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Journal of Hepatology Jun 2022Although proposed for the first time several decades ago, the possibility that long-term human albumin could be effective for the treatment of patients with cirrhosis... (Review)
Review
Although proposed for the first time several decades ago, the possibility that long-term human albumin could be effective for the treatment of patients with cirrhosis and ascites has become a topic of scientific and clinical discussion in the last decade. Long-term albumin administration represents a completely different treatment perspective compared to acute or short-term uses of albumin. Results from the ANSWER and the MACHT studies indicate that long-term albumin treatment can be effective, safe and able to modify the course of the disease provided that albumin is given at a sufficient dose and for a sufficient time to restore physiological levels and functions of the circulating molecule, which are compromised, at least partially, in patients with decompensated cirrhosis. Further clinical studies and randomised trials are warranted to confirm the clinical benefits of long-term albumin therapy. Important areas for further research include determining the precise target population, the biomarkers of response, the optimal dose and frequency of albumin infusions, the stopping rules, and the cost-effectiveness of treatment in different healthcare systems across the world, particularly in those where the logistical issues and costs related to the periodic intravenous infusions may represent an important limitation to the implementation of this innovative approach in clinical practice. In this review, we will critically analyse the available data on long-term albumin treatment, focusing on the differences that exist between studies, the controversial issues and the future perspectives.
Topics: Albumins; Ascites; Fibrosis; Humans; Liver Cirrhosis; Serum Albumin, Human
PubMed: 35589252
DOI: 10.1016/j.jhep.2022.03.005 -
Romanian Journal of Internal Medicine =... Dec 2021Spontaneous bacterial peritonitis (SBP) is a common complication in patients with liver cirrhosis, with an increased risk of mortality. For this reason, a diagnostic...
Spontaneous bacterial peritonitis (SBP) is a common complication in patients with liver cirrhosis, with an increased risk of mortality. For this reason, a diagnostic paracentesis should be performed in all patients with ascites and clinical features with high diagnostic suspicion. Although literature data abound in identifying new diagnostic markers in serum or ascites, they have not yet been validated. The final diagnosis requires the analysis of ascites and the presence of > 250 mm neutrophil polymorphonuclear (PMN) in ascites. If previous data showed that the most common microorganisms identified were represented by gram-negative bacteria, we are currently facing an increase in gram-positive bacteria and multidrug-resistant bacteria. Although prompt and effective treatment is required to prevent outcomes, this becomes challenging as first-line therapies may become ineffective leading to worsening prognosis and increased in-hospital mortality. In this paper we will make a brief review of existing data on the diagnosis and treatment of SBP.
Topics: Adult; Anti-Bacterial Agents; Ascites; Bacterial Infections; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Neutrophils; Paracentesis; Peritonitis; Treatment Outcome
PubMed: 34182617
DOI: 10.2478/rjim-2021-0024 -
Journal of Hepatology Jul 2024Patients with cirrhosis are prone to developing acute kidney injury (AKI), a complication associated with a markedly increased in-hospital morbidity and mortality, along... (Review)
Review
Patients with cirrhosis are prone to developing acute kidney injury (AKI), a complication associated with a markedly increased in-hospital morbidity and mortality, along with a risk of progression to chronic kidney disease. Whereas patients with cirrhosis are at increased risk of developing any phenotype of AKI, hepatorenal syndrome (HRS), a specific form of AKI (HRS-AKI) in patients with advanced cirrhosis and ascites, carries an especially high mortality risk. Early recognition of HRS-AKI is crucial since administration of splanchnic vasoconstrictors may reverse the AKI and serve as a bridge to liver transplantation, the only curative option. In 2023, a joint meeting of the International Club of Ascites (ICA) and the Acute Disease Quality Initiative (ADQI) was convened to develop new diagnostic criteria for HRS-AKI, to provide graded recommendations for the work-up, management and post-discharge follow-up of patients with cirrhosis and AKI, and to highlight priorities for further research.
Topics: Humans; Acute Kidney Injury; Liver Cirrhosis; Hepatorenal Syndrome; Ascites; Consensus
PubMed: 38527522
DOI: 10.1016/j.jhep.2024.03.031 -
Clinics in Liver Disease Nov 2019Ascites occurs in up to 70% of patients during the natural history of cirrhosis. Management of uncomplicated ascites includes sodium restriction and diuretic therapy,... (Review)
Review
Ascites occurs in up to 70% of patients during the natural history of cirrhosis. Management of uncomplicated ascites includes sodium restriction and diuretic therapy, whereas that for refractory ascites (RA) is regular large-volume paracentesis with transjugular intrahepatic portosystemic shunt being offered in appropriate patients. Renal impairment occurs in up to 50% of patients with RA with type 1 hepatorenal syndrome (HRS) being most severe. Liver transplant remains the definitive treatment of eligible candidates with HRS, whereas combined liver and kidney transplant should be considered in patients requiring dialysis for more than 4 to 6 weeks or those with underlying chronic kidney disease.
Topics: Annexins; Ascites; Diet, Sodium-Restricted; Diuretics; Hepatorenal Syndrome; Humans; Hypertension, Portal; Inflammation; Kidney Transplantation; Liver Transplantation; Paracentesis; Portasystemic Shunt, Transjugular Intrahepatic; Renal Dialysis; Splanchnic Circulation; Vasodilation
PubMed: 31563217
DOI: 10.1016/j.cld.2019.06.002 -
Therapeutic Apheresis and Dialysis :... Aug 2022
Topics: Ascites; Humans
PubMed: 34898003
DOI: 10.1111/1744-9987.13776 -
Journal of General Internal Medicine Sep 2022
Topics: Ascites; Humans
PubMed: 35794310
DOI: 10.1007/s11606-022-07727-7 -
QJM : Monthly Journal of the... Nov 2021
Topics: Ascites; Endometriosis; Humans
PubMed: 33734393
DOI: 10.1093/qjmed/hcab057 -
Nagoya Journal of Medical Science Aug 2022
Topics: Ascites; Humans
PubMed: 36237875
DOI: 10.18999/nagjms.84.3.686 -
Indian Journal of Pediatrics Jul 2023
Topics: Infant, Newborn; Humans; Hyperkalemia; Ascites; Liver Cirrhosis; Hyponatremia
PubMed: 37043107
DOI: 10.1007/s12098-023-04583-z -
Clinics in Liver Disease May 2021Considering the poor prognosis, severe and refractory ascites is a milestone in cirrhotic patients. Liver transplantation must be considered first. In the case of... (Review)
Review
Considering the poor prognosis, severe and refractory ascites is a milestone in cirrhotic patients. Liver transplantation must be considered first. In the case of contraindication to liver transplantation or when the waiting period is estimated to be more than 6 months, transjugular intrahepatic portosystemic shunt should be discussed in eligible patients. Regardless of the type of treatment, a careful selection of patients is crucial to avoid further decompensation and specific complications of each treatment.
Topics: Ascites; Humans; Liver Cirrhosis; Liver Transplantation; Portasystemic Shunt, Transjugular Intrahepatic; Treatment Outcome
PubMed: 33838859
DOI: 10.1016/j.cld.2021.01.010