a predictor of mortality in patients with cirrhosis and AVB.

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Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

Cited by 10 publications

References 40 publications

Acute Kidney Injury in Patients with Liver Cirrhosis: Prevalence, Predictors, and In-Hospital Mortality at a District Hospital in Ghana

Acute Kidney Injury in Patients with Liver Cirrhosis: Prevalence, Predictors, and In-Hospital Mortality at a District Hospital in Ghana

Effect of Body Mass Index on the Prognosis of Liver Cirrhosis

Impact of acute kidney injury on mortality in patients with acute variceal bleeding

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